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52 Cards in this Set
- Front
- Back
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What are the 4 potential fates of TB bacilli?
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• killed by the immune system
• multiply and cause primary TB • become dormant and remain asymptomatic • proliferate after a latency period (reactivation disease) |
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What are some factors that can reactivate TB?
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• alcoholism
• gastrectomy • HIV • malnutrition • neoplastic ds • steroid tx |
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What are symptoms of TB?
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• weight loss
• hemoptysis • night sweats also • anorexia • chest pain • chills • fatigue • fever • productive cough |
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What are other areas of the body where TB can manifest, besides the lung?
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• brain (meningitis)
• skeleton • joints • genitourinary system • gastrointestinal system • lymph nodes • skin (cutaneous) |
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What is the most common skeletal site of TB involvment?
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spine (called Pott's disease)
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True/False: TB arthritis is typically polyarticular
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• TB arthritis typically involves one joint
• The correct answer is: False |
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What is the most common joint involved for TB arthritis?
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• hip or knee (most common), followed by:
• ankle • elbow • wrist • shoulder |
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What are manifestation of genitourinary TB?
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• flank pain, dysuria, urinary frequency
• can manifest in men as epididymitis or scrotal mass • can manifest in women as PID (ESP) |
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What is scrofula?
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• tuberculosis lymphadenitis
• usually unilateral with little to no pain |
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What is the most common site of scrofula?
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in the neck (sternocleidomastoid muscle-SCM)
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What is the most common cutaneous manifestation of TB?
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• Lupus vulgaris
• reddish-brown plaque on the face or extremities |
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How is TB treatment adjusted for infants?
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• treatment time is longer because of the possible impaired immune system
• 9-12 months |
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What percentage of extra-pulmonary TB will have a normal chest x-ray?
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50%
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Presenation of HIV with TB is similar to PCP. What is one test that can be used to differentiate between the two?
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measure LDH level
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What are the 4 identifiable syndromes of patients that progress to symptomatic TB?
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• atypical pneumonia
• tuberculous pleurisy & effusion • direct progression • early systemic dissemination |
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What is the most common clinical form of TB?
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reactivation TB
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What does a positive PPD test indicate?
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• indicates infection has occured
• does not indicate active TB |
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What are the 3 cutoff points when interpreting skin induration with a PPD test?
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• > 5 mm
• > 10 mm • > 15 mm |
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Which patients are considered to have a positive PPD test with skin induration greater than 5 mm?
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• 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 |
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Who is considered to have a positive PPD test with skin induration greater than 10 mm?
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• 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 |
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What is anergy testing?
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• used to test immunologic impairment
• Candida, mumps, tetanus toxoid antigens are used simultaneously on patients testing negative but w/ high suspicion of TB |
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How does primary TB usually manifest on CXR?
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a central apical portion (Ghon complex) with a left lower lobe infiltrate or pleural effusion and ipsilateral hilar lymphadenopathy
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How does reactivation TB typically show on CXR?
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apical infiltrate (patchy or nodular) w/out pleural effusion
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What does miliary TB look like on CXR?
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the appearance of numerous small nodular lesions, resembling millet seeds
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When do you stop giving certain drugs in the RIPE regimen?
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• 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) |
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How do you adjust the RIPE regimen if INH resistance is documented?
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D/C INH and continue treatment w/ Rifampin, pyrazinamide, and ethambutol for 6 months
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What is the treatment regimen for a patient with a significant PPD result and a ruled-out active infection?
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• INH 6-9 months
OR • Rifampin 4 months |
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What is the treatment for patients with multi-drug resistant TB?
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• ethambutol and pyrazinamide for 6-12 months
OR • pyrazinamide and levofloxacin for 6-12 months |
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What is the classic triad of pulmonary embolism (PE)?
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• dypnea
• chest pain • hemoptysis * only occurs in 20% of diagnosed PE |
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What is the most common cause of acute corpulmonale?
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PE
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You can rule-out PE in a patient with a fever above this temperature
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> 103.1ºF
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What criteria is +1 points on the Wells Criteria?
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• 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) |
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When do you subtract 2 points in the Well's criteria?
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alternative diagnosis as more likely than a PE
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How do you interpret the Well's criteria?
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• >3 high
• 1-2 moderate • <1 low (do a D-dimer) |
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What are the 2 types of D-dimer tests?
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• latex agglutination test
• ELISA test |
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What are chest x-ray findings of a PE?
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• Atelectasis
• elevated hemidiaphragm • Hampton's hump • small pleural effusion • Westermark sign • Wedge (focal peripheral consolidation) |
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What is a Westermark sign?
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dilation of pulmonary vessels and a sharp cutoff
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What is Hampton's hump?
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focal consolidation at the costophrenic angle
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What test is becoming the dianostic study of choice for PE?
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spiral CT scan
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What test is the gold standard for diagnosing PE?
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pulmonary angiography
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What are the most common EKG abnormalities seen with PE?
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• tachycardia (#1)
• nonspecific ST-T wave changes |
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Which patients are indicated for an IVC filter?
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• 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 |
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What are the 4 main types of fluids in the pleural space?
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• serous fluid (hydrothorax)
• blood (hemothorax) • lipid (chylothorax) • pus (pyothorax or empyema) |
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What is the most common cause of transudative effusion?
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CHF
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What is the most common symptom associated with pleural effusion?
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dyspnea
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How many mL of fluid will cause blunting of the costophrenic angle?
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more than 175 ml
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What are the 4 types of pneumothorax?
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• traumatic
• tension • spontaneous • Iatrogenic |
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Spontaneous pneumothorax is most common in who?
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tall, thin males who smoke
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What is the recommended site for a needle thracostomy?
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2nd intercostal space in the midclavicular line
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What is the definitive treatment for pneumothorax?
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chest tube
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Where should you place a chest tube?
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over the 5th or 6th rib in the midaxillary line
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How do you treat a small, minimally symptomatic pneumothorax?
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• 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 |
