Podcast
Questions and Answers
When should a patient be hospitalized for active TB? (Select all that apply.)
When should a patient be hospitalized for active TB? (Select all that apply.)
- When the patient is diagnosed with a drug-resistant strain.
- When the patient's symptoms persist longer than 2 months.
- When the patient is thought to be a risk for spreading TB to others. (correct)
- When the patient is non-compliant with treatment. (correct)
What is the recommended duration of treatment for a person with HIV who has active TB?
What is the recommended duration of treatment for a person with HIV who has active TB?
- 9 months (correct)
- 4 months
- 2 months
- 6 months
Which of the following medications is NOT typically used for the initial treatment of active TB?
Which of the following medications is NOT typically used for the initial treatment of active TB?
- Rifampin
- Isoniazid
- Fluconazole (correct)
- Pyrazinamide
Which of the following is a sign of drug resistance in active TB?
Which of the following is a sign of drug resistance in active TB?
What is the function of a negative pressure room for a patient with active TB?
What is the function of a negative pressure room for a patient with active TB?
What is the recommended duration of INH treatment for an individual with a positive TB skin test who is an immigrant from a high prevalence area?
What is the recommended duration of INH treatment for an individual with a positive TB skin test who is an immigrant from a high prevalence area?
Which of the following PFT measures the volume of gas remaining in the lungs after maximal expiration?
Which of the following PFT measures the volume of gas remaining in the lungs after maximal expiration?
What is the name of the bacterium that causes pertussis?
What is the name of the bacterium that causes pertussis?
What is the causative agent of Tuberculosis?
What is the causative agent of Tuberculosis?
Which medical condition carries the highest increased risk for Latent TB to progress to active TB?
Which medical condition carries the highest increased risk for Latent TB to progress to active TB?
Which of the following is NOT considered diagnostic for active TB?
Which of the following is NOT considered diagnostic for active TB?
What should be given with Isoniazid to decrease the risk of neuritis and other side effects?
What should be given with Isoniazid to decrease the risk of neuritis and other side effects?
Which diagnostic tool provides presumptive evidence of active TB but is not definitive?
Which diagnostic tool provides presumptive evidence of active TB but is not definitive?
What is a key characteristic symptom of pertussis during its late stages?
What is a key characteristic symptom of pertussis during its late stages?
During which weeks of pregnancy does the CDC recommend that women receive the Tdap vaccine?
During which weeks of pregnancy does the CDC recommend that women receive the Tdap vaccine?
What is the recommended antibiotic treatment within the first three weeks of a pertussis infection?
What is the recommended antibiotic treatment within the first three weeks of a pertussis infection?
Which of the following statements about pertussis is true?
Which of the following statements about pertussis is true?
What happens to the alveoli in the lungs of the elderly?
What happens to the alveoli in the lungs of the elderly?
Which of the following is NOT a common diagnostic method for pertussis?
Which of the following is NOT a common diagnostic method for pertussis?
What complication can arise from coughing fits in individuals with pertussis?
What complication can arise from coughing fits in individuals with pertussis?
Which of these infections is most commonly associated with pneumonia in elderly patients?
Which of these infections is most commonly associated with pneumonia in elderly patients?
Which of the following best describes the nature of Mycobacterium tuberculosis?
Which of the following best describes the nature of Mycobacterium tuberculosis?
An individual with latent tuberculosis infection (LTBI) would typically present with which of the following symptoms?
An individual with latent tuberculosis infection (LTBI) would typically present with which of the following symptoms?
A patient's chest X-ray shows a small homogeneous infiltrate in the upper lobes. What is the next most appropriate step?
A patient's chest X-ray shows a small homogeneous infiltrate in the upper lobes. What is the next most appropriate step?
During the initial phase of pharmacologic treatment for tuberculosis, which medication requires specific attention to visual acuity and red-green color perception?
During the initial phase of pharmacologic treatment for tuberculosis, which medication requires specific attention to visual acuity and red-green color perception?
A patient has positive AFB smears, what does this result indicate?
A patient has positive AFB smears, what does this result indicate?
What is a potential side effect of Rifampin in patients undergoing treatment?
What is a potential side effect of Rifampin in patients undergoing treatment?
Which PFT measures the maximal airflow rate achieved during forced expiration?
Which PFT measures the maximal airflow rate achieved during forced expiration?
For which group is a positive skin test defined as 5 mm?
For which group is a positive skin test defined as 5 mm?
What action should be taken if a patient with active TB continues to show positive cultures after 3 months?
What action should be taken if a patient with active TB continues to show positive cultures after 3 months?
What is the minimum duration of treatment for a person with HIV who has active TB?
What is the minimum duration of treatment for a person with HIV who has active TB?
What is the purpose of notifying the local health department in cases of TB?
What is the purpose of notifying the local health department in cases of TB?
Which of the following is a typical characteristic of whooping cough?
Which of the following is a typical characteristic of whooping cough?
In the management of active TB, when should sputum smears and cultures be monitored after initiating therapy?
In the management of active TB, when should sputum smears and cultures be monitored after initiating therapy?
What is the primary reason for pregnant women to receive the Tdap vaccine?
What is the primary reason for pregnant women to receive the Tdap vaccine?
Which of the following early symptoms is associated with pertussis?
Which of the following early symptoms is associated with pertussis?
What is a critical aspect of diagnosing pertussis?
What is a critical aspect of diagnosing pertussis?
What is NOT recommended in the treatment of pertussis?
What is NOT recommended in the treatment of pertussis?
What are late-stage symptoms of pertussis typically characterized by?
What are late-stage symptoms of pertussis typically characterized by?
Which of the following describes pulmonary changes in the elderly?
Which of the following describes pulmonary changes in the elderly?
What is a serious risk for children under one year old regarding pertussis?
What is a serious risk for children under one year old regarding pertussis?
Which common pathogen is associated with pneumonia in elderly patients?
Which common pathogen is associated with pneumonia in elderly patients?
Flashcards
Tuberculosis (TB)
Tuberculosis (TB)
A bacterial infection that primarily affects the lungs. It is spread through the air when an infected person coughs or sneezes. It can be latent (in the body but not causing symptoms) or active (causing symptoms).
Latent TB
Latent TB
An infection with Mycobacterium tuberculosis bacteria, but not actively causing symptoms. It is often asymptomatic but can progress to active TB if the immune system weakens.
Active TB
Active TB
Type of tuberculosis that shows symptoms and can spread to others. It can cause symptoms like fever, cough, weight loss, and night sweats.
QuantiFERON-TB Gold Test
QuantiFERON-TB Gold Test
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Pharmacologic Treatment for TB
Pharmacologic Treatment for TB
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Rifampin Side Effects
Rifampin Side Effects
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Monitoring for Rifampin Side Effects
Monitoring for Rifampin Side Effects
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Drug Susceptibility in TB Treatment
Drug Susceptibility in TB Treatment
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TB Treatment Duration and Regimen
TB Treatment Duration and Regimen
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TB Treatment Duration for HIV-Positive Individuals
TB Treatment Duration for HIV-Positive Individuals
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Tuberculin Skin Test Interpretation: HIV-Infected Individuals
Tuberculin Skin Test Interpretation: HIV-Infected Individuals
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Tuberculin Skin Test Interpretation: High-Risk Groups
Tuberculin Skin Test Interpretation: High-Risk Groups
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Tuberculin Skin Test Interpretation: General Population
Tuberculin Skin Test Interpretation: General Population
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What is Pertussis?
What is Pertussis?
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What are the early symptoms of Pertussis?
What are the early symptoms of Pertussis?
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What are the late symptoms of Pertussis?
What are the late symptoms of Pertussis?
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How can you protect yourself and a baby from Pertussis?
How can you protect yourself and a baby from Pertussis?
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How is Pertussis diagnosed?
How is Pertussis diagnosed?
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How is Pertussis treated?
How is Pertussis treated?
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How do lungs change with age?
How do lungs change with age?
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What are the gerontology considerations for pneumonia?
What are the gerontology considerations for pneumonia?
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What is a Latent TB infection?
What is a Latent TB infection?
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What is Active TB?
What is Active TB?
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What is the QuantiFERON-TB Gold Test?
What is the QuantiFERON-TB Gold Test?
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What is a PPD test?
What is a PPD test?
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What is the typical treatment plan for TB?
What is the typical treatment plan for TB?
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Rifampin's Side Effect?
Rifampin's Side Effect?
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TB Diagnosis Reporting?
TB Diagnosis Reporting?
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TB Test: Immigrant Risk
TB Test: Immigrant Risk
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FVC Lung Function Test
FVC Lung Function Test
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What are Pulmonary Function Tests?
What are Pulmonary Function Tests?
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TB Patient Isolation?
TB Patient Isolation?
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Persistent TB Symptoms?
Persistent TB Symptoms?
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How can Pertussis be prevented?
How can Pertussis be prevented?
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Explain the treatment for Pertussis.
Explain the treatment for Pertussis.
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How do aging lungs affect oxygen uptake?
How do aging lungs affect oxygen uptake?
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What are the gerontological considerations for pneumonia?
What are the gerontological considerations for pneumonia?
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Study Notes
Tuberculosis (TB)
- TB is an airborne infectious disease caused by Mycobacterium tuberculosis, an acid-fast aerobic bacterium.
- The bacterium can survive outside the host for a long time.
- Certain medical conditions like diabetes mellitus (DM) and HIV infection significantly increase the risk of latent TB progressing to active TB. The risk is 3 times higher with DM and 100 times higher with HIV compared to those without these conditions.
Clinical Presentation of TB
- Individuals infected with Mycobacterium tuberculosis but without active disease (LTBI) show no symptoms.
- Symptoms of active TB may include fatigue, anorexia, dry cough that may become productive and sometimes blood-tinged, weight loss, low-grade fever, and night sweats.
Diagnosis of TB
- Screening is the initial step in diagnosing TB, identifying high-risk individuals and those needing treatment.
- Definitive diagnosis involves 3 positive results of Nucleic Acid Amplification Test (NAAT) culture of M. tuberculosis.
- QuantiFERON-TB Gold blood test can be used.
- AFB smears offer a presumptive indication of active TB, but they are not diagnostic.
- Chest X-ray (CXR) may show small homogeneous infiltrates in upper lobes, but it's not diagnostic for active disease; repeat CXR in 6 months if needed.
Differential Diagnosis of TB
- Tuberculosis
- Pneumonia
- Acute Bronchitis
- Carcinoma
Pharmacologic Treatment of TB
- Initial treatment typically involves Isoniazid (INH) 300 mg, Rifampin (RIF) 600 mg, Pyrazinamide 1.5-2.0 gm, and Ethambutol 15 mg/kg daily for 3-4 months.
- Vitamin B6 (pyridoxine) is often administered with INH to reduce the risk of neuritis and neuropathy; also hepatitis and seizures need to be monitored closely.
- Visual acuity (eye health) should be assessed and red-green perception tested before and during treatment with ethambutol.
- Liver function tests (CBC, serum creatinine) should be done at baseline and monitored regularly during treatment.
- If the bacteria is shown to be fully susceptible to INH and RIF, the 4th drug may be removed from the treatment regimen.
- If HIV positive, treatment should continue for 9 months.
Management of TB
- Notify local health departments of reported cases of TB.
- Hospitalization is not always required, but should be considered if the patient is non-compliant or is likely to expose susceptible individuals to TB.
- Patients with active TB should be isolated in a negative-pressure room.
- Patients with pulmonary TB should be monitored with weekly sputum smears and cultures for the first 6 weeks after treatment then monthly until negative cultures are documented.
- Continued symptoms or positive cultures after 3 months should raise a high suspicion of drug resistance.
Important Facts to Recall
- Individuals with a positive TB skin test should receive 6 months of INH treatment.
- A positive skin test reaction of 5 mm is considered positive for HIV-infected individuals, recent contacts, those with a chest x-ray considered suggestive of TB, or organ transplant recipients.
- A positive reaction of 10 mm is considered positive for immigrants from high prevalence areas, those in high-risk groups (healthcare workers, incarcerated, those with diabetes or over 4 years of age).
- A positive reaction of 15 mm is considered positive for all other individuals not in high prevalence groups.
Pulmonary Function Tests (PFTs)
- PFTs measure how effectively the lungs take in and release air.
- PFTs evaluate the lungs' transfer of oxygen from the atmosphere into the circulatory system.
- Key measurements include Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), FEV25-75, Peak Expiratory Flow Rate (PEFR), Total Lung Capacity (TLC), Functional Residual Capacity (FRC), and Residual Volume (RV).
Pertussis (Whooping Cough)
- Pertussis is a highly contagious respiratory infection (disease) caused by Bordetella pertussis.
- Symptoms include uncontrollable violent coughing, difficulty breathing, and a "whooping" sound during inhalation.
- Pertussis can be serious, especially in infants less than a year old.
- Vaccination is the primary method of protection against pertussis.
- Diagnosis is performed by PCR (Polymerase chain reaction) tests to detect Bordetella pertussis or Bordetella parapertussis from nasopharyngeal swabs.
- Treatment involves antibiotic therapy (azithromycin, clarithromycin, or erythromycin) within the first 3 weeks of infection.
Clinical Manifestations of Pertussis
- Early symptoms (1-2 weeks): runny nose, low-grade fever, and occasional cough.
- Late-stage symptoms (10 weeks or longer): coughing fits followed by a whoop sound, vomiting, exhaustion.
Pertussis and Pregnant Women
- Pregnant women should receive a Tdap vaccine during their pregnancy to protect themselves and pass immunity to their infants.
- The vaccine is most effective when administered during the 27th-36th week of pregnancy.
Pertussis Diagnosis and Treatment
- Diagnosis is usually made using PCR tests.
- Antibiotics (e.g., azithromycin, clarithromycin, erythromycin) are typically administered for treatment within the first 3 weeks of infection.
- Cough suppressants are not recommended during treatment.
- Adequate hydration should be maintained.
- Frequent, light meals help prevent vomiting.
Gerontology Considerations for Pulmonary Conditions in the Elderly
- Lung tissues become stiffer, diminishing respiratory strength and endurance.
- Chest walls become less flexible and more rigid, increasing the anteroposterior (AP) diameter.
- Reduced alveolar surface area and susceptibility of alveoli collapsing due to decreased surface tension.
- Mucus production increases while the cough reflex decreases.
- Pneumonia risk is significantly higher (over 50%) in adults over 65 years old, especially in Long Term Care (LTC) facilities (over 30% risk over 2 years).
- Common pneumonia pathogens include Streptococcus pneumonia, gram-negative bacilli, and Staphylococcus aureus.
- Chest X-rays (CXRs) may show varied presentations depending on the pathogen.
Parotid Gland Swelling
- A patient with chronic parotid gland swelling not responding to antibiotics, and without increasing swelling, suggests a diagnostic test for diseases other than infections.
- Fine-needle aspiration (FNA) is the most appropriate diagnostic test.
Chronic Lesions and Fine-Needle Aspiration
- Chronic lesions in the parotid gland could be due to either tuberculosis or malignancy.
- Fine-needle aspiration is the most effective method for distinguishing if the lesion is infectious or malignant.
- Imaging techniques like radiographic studies can identify the extent of the lesion, but they are often not diagnostic.
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