Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

52 Cards in this Set

  • Front
  • Back
What are the 4 potential fates of TB bacilli?
• killed by the immune system
• multiply and cause primary TB
• become dormant and remain asymptomatic
• proliferate after a latency period (reactivation disease)
What are some factors that can reactivate TB?
• alcoholism
• gastrectomy
• malnutrition
• neoplastic ds
• steroid tx
What are symptoms of TB?
• weight loss
• hemoptysis
• night sweats
• anorexia
• chest pain
• chills
• fatigue
• fever
• productive cough
What are other areas of the body where TB can manifest, besides the lung?
• brain (meningitis)
• skeleton
• joints
• genitourinary system
• gastrointestinal system
• lymph nodes
• skin (cutaneous)
What is the most common skeletal site of TB involvment?
spine (called Pott's disease)
True/False: TB arthritis is typically polyarticular
• TB arthritis typically involves one joint
• The correct answer is: False
What is the most common joint involved for TB arthritis?
• hip or knee (most common), followed by:

• ankle
• elbow
• wrist
• shoulder
What are manifestation of genitourinary TB?
• flank pain, dysuria, urinary frequency
• can manifest in men as epididymitis or scrotal mass
• can manifest in women as PID (ESP)
What is scrofula?
• tuberculosis lymphadenitis
• usually unilateral with little to no pain
What is the most common site of scrofula?
in the neck (sternocleidomastoid muscle-SCM)
What is the most common cutaneous manifestation of TB?
• Lupus vulgaris
• reddish-brown plaque on the face or extremities
How is TB treatment adjusted for infants?
• treatment time is longer because of the possible impaired immune system
• 9-12 months
What percentage of extra-pulmonary TB will have a normal chest x-ray?
Presenation of HIV with TB is similar to PCP. What is one test that can be used to differentiate between the two?
measure LDH level
What are the 4 identifiable syndromes of patients that progress to symptomatic TB?
• atypical pneumonia
• tuberculous pleurisy & effusion
• direct progression
• early systemic dissemination
What is the most common clinical form of TB?
reactivation TB
What does a positive PPD test indicate?
• indicates infection has occured
• does not indicate active TB
What are the 3 cutoff points when interpreting skin induration with a PPD test?
• > 5 mm
• > 10 mm
• > 15 mm
Which patients are considered to have a positive PPD test with skin induration greater than 5 mm?
• people who are in close contact with newly diagnosed TB patient
• HIV +
• pts w/ organ transplant or taking the equivalent of > 15 mg/d of predisone for 1 mo. or more
• pts w/ fibrotic lesions on CXR
Who is considered to have a positive PPD test with skin induration greater than 10 mm?
• Pt’s c medical conditions that increase the risk of TB
• Recent converter- At least 10 mm increase in skin test in past 2 yrs (regardless of age)
• Recent immigrants (within 5 yrs) from a high-prevalence country
• Children < 4 y/o exposed to adults @ high risk for TB
• Residents and employees of facilities for LTC
What is anergy testing?
• used to test immunologic impairment
• Candida, mumps, tetanus toxoid antigens are used simultaneously on patients testing negative but w/ high suspicion of TB
How does primary TB usually manifest on CXR?
a central apical portion (Ghon complex) with a left lower lobe infiltrate or pleural effusion and ipsilateral hilar lymphadenopathy
How does reactivation TB typically show on CXR?
apical infiltrate (patchy or nodular) w/out pleural effusion
What does miliary TB look like on CXR?
the appearance of numerous small nodular lesions, resembling millet seeds
When do you stop giving certain drugs in the RIPE regimen?
• stop ethambutol or streptomycin once the isolate is known to be fully susceptible
• stop pyrazinamide after 2 months of therapy
• continue INH & Rifampin for 4 more months (6 months total)
How do you adjust the RIPE regimen if INH resistance is documented?
D/C INH and continue treatment w/ Rifampin, pyrazinamide, and ethambutol for 6 months
What is the treatment regimen for a patient with a significant PPD result and a ruled-out active infection?
• INH 6-9 months
• Rifampin 4 months
What is the treatment for patients with multi-drug resistant TB?
• ethambutol and pyrazinamide for 6-12 months
• pyrazinamide and levofloxacin for 6-12 months
What is the classic triad of pulmonary embolism (PE)?
• dypnea
• chest pain
• hemoptysis

* only occurs in 20% of diagnosed PE
What is the most common cause of acute corpulmonale?
You can rule-out PE in a patient with a fever above this temperature
> 103.1ºF
What criteria is +1 points on the Wells Criteria?
• Lower limb trauma or surgery or immobilization in a plaster cast
• Bedridden for >3 d or surgery within the last 4 wks
• Tenderness along deep venous system
• Calf >3 cm bigger circumference, 10 cm below tibial tuberosity
• Pitting edema
• Dilated collateral superficial veins (nonvaricose) (+cords)
• Malignancy (including tx up to six mo previous)
When do you subtract 2 points in the Well's criteria?
alternative diagnosis as more likely than a PE
How do you interpret the Well's criteria?
• >3 high
• 1-2 moderate
• <1 low (do a D-dimer)
What are the 2 types of D-dimer tests?
• latex agglutination test
• ELISA test
What are chest x-ray findings of a PE?
• Atelectasis
• elevated hemidiaphragm
• Hampton's hump
• small pleural effusion
• Westermark sign
• Wedge (focal peripheral consolidation)
What is a Westermark sign?
dilation of pulmonary vessels and a sharp cutoff
What is Hampton's hump?
focal consolidation at the costophrenic angle
What test is becoming the dianostic study of choice for PE?
spiral CT scan
What test is the gold standard for diagnosing PE?
pulmonary angiography
What are the most common EKG abnormalities seen with PE?
• tachycardia (#1)
• nonspecific ST-T wave changes
Which patients are indicated for an IVC filter?
• pts w/ acute venous thromboemolism who have an absolute contraindication to anticoagulant therapy
• pts w/ massive PE who survived but in whom recurrent embolism will be fatal
• pts w/ documented recurrent venous thromboembolism
What are the 4 main types of fluids in the pleural space?
• serous fluid (hydrothorax)
• blood (hemothorax)
• lipid (chylothorax)
• pus (pyothorax or empyema)
What is the most common cause of transudative effusion?
What is the most common symptom associated with pleural effusion?
How many mL of fluid will cause blunting of the costophrenic angle?
more than 175 ml
What are the 4 types of pneumothorax?
• traumatic
• tension
• spontaneous
• Iatrogenic
Spontaneous pneumothorax is most common in who?
tall, thin males who smoke
What is the recommended site for a needle thracostomy?
2nd intercostal space in the midclavicular line
What is the definitive treatment for pneumothorax?
chest tube
Where should you place a chest tube?
over the 5th or 6th rib in the midaxillary line
How do you treat a small, minimally symptomatic pneumothorax?
• admit, observe closely and monitor using serial chest radiographs
• 100% oxygen promotes resolution by speeding the absorption of gas from the pleural cavity into the pulmonary vasculature