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Pulmonology > 08.21 - TB (Cross) - Questions > Flashcards

08.21 - TB (Cross) - Questions Flashcards

1
Q

TB culture in liquid media will show results in

A

2 weeks

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1
Q

How does IGRA work

A

Blood cells from patient are exposed to antigens from MTB and amount of IFN-gamma released from cells is measured

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2
Q

Secondary infection usually involves

A

Apices of lungs (higher oxygen content)

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3
Q

What protein is thought to play major role in inhibiting phagosome-lysosome function

A

PknG

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3
Q

What stains tears

A

Rifampin and related

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3
Q

What is positive PPD if no know risk factors?

A

>15 mm

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3
Q

What is positive PPD if HIV, recent contact, immunosuppressed?

A

5-10mm

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4
Q

Only evidence of primary infection in majority of patients is

A

Calcified lung nodule

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4
Q

Possible NRAMP1 mutation –>

A

Unchecked bacillary proliferation –> Bacteremia, seeding of multiple sites

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5
Q

How do TH1 cells activate macrophages

A

IFN-gamma

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5
Q

Why not take rifampin and pyrazinamide together

A

Liver toxicity

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6
Q

In XDR TB, resistance is to

A

INH, RIF, Fluoroquinolone, at least one other

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7
Q

Adverse effects of Ethambutol

A

Optic Neuritis, Vision Discrimination, Hyperuricemia

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9
Q

Function of Sulfatides (Surface Glycolipids)

A

Inhibit phagolysosome function

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10
Q

Rifampin and other Rifamycins are __ inducers

A

CYP inducers

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11
Q

Agar used for TB culture

A

Lowenstein-Jensen Agar

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12
Q

Progressive primary TB initially looks like

A

Acute bacterial pneumonia: Lobar consolidation, Infiltrates, Adenopathy

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12
Q

What is positive PPD if “at risk”: homeless, nursing home, immigrant, children

A

10-15 mm

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13
Q

Can’t drink alcohol with

A

INH

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15
Q

TB remains dormant until

A

Immune defense are lowered

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17
Q

Spread of strep

A

Person-to-person (coughing)

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18
Q

Virulent strains grow in characteristic ____ pattern, avirulent strains don’t

A

cord-like

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18
Q

Most important virulence factor of MTB

A

Cell wall

19
Q

Common adverse effect of Ethambutol and Pyraziniamide

A

Hyperuricemia

20
Q

___ following primary infection can result in miliary/disseminated TB

A

Lymphohematogenous Dissemination

21
Q

Importance of TNF-alpha

A

TNF-alpha inhibitor will allow granuloma to degrade, freeing and reactivating the TB

21
Q

Common toxicity of Rifampin and Pyrazinimide

A

Hepatotoxic

23
Q

RIPE =

A

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

24
Q

__ is produced by TH-1 cells and enables macrophages to contain the infection

A

IFN-gamma

25
Q

Inhibits macrophage maturation and induces TNF-alpha release

A

Cord-Factor

26
Q

When can PPD be false positive

A

Immunization with BCG; Infection with nontuberculous MB

28
Q

What percent of patients who contract TB will contract from smear-negative patients

A

20%

29
Q

___ response leads to granuloma formation and caseous necrosis

A

TH1 response

29
Q

Rifampin could cause drug-drug interactions in ___ patients

A

HIV

30
Q

__ % of patients with primary TB will develop clinically significant disease

A

5%

31
Q

Which component of MTB retains AF stain?

A

Mycolic Acid

32
Q

Most important determinant of whether over disease occurs

A

Adequacy of host’s cell-mediated immune response

33
Q

Anterior leg rash seen in TB

A

Erythema Nodosum

34
Q

Cavitation / Bronchial damage more severe in

A

Immunocompetent patients

35
Q

TB tx in HIV patients

A

RIPE for 9-12 months

37
Q

What cell mediates tuberculin positivity on skin test

A

TH1

39
Q

Vision discrimination probs

A

Ethambutol

41
Q

Function of Cord Factor

A

Inhibits macrophage maturation and induces TNF-alpha release

42
Q

When do we use 4 drug cocktail

A

Active disease, HIV

44
Q

Hyperuricemia

A

Pyrazinamide, Ethambutol

45
Q

With reduced immune response as in HIV, there are few ___ in sputum

A

AFB

46
Q

Hetpatoxic

A

Rifampin, Pyrazinimide

47
Q

PPD injection stimulates

A

Delayed type hypersenstivity by T lymphocytes

48
Q

In HIV patients with TB, there is incr freq of ___, and absence of ___ in tissues

A

Incr freq of false negative sputum smears; and absence of granulomas in tissues

49
Q

How does alveolar macrophage activate T Cell

A

Class 2 MHC + IL-12

50
Q

T/F: Mycolic acid cleaves antibiotics to render them ineffective

A

FALSE

52
Q

Optic neuritis

A

Ethambutol

53
Q

Initial test for TB:

A

Acid fast; but culture should be done at same time

54
Q

PPD and IGRA in HIV patients

A

False negatives in both can occur

55
Q

In MDR TB, most common resistance is to ___; in ___ patients

A

INH and RIF; AIDS patients

Pulmonology (31 decks)

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