Term
| Approx how much of the world population is infected with TB? |
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Definition
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Term
| Name 4 factors that led to the increase of TB in early 1990s |
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Definition
HIV epidemic
Immigration from TB prevalent countries
Rise of multi-drug resistance
Decline of TB control programs |
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Term
| Compare TB rates in US population: foreign born vs. US born |
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Definition
| foreign born rate 11.5x the rate of US born individuals |
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Term
| Prevalence of extensively drug resistant TB (XDR-TB) |
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Definition
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Term
| briefly describe Extensively Drug-Resistant TB |
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Definition
| Resistant to the top 8 drugs used to treat TB |
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Term
| 3 factors (describing airborne particles) in risk of transmission |
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Definition
number of bacteria excreted
closeness
duration of exposure |
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Term
| Top 3 most at risk for developing TB |
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Definition
Close contact with TB suspects
Immunosuppressed
Recently exposed |
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Term
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Definition
Mantoux test
Purified Protein Derivative tuberculin |
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Term
| How long til PPD test is read |
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Definition
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Term
| What is evaluated in appearance of PPD test |
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Definition
| Induration and size, NOT COLOR |
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Term
| When is PPD test considered positive for healthcare workers |
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Definition
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Term
| What size of induration indicates a positive test for ANY person |
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Definition
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Term
| 2 Other tests for TB besides PPD |
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Definition
Interferon Gamma Release Assays
Xpert MTb/RIF |
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Term
| Name advantages of IGRA compared to PPD |
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Definition
Faster
one pt visit
does not boost responses by subsequent tests
less subjectivity
minimally influenced by BCG
not counfounded by mycobacterium avium |
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Term
| Name some disadvantages to IGRA compared to PPD skin test |
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Definition
not well proven in children and immunocompromised
must be processed within 12 hours
not useful for recent exposures
more expensive |
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Term
| Which TB test uses PCR and looks for Rifampin resistance |
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Definition
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Term
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Definition
Cough
sweats
fever
chills
malaise
anorexia
weight loss |
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Term
| How often are ocular signs found in Non-HIV+ Tb patients |
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Definition
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Term
| How often are ocular signs found in HIV+ TB patients |
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Definition
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Term
| Common symptom in TB in CHILDREN |
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Definition
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Term
| External Ocular symptoms of TB |
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Definition
ulceration of lids/ectropion
cellulitis
dacryadenitis
Phylctenulosis
Keratoconjunctivitis
Interstitial keratitis
Episcleritis/scleritis
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Term
| Describe how you may differentiate the cause of phylctenulosis |
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Definition
| Can be caused by Staph and TB, however if caused by staph it will most likely be accompanied by blepharitis and other signs of infection on lids and lashes |
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Term
| Posterior segment ocular signs of TB |
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Definition
Uveitis
Choroiditis
Retinal periphlebitis
Optic neuritis
Cranial neuropathy |
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Term
| What is gold standard in TB diagnosis |
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Definition
Cultures of sputum
but they are very slow |
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Term
| TB test that is faster but requires higher bio safety standards |
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Definition
Microscopic Observation Drug Susceptibility (MODS)
takes 7 days |
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Term
| Traditional tx of LATENT TB |
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Definition
Isoniazid qd for 9 months
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Term
| chief problem with Isoniazid treatment |
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Definition
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Term
| Chief risk with isoniazid treatment |
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Definition
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Term
| New treatment of LATENT TB |
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Definition
Combination of Isoniazid and Rifapentine is 12 once/weekly doses under direct observation
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Term
| What drug is used in treatment of latent TB to diminish risk of peripheral neuropathy from isoniazid |
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Definition
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Term
| Preferred tx of ACTIVE TB |
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Definition
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
Pyridoxine
qd x 8 weeks
Then INH and Rif w Pyridoxine 2/week x 18 weeks |
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Term
| Compare timelines of latent and active TB treatment |
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Definition
Traditional Latent 9 months
New Latent- 12 weeks
Active-26 weeks |
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Term
Adverse effects of Rifampin
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Definition
Resistance develops easily
N&V, fever, rash
red secretions |
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Term
| Adverse effects of Pyrazinamide |
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Definition
| Never given alone because resistance develops so easily |
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Term
| Adverse effects of Ethambutol |
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Definition
OPTIC NEURITIS
Macular edema
Pigmentation changes |
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Term
| Which drug is a big cause of optic neuritis |
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Definition
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Term
| How often should TB patients be seen by their optometrist? |
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Definition
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Term
| What tests should an optometrist perform on a TB pt? |
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Definition
VAs
Pupils
EOMs
Red Green
Amsler
Visual Field
DFE |
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Term
| No masks are needed around a treated TB patient after how long? |
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Definition
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Term
| Primary involvement of histoplasmosis in adults is where? |
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Definition
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Term
| Primary involvement of histoplasmosis in children is where? |
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Definition
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Term
| Approx how many ppl in US are infected by Histoplasmosis |
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Definition
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Term
| Incidence of Histoplasmosis each year? |
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Definition
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Term
| Name 2 areas where histoplasmosis infection is common |
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Definition
| Valleys of Ohio and Mississippi River |
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Term
| Describe the dz process of histo |
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Definition
Fungi proliferate in lungs and are phagocytized by PMNs and macrophages
Fungi Duplicate inside and travel to lymph nodes in macrophages
Enters blood, immune response occurs causing granulomas, necrosis, fibrotic encapsulation
Necrotic areas calcify in months to yrs |
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Term
| Symptoms associated with primary acute histo |
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Definition
fever
chills
dry cough
malaise
HA
myalgia
arthralgia |
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Term
| Age group primary acute histo is generally found in |
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Definition
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Term
| Describe tx of Primary acute histo |
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Definition
| commonly resolves within 2-3 month without treatment |
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Term
| What is the most common form of histoplasmosis? |
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Definition
| Benign is more common (90% of infections) |
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Term
| How are most benign forms of histo discovered? |
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Definition
| By accident with skin test or routine chest x-ray |
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Term
| In which category of histo is the ocular form most likely to occur? |
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Definition
| POHS occurs in the benign form |
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Term
T/F
AC and vitreous inflammation is common in Presumed Ocular Histoplasmosis syndrome |
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Definition
False
Typically not present |
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Term
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Definition
circumpapillary choroiditis
atrophic chorioretinal scars (histo spots)
exudative maculopathy |
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Term
| Age groups commonly affected by disseminated histoplasmosis |
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Definition
Very young
Old
Immunocompromised adults |
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Term
| Pathophys that results in disseminated histo |
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Definition
| Poor T-cell immune response allows the fungi to disseminate |
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Term
| In which form of histo can hypersplenism occur? |
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Definition
| Disseminated histoplasmosis |
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Term
| Symptoms of disseminated histo |
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Definition
fever
chills
cough
malaise
HA
diarrhea
weight loss
dyspnea |
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Term
| What disease can result due to adrenal gland involvement in the histoplasmosis disease process |
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Definition
| Can result in Addison's disease |
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Term
| endocrine levels associated with Addison's dz |
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Definition
| not producing cortisol or aldosterone |
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Term
| Common result when disseminated histo goes untreated |
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Definition
| 80% mortality rate within 4-10 months |
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Term
| Why may patients who have histo still demonstrate a negative skin test result |
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Definition
| They may give a negative response because their bodies are not mounting an immune response to the organism |
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Term
| Which form of Histo commonly occurs in pts with COPD or emphysema? |
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Definition
| Chronic pulmonary histoplasmosis-infects lung tissue that is already compromised |
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Term
| 2 features of chronic pulmonary histo found in the lungs |
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Definition
Histoplasmomas
Bronchiectasias |
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Term
| 5 aspects of diagnosis of histoplasmosis |
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Definition
History
Cultures
Skin test
X-rays
Serologic tests |
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Term
| Disadvantage of Histoplasmosis cultures |
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Definition
| Very slow, take 5-6 weeks |
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Term
| Which patients are histo skin tests useful in |
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Definition
Infants
previous negatives |
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Term
| What may be seen in a chest x ray of a histo pt |
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Definition
| Multiple calcified foci in both lungs |
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Term
| Why may a histo skin test be contraindicated when you suspect the lesion in your patient's eye is due to histo? |
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Definition
| The skin test can reactivate the disease and cause even more damage to the eye, best to just presume thats what it is and not worry about proving it |
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Term
| Which forms of histo require no tx |
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Definition
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Term
| How is disseminated histo treated? |
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Definition
with anti-fungals
and systemic corticosteroids (for Addison's) |
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Term
| Time line of histo treatment for immunosuppressed patients |
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Definition
| Probably on anti-fungals for the rest of their life |
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Term
| 3 Antifungals used in tx of histo and method of administration |
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Definition
Amphotericin B (IV)
Ketoconazole (oral)
Itraconazole (oral) |
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Term
| Adverse reactions associated with anti-fungals |
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Definition
N& V
anemia
nephrotoxicity
liver toxicity |
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Term
| 2 Reasons why systemic corticosteroids are given to histo pts |
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Definition
To treat Addison's dz
to decrease damage from inflammation |
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Term
| What is the only situation where systemic corticosteroids are given to a histo pt |
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Definition
| Only when they are given in conjunction with anti-fungals |
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