Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
26 Cards in this Set
- Front
- Back
Who is most at risk for TB? |
immigrants homeless/prisoners IV drug users immunocompromised <4 yrs old |
|
What vaccine is used for TB? |
BCG - attenuated strain of M. bovis - not for HIV or SCID - variable efficacy (mostly used in other countries & can make future TB test +)(works better for kids) |
|
Tb causes ______________, cervical lymphatenitis. It is the number one cause of lymphatenitis |
scrofula
(eroding lymph nodes in neck) |
|
Tb also causes _____________ of the thoracic spine |
Potts Disease |
|
Mycobacterium Tuberculosis is an obligate aerobe, and does NOT gram stain. How does it stain |
acid-fast bacilli |
|
How is Tb transmitted? |
if ACTIVE it is transmitted via respiratory drops
(once ingested, alveolar macrophages quaritine it in granulomas until it becomes active) |
|
How can you check for a latent (inactive) TB infection? |
using a skin PPD test + if > 15 normal person > 10 immigrant or younger than 4 > 5 HIV or exposed to active Tb individual |
|
When would you use the two step tuberculin skin test? |
booster phenomenon individual with LTBI (latent Tb) if a first test is positive *no previous Tb skin test |
|
What could lead to a false +? false -? |
false +: BCG vaccine, other mycobacteria
false -: corticosteroid therapy, renal failure, HIV |
|
what is the MOST SPECIFIC Tb test, especially recommended for LTBI? When can you not use it? |
Quantiferon - Gold (blood antibody test)
in immune compromised pts |
|
Clinical Presentation of Tb |
weight loss Hemoptysis (cough) Wheezes/rhonchi pleural effusion |
|
What are the progressive steps in Tb diagnosis? |
1. PPD skin test (if postitive-->) 2. CXR (if abnormal--->) 3. Evaluate for active TB (QFN-G)
(if CXR is normal, consider treatment for LTBI) |
|
Besides QFN-gamma, how else can active Tb be diagnosed? |
NAA (nucleic acid amplification) biopsy/culture acid fast staining (not always accurate) |
|
What 4 factors should you consider when determining ACTIVE (not latent) Tb diagnosis? |
1. concentration of bacilli 2. infectivity 3. duration of exposure to Tb + indiv. 4. environment (close quarters w/ infected) |
|
What is likely to be seen on a CXR for a TB + patient? |
cavitary lesions (posterior segment of upper lobe or apical lower lobe) hilar lymphadenopathy pleural effusion ghon complex
|
|
What are the first line drugs used to treat TB? (give all for 4 months or until culture -) |
RIPE rifamin isoniazid ethambutol pyrazinamode |
|
__________ causes peripheral neuropathy & should be give w/ a Vit B6 supplement |
isoniazid |
|
_________ causes thrombocytopnia hypersensitivity & changes the color of urine |
rifampin |
|
________ causes eye problems (visual acuity, floating) |
ethambutol
(E for eye) |
|
________ causes hepatitis & should be avoided in pregnancy if possible |
pyrazinamide |
|
What are the 2 common second line drugs? Which should be avoided in pregnancy? |
streptomycin (avoid in pregnancy)
flouroquinolones |
|
Once a - culture has been obtained, you should continue treatment with what 2 drugs for an additional 4-7 months? |
isoniazid rifampin |
|
* When should isoniazid be given prohylactically? |
*ANYONE who is in contact w/ an ACTIVE TB patient -new TST conversion over past 2 yrs -PPD+ pt w/ HIV -PPD+ (unknown duration) in pt younger than 35 -pt w/ x-ray evidence on inactive TB
(used to prevent latent tb--> becoming active)* |
|
In pediatric pts, which first line drug should be excluded from treatment? |
ethambutol ^ risks decreased visual acuity |
|
In pregnant pts, which first line drug should be excluded? |
pyrazinamide (if possible) && streptomyxin
(give pyridoxine w/ isoniazid to prevent neuropathy) |
|
T/F HIV increases the likelihood of TB transmission |
FALSE |