Term
| Why does the WHO endorse the MTB/RIF test? |
|
Definition
| It is simple, fast, and highly sensitive while providing minimal risk of exposure for the practitioner |
|
|
Term
| What are downsides of the MTB/RIF test? |
|
Definition
needs good electrical power
require annual calibration by a skilled, trained technician |
|
|
Term
| Does a positive TB test mean that you have an active TB? |
|
Definition
|
|
Term
| How are active vs latent RB infections differentiated? |
|
Definition
|
|
Term
| What are other areas that TB can affect besides the lungs? |
|
Definition
lymphatic system
bones and joints
meninges |
|
|
Term
| What % of TB infections will be pulmonary? |
|
Definition
|
|
Term
|
Definition
| No, you must also know the epidemiology of the pt before ruling TB in or out |
|
|
Term
| What demographic is more at risk for TB infection in the meninges? |
|
Definition
|
|
Term
| What % of non-HIV pt's with TB have ocular manifestation? |
|
Definition
|
|
Term
| What % of HIV pt's have TB manifest with ocular SE? |
|
Definition
|
|
Term
| Can ocular SE be the first signs of TB? |
|
Definition
|
|
Term
| What are external ocular signs of TB? |
|
Definition
ulceration of lids
cellulitis
dacryoadenitis
phlyctenulosis
keratoconjunctivitis
interstitial keratitis
episcleritis and scleritis |
|
|
Term
| What are ocular signs of TB found on the posterior segment? |
|
Definition
uveitis
choroiditis
retinal periphlebitis
optic neuritis
cranial neuropathy |
|
|
Term
| What are the two most common ocular signs of TB that Dr. Lingel observed? |
|
Definition
|
|
Term
| How should a bacteriologic evaluation of sputum be performed? |
|
Definition
3 samples over 3 days
stain, culture, and perform NAA test |
|
|
Term
| What is the gold standard for TB dx? |
|
Definition
| cultures, however they are very slow and take weeks to complete |
|
|
Term
| What is a new test for TB that may be better than running a culture? |
|
Definition
|
|
Term
| How long does it take to run a MODS assay? |
|
Definition
|
|
Term
| What is a precaution that must be made when performing a MODS assay? |
|
Definition
| requires high bio safety standards |
|
|
Term
| When should a TB sputum sample be taken? |
|
Definition
| Preferably in the morning |
|
|
Term
|
Definition
| Nucleic Acid Assay test. DNA is amplified in order to identify origin. Often used in TB dx |
|
|
Term
| What are the tx goals for TB? |
|
Definition
eradicate infection
prevent drug resistance
prevent reactivation |
|
|
Term
| Is the MODS assay currently used everywhere in the US? |
|
Definition
| No, some areas do not use it as it requires higher bio safety, careful handling, etc |
|
|
Term
| What is a latent TB infxn? |
|
Definition
| pt is positive for TB, but has no active infxn |
|
|
Term
| What is the tx for latent TB? |
|
Definition
ensure no active TB through x-ray and sputum culture
DOC is Isoniazid |
|
|
Term
| What is the most potent anti-TB drug? |
|
Definition
|
|
Term
| What is the abbreviation for Isoniazid? |
|
Definition
|
|
Term
| What is the tx course for Isoniazid? |
|
Definition
|
|
Term
| What is the primary risk of INH? |
|
Definition
|
|
Term
| Who is at higher risk for INH related hepatotoxicity? |
|
Definition
|
|
Term
| What are general SE of isoniazid? |
|
Definition
anemia
GI s/sx
peripheral neuropathy
subepithelial corneal infiltrates
optic neuritis
visual field defects
EOM paresis |
|
|
Term
| What is Vit B6 used for in TB tx? |
|
Definition
tx for latent TB
very important for pregnant, DM, EtOH abuse, and malnourished pt's
diminishes risk of peripheral neuropathy from INH |
|
|
Term
| What are anti-mycobacterial drgs? |
|
Definition
rifampin
pyrazinamide
ethambutol |
|
|
Term
| What drugs are taken q.d. for 8 weeks concurrent with INH in TB tx? |
|
Definition
rifampin
pyrazinamide
ethambutol
pyridoxine |
|
|
Term
| From weeks 9 through 27, what drugs are taken for TB tx? |
|
Definition
|
|
Term
| What TB drug often suffers from resistant strains of TB? |
|
Definition
|
|
Term
| What are SE of Rifampin use? |
|
Definition
nausea and vomiting
rash
fever
causes orange tears and CL discoloration |
|
|
Term
| What is a common ocular SE of rifampin use? |
|
Definition
| reddish orange tears and CL discoloration that may appear as blood coming from the eyes |
|
|
Term
| What TB drug has no SE, but is highly susceptible to TB resistance? |
|
Definition
|
|
Term
| What TB drug presents with optic neuritis and macular edema with pigment changes as SE's? |
|
Definition
|
|
Term
| What comorbidity would alter the tx of TB? |
|
Definition
|
|
Term
| What are baseline tests that should be monitored by an optometrist in TB? |
|
Definition
Every month check:
VA's
pupil exam
EOM's
R/G color vision
Amsler Grid
Visual Field
Dilated fundus exam |
|
|
Term
| What must be done by either the PCP or optometrist when a TB infxn is identified? |
|
Definition
| Ensure that the TB infxn has been reported to CDC |
|
|
Term
| Does TB tx have a high or low pt compliance rate? |
|
Definition
| Low, because the drugs must be taken daily for 9 months |
|
|
Term
| What is a possible way to avoid TB from developing resistance? |
|
Definition
| directly observed therapy to ensure pt compliance |
|
|
Term
| How is nosocomial TB transmission avoided? |
|
Definition
place pt in isolated room
pt must wear a mask
ask pt to cover their mouth/nose when coughing/sneezing
HEPA mask for HCP's |
|
|
Term
| When can nosocomial transmission precautions be stopped in TB pt's? |
|
Definition
|
|
Term
| How effective is having a TB pt wear a surgical mask at stopping transmission? |
|
Definition
| 50% reduction of nosocomial infxn |
|
|
Term
| What must be done before TB can be truly ruled out? |
|
Definition
| Two tests 8 weeks apart to ensure no infxn |
|
|
Term
|
Definition
|
|
Term
| What is the primary and secondary sights of infxn for histoplasmosis? |
|
Definition
| lungs are primary for adults, liver is primary for children. Secondary site in spleen and lymph nodes |
|
|
Term
| Where is histoplasmosis often found? |
|
Definition
|
|
Term
| Can histoplasmosis be transferred horizontally from pt to pt? |
|
Definition
|
|
Term
| Do most people have the ability to combat histoplasmosis? |
|
Definition
| Yes, it is generally a benign infxn as a result |
|
|
Term
| What is the prevalence of latent and active histoplasmosis? |
|
Definition
both women and men have 50% prevalence for a skin test, however men have a higher risk for active infxn
50 million people in US infected |
|
|
Term
| Does histoplasmosis infection discriminate by age? |
|
Definition
|
|
Term
| How many new infxn's of histoplasmosis is found each year? |
|
Definition
|
|
Term
| What river watersheds are most common sites for histoplasmosis? |
|
Definition
| Ohio and Mississippi river systems |
|
|
Term
| What are activated to fight histoplasmosis in the lungs? |
|
Definition
| PMN's and macrophages infiltrate and phagocytize the fungi |
|
|
Term
| Do macrophage's destroy histoplasmosis they phagocytize? |
|
Definition
| No, fungus duplicates inside macrophage and is then spread to regional lymph nodes |
|
|
Term
| How does histoplasmosis spread systemically? |
|
Definition
| Starts in lungs --> macrophages --> lymph system --> blood system --> spreads throughout body |
|
|
Term
| After histoplasmosis spreads systemically, what s/sx will be found |
|
Definition
granuloma formation
necrosis
fibrotic encapsulation
months to years later necrotic areas become calcified |
|
|
Term
| What are the four categories of histoplasmosis? |
|
Definition
primary acute
benign
disseminated
chronic pulmonary |
|
|
Term
| How long after primary infxn can histoplasmosis necrotic areas become calcified? |
|
Definition
|
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