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59 Cards in this Set
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TB test is + if :
3 for >5mm induration |
immunosuppressed,
in contact w/ someone that has it chest x-ray shows the fibrosis of TB |
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TB test + if :
for >10mm induration |
any high risk individual that doesn't meet first criteria `
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IGRA-
what is the method of doing this test? how is the results determined? |
bl sample is mixed with TB proteins and controls. if it is present - WBC will release a IG - interferon gamma
by the riskfactors and health of pt. |
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what is the advantages of IGRA
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one visit
results w/i 24 hrs no boost responses more precise minimal influence of the BCG vaccine not confounded my Mycobac Avium |
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what are disadvantages of the IGRA?
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not well proved in kids and immune compromised individuals.
bl samples have to be processed in 12 hrs not proved for eval for recent exposure ppl more expensive... |
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does BCG help protect the lungs?
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no
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where does TB hit besides lung?
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lymph system, bones, joints, meninges
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how do you do a bacteriologic eval of sputem?
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3 samples over three days
stain and culture and do NAA test gold st but very slow! |
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what is the new test for bacteriologic eval?
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MODs assay, 7 days but need high bio safety standards
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how may TB pts has eye signs?
nl pts |
1-2%
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how many of HIV+ ppl with TB has eye signs?
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18%
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what happens external eye-on ppl with TB
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ulcer-lid and get scars and ectropian
celulitis dacryoadenitis phlyctenulosis IK Keratoconj Episcleritins and scleritis |
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what happens in the posterior seg of TB pts?
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uveitis
chorditis retinal periphlebitis optic nueritis cranial neuropathy |
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how should u treat latent TB?
drugs - 2 |
Pyridoxine - vit B6
Isoniazid - INH |
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what is the chief risk of INH?
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hepatotox and risk will increase with age.
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what is the most potent TB drug?
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INH
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how long should you use INH for Latent TB?
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9 mo , qd
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what is latent TB?
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you have pos screening test, no sign of infection
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How do you rule out active TB?
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sputum sample and chest x-ray
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SE of INH
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anemia
GI peri neuropathy (this is why u use pyridoxine) sub epi K infiltrates ON VF defects EOM paresis |
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what are SE of INH that involves eye?
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EOM paresis, Subepithelial K infiltrates, ON, VF defects,
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how should you treat active TB?
qd for 2 mo |
INH
Rifampin Pyrazinamide Ethambutol Pyridoxine |
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for active TB, after the qd for 2 mo regime, what do you give 2x a week for addn 5 mo?
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Isoniazid
Rifampin Pyridoxine |
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which are the mycobacterial drugs?
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Rifampin
Pyrazinamide Ethambutol |
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SE of Ethambutol
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ON
macular edema and pigmentation changes also reported. |
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Primary Acute Histoplasmosis
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infants, kids
not diagnosed often resolved in 2-3 mo usually |
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What % is benign histo?
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more than 90%
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what causes the fungi to disseminate in histo?
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poor T-cell immune response
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what is the most common seen on the x-ray? for disseminated hist?
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diffuse interstital infiltrates
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what else can begnin histo cause?
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affects liver
lymph gi cns panothalmitis |
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what happens in chronic pulmonary hist?
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infection of the lung tissue thats already compromised by soemthing else.
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what is formed in chronic pulmonary hist?
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histoplasmomas and bronchiectasis
weight loss, fever, chronic cough, chest pain. |
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what antifung should you give hist pts?
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IV: amphoterican B
oral: ketoconzaole, itraconazole |
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what are other organ systems invovled in CF and what happens?
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poor digestion of fats
malabsorbtion of proteins and carbs infertility cirrhosis |
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what is the pulmonary involvement for CF?
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infections with normal flora bac and then infection with other bacteria and the persistent infection and inflammation cause damage to the airway walls and obliterates the small ariways. common cause of death - pulmonary failure.
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what tx is used for airway clearance in CF?
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percussion and postural drainage
all areas of the lung are percussesd BID pulmozyme- makes sputem less viscous and easy to clear. QD or QOD may get watery discharge and conjunctivitis |
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what is the oral tx for CF?
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oral antibiotics - azithro 3x week
*most long term, doesnt work. |
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what is the inhaled tx for cf?
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28 days and then stopped for 28 days
high dose TOBI 15 min BID aztreonam for inhalation solution 5 min TID |
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what is the most important factor for increased life span in CF?
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inhaled antibios
expensive but decreases the scaring due to infection. |
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what other tx is for cf?
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bronchodialators
nutritional support 7% NaCl Ibuprofen Lung Transplant |
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What type of bronchodialtors is used in cf?
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beta -2 adrenergic receptor agonist
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when can ibuprofen work in cf?
what is risks? |
high dose can help in younger ppl, slowing the rate of decline.
gi bleed and kidney damage |
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After lung transplant, how long for survival?
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65% survive 5 years
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what are some restrictive lung dx, that is infiltrative?
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pnemoconiosis
collagen vasular dx sarcodosis |
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what are the restiv lung dz, contributed to chest wall abnormalities?
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kyphoscoliosis, obesity, respiratory muscle fatigue.
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what happens in asbestos?
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fibers stay in lungs and stimulate inflammation
takes about 20-40 ears to take full affect. |
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what can result from asbestosis?
what kind of cancer? |
pleural effusion to progressive pul fibrosis.
bronchogenic carcinoma malignant mesotheliomas of pleura and peritoneum |
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what is the most prev occupational dz in the world?
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silicosis
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Adverse effects
Adrenergic bronchodilators 5 |
URI
cough and dry mouth HA pradox bronchospasms skeletal muscle tremors |
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Ipratropium bromide (tiotropium for COPD)? what kind and what does it do?
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anticholingeric
prevents the contraction of the airways SM and mucus sercreation less effective than b2 agonists |
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Ipratropium bromide (tiotropium for COPD)
SE |
blurry vision HA
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what happens in cb?
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inflammed airways
hypertorphy of the mucus gland in airway, hyper mucus |
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when do you use theophylline?
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for CB,
but its toxic, seizures, arrhythmias |
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why do you use volume reduction surgery?
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removing part of the lung so less pressure and wont collapse the less diseased portions
allows more space in the thoracic cavity. |
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how to characterize restric lung dz?
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abilit of lungs to change shape and fill is restricted
decreased in expansion of lung parenchyma. |
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what is often the 1st presenting sign of sarcodosis?
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lac gland inflammation
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eye signs for sarcoidosis
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ONH edema
coj granulomas on lid, iris, retina wbc on bc of K and on iris anterior uveitis lac gland inflam candle wax drippings crainal neuropathies |
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Sarcoidosis symptoms
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respiratory problems
-dry cough -dyspnea -paratracheal and hilar adenopathy fatigue and fever lymphadenopathy all over body |
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what is a better prognosis for sarcoidosis?
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acute onset pts. they are more likely to have spont remission
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