CPR Exam 2 > TB DSA > Flashcards

TB DSA Flashcards

(38 cards)

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1
Q

As immunity to Mycobacterium TB develops, how does the patient react to the tuberculin skin test (TST) and the interferon-y release assay (IGRA)?

A

Positive

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2
Q

If the TB infection is contained, a person is said to be what?

A

In a state of latent TB infection (LTBI), without systemic manifestations, however the risk for reactivation remains for years.

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3
Q

Reactivation TB is usually localized to the _____.

A

Lungs

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4
Q

What are risk factors for primary progression and reactivation of quiescent TB?

A
  1. HIV/AIDS***
  2. Malnutrition
  3. Immunosuppressed states
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5
Q

What form the cornerstone of control of active TB infection?

A
    1. Agressive screening
    1. High amount of suspicion
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6
Q

How can we promote primary and secondary prevention of TB?

A
  • Primary: isolate (in hospital, put in room with (-) air pressure and all entering people should have masks with filtering capacity of 95%)
  • Secondary: treat patients with suspected LTBI
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7
Q

ALL high-risk patients with + TST/IGRA should be offered _______, unless prior treatment is noted or medically contraindicated.

A

LTBI treatment

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8
Q

Who is screening for TB performed for and via what methods?

A
    • Screening is NOT needed for low-risk indiviuals.
    • High risk of exposure or contraction: Mantoux TST or IGRA
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9
Q

A (+) TST is defined by _________

A

the diameter of the indurated area, considering risk profile.

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10
Q

Induration >5mm is postive for whom?

A
    1. HIV infection
    1. Recent contract with case of active TB
    1. Person with fibrotic changes changes on CXR that show old TB
    1. Organ transplant/immunosupressed.
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11
Q

Induration >10mm is postive for whom?

A
    1. Immigrant from country with high TB prevelance within 5 yrs
    1. IV drug user
    1. Person who works are high-risk congregate area
    1. Health care worker, child under 4 YO or expossed to adult
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12
Q

Induration >15mm is postive for whom?

A

Person w no risk factors for TB

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13
Q

Why should re-testing or empiral treatment be done for high risk patients (ex. those with HIV)?

A

Skin test results may not become + for 12 weeks after exposure to active infection.

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14
Q

When should two-step testing be performed and why?

A
  • Pt exposed to TB in the distant past could have a (-) skin test.
    • Thus, a second test done 7-21 days after first can help reduce false (-) response rate => uncover a true positive.
  • Perform at regular testing programs (nursing home, hospital)
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15
Q

How is IGRA different from TST?

What population is it preferred for?

A
  1. IGRA asses T-cell response to M. TB.
  2. More expensive, but done in a single blood draw and no need to come back.
  3. Does not give a false postive in person w BCG vaccine
  4. Preferred for: person w BCG vaccine and those unlikely to return for TST interpretation,
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16
Q

What test is preffered for children UNDER 5 YO?

17
Q

IGRA and TST are used separtely.

In what specific situations are they performed separetly?

Study These Flashcards
A
  • Initial test is is indeterminate or (-), but high clinical suspicion.
18
Q

Which test can differentiate between LTBI and active TB?

19
Q

If IGRA or TST is (+), how do we determine is patient has active TB or LTBI?

20
Q

Patients with pulmonary TB, often have what sx?

Study These Flashcards
A

ASYMPTOMATIC.

Constitutional symptoms, as well as local sx (cough) can develop.

21
Q

The most common pulmonary finding in patients with active tuberculosis is

Study These Flashcards
A

Normal examination

22
Q

HIV or immunocompromised TB patients will …

Study These Flashcards
A
  • have a greater liklihood of dissemination/extrapulmonary infection

but classic sx of TB are absent and CXR may be NL

23
Q

What are the differential dx of TB?

Study These Flashcards
A
    1. Non-TB mycobacterial infection: perform CT
    1. Sarcoidosis
    1. Aspiration pneumonia
    1. Lung abscess
    1. Histoplasmosis cocidiodomycosis
    1. Wegners
    1. Actinomycosis
    1. Lung cancer
24
Q

What is the cornerstone of management of TB?

Study These Flashcards
A
  • 1. Bacteriologic confirmation
  • 2. Susceptibility testing
25
In patients with infection, TST is usually positive within ________ hours.
48-72
26
Which patients with **active TB** can show a **false-negative?**
**- Anergic patients** **- 25% of patients with active TB**
27
What tests should be run on a patient suspected of **ACTIVE TB?**
1. **Acid-fast bacili smear** 2. **Cultures** of pulmonary and suspected site of infection 3. **CXR** 4. **TST** or **IGRA**
28
What test can be formed to exclude TB in patients with false (+) sputum or to confirm TB in some patients with false (-) smears?
**Nucleic acid amplication test of sputum**
29
What is the **gold standard** used for diagnosis of TB?
**Solid media culture + liquid media culture**
30
What test is run for patients suspected of **pleural TB**?
**thoracentesis** or **pleural biopsy**
31
On radiology, what does reactivation of TB look like?
Lesions in the **apical posterior segments** of the **upper lung** and **superior segments of the lower lobe**
32
What can we see on radiology for patients with 1. **Primary progressive TB** 2. **immunocompromised pts**
* 1. **Hilar adenopathy** or infiltrates in **any part of lung** * 2. **Atypical** or **absent** **findings**
33
What is the standard treatment for **suspected or confirmed active TB?**
**RIPE** (rifampin, isoniazid, pyrazinamide and ethambutol) for **6 months.**
34
How can we **monitor** **treatment** administered to patients with suspective/active TB infection?
- **Repeat suptum smear and culture after 2 month phase,** to determine whether patient should continue for 4 months or 7 months.
35
* **MDR TB** is resistant to * **Extensively drug-resitant TB (XDR)** is resistant to
* **Isoniazid** and **rifampin** * **Isoniazid** and **rifampin** + **fluoroqinolones** and at least **kanamycin**, **amikacin** or **capreomycin**.
36
How do we treat **MDR** or **XDR**?
Individualized regimen based on comphrensive drug susceptilbilty and consutation with a expert.
37
How are patients with **LTBI** treated?
**Individualized:** * 1. Isoniazid/day/ 9 months * 2. Rifampin/day/4 months * 3. Rifapentine + isonizid/1wk/3months via directly observed therapy. B4 tx: **exclude active TB**, **risk and benefits**, obtain **blood tests** to test for drug toxicities that may complicate tx.
38
How should we follow up with TB patients
Careful monitoring * 1. **Monthly** sputum cultures * 2. **Adjust drugs** * 3. **Contact TB expert** if sputum culture remains positive or if pt has not improved clinically after 3 months. * 4. **Periodic assessments for adverse reactions**
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