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Fitz 9th > 157 - Tuberculosis and Infections with Atypical Mycobacteria > Flashcards

157 - Tuberculosis and Infections with Atypical Mycobacteria Flashcards

1
Q

Main cause of death in patients infected with HIV

A

TB

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2
Q

Highest burden of TB in the following countries

A 
India
Indonesia
China
Philippines
Pakistan
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3
Q

In contrast to the obligate pathogens, _____ pathogens do not cause disease by person-to-person spread

A

Facultative

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4
Q

2 most frequent forms of skin tuberculosis

A

Lupus vulgaris

Scrofuloderma

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5
Q

In the tropics, LV is rare, wherease _____ lesions predominate

A

Scrofuloderma

Tuberculosis verrucosa cutis

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6
Q

Exogenous infection with naive host immune status

A

Primary inoculation tuberculosis

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7
Q

Exogenous infection with immune host status

A

Tuberculosis verrucosa cutis

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8
Q

Endogenous spread with high host immune status

A

Lupus vulgaris

Scrofuloderma

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9
Q

Endogenous spread with low host immune status

A

Acute miliary tuberculosis
Orificial tuberculosis
Metastatic tuberculous abscess (tuberculous gumma)

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10
Q

Tuberculosis caused by bacille Calmette-Guerin

A

Normal primary complex-like reaction
Perforating regional adenitis
Postvaccination lupus vulgaris

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11
Q

Tuberculids: conditions in which Mycobacterium tuberculosis/Mycobacterium bovis appears to play a significant role

A

Lichen scrofulosum

Papulonecrotic tuberculid

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12
Q

Facultative tuberculids: conditions in which M. tuberculosis/M. bovis may be one of several pathogenic factors

A

Nodular vasculitis/erythema induratum of Bazin

Erythema nodosum

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13
Q

Most common cause of disseminated bacterial infection in patients with AIDS

A

Mycobacterium avium-intracellulare complex

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14
Q

In AIDS patients, Mycobacterium _____ is more common than M. tuberculosis

A

kansasii

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15
Q

Cutaneous disease in AIDS is frequently caused by Mycobacterium _____

A

Other than Mycobacterium tuberculosis

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16
Q

A large number of bacteria can be found in the lesions of

A

Primary chancre

Acute miliary tuberculosis

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17
Q

Delayed-type hypersensitivity reaction induced by mycobacteria during primary infection

A

Tuberculin reaction (Koch phenomenon)

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18
Q

Maximum intensity of tuberculin reaction after

A

48 hours

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19
Q

QuantiFERON-TB Gold test measures specific antigen-driven _____ synthesis

A

Interferon-gamma

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20
Q

Tuberculin sensitivity usually develops _____ after infection and persists throughout life

A

2 to 10 weeks

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21
Q

In patients with clinical tuberculosis, an increase in skin sensitivity usually indicates a (favorable/poor) prognosis

A

Favorable

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22
Q

In tuberculous skin disease accompanied by high levels of skin sensitivity, the number of bacteria within the lesions is (small/large)

A

Small

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23
Q

Although more sensitive than the tuberculin skin test, _____ may be negative in patients with early active tuberculosis and indeterminate results are more common in immunocompromised individuals and young children

A

QFT-G

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24
Q

Measures the IFN-gamma producing T cells

A

T-SPOT TB test

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25
Q

Procedure that has been used to ascertain the presence of mycobacterial DNA in skin specimens

A

Polymerase chain reaction

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26
Q

PCR showed _____% sensitivity in multibacillary disease. In paucibacillary disease, PCR testing showed _____% sensitivity and specificity

A

100

55

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27
Q

Multidrug resistant TB is defined as

A

Resistance to at least rifampicin and isoniazid

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28
Q

Regimen for extrapulmonary tuberculosis

A

Initial Phase
INH, RIF, PZA, EMB
7 days per week for 56 doses (8 weeks) or
5 days per week for 40 doses (8 weeks)

Continuation Phase
INH/RIF
7 days per week for 128 doses (18 weeks) or
5 days per week for 90 doses (18 weeks)

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29
Q

Doses of medications (maximum dose) when given daily

A

EMB 18 mg/kg (1600 mg)
INH 5 mg/kg (300 mg)
PZA 25 mg/kg (2000 mg)
RIF 10 mg/kg

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30
Q

Tuberculosis verrucosa cutis and localized forms of LV without evidence of associated internal tuberculosis may be treated with

A

Isoniazid alone for up to 12 months

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31
Q

Because viable mycobacteria have been found in clinically healed lesions, treatment should be continued for at least _____ after complete involution of the lesion

A

2 months

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32
Q

Extensively multidrug-resistant TB is defined as

A

Resistance to at least rifampicin and isoniazid in addition to resistance to any fluoroquinolone, and to at least 1 of the 3 injectable second-line anti-TB drugs (capreomycin, kanamycin, and amikacin)

33
Q

Tuberculous chancre and affected regional lymph nodes constitute the

A

Tuberculous primary complex

34
Q

Most often affected with primary inoculation tuberculosis

A

Children

35
Q

Primary inoculation tuberculosis is initially (paucibacillary/multibacillary)

A

Multibacillary, but becomes paucibacillary as immunity develops

36
Q

PPD reaction finding in primary inoculation tuberculosis

A

Negative initially and later converts to positive

37
Q

Paucibacillary disorder caused by exogenous reinfection (inoculation) in previously sensitized individuals with high immunity

A

Tuberculosis verrucosa cutis

38
Q

Extremely chronic, progressive form of cutaneous tuberculosis occurring in individuals with moderate immunity and a high degree of tuberculin sensitivity

A

Lupus vulgaris

39
Q

(Males/Females) are appear to be more commonly affected in lupus vulgaris

A

Females

40
Q

In approximately 90% of patients, the _____ are involved in LV

A

Head and neck

41
Q

After a transient impairment of immunity, particularly after measles, multiple disseminated lesions may arise simultaneously in different regions of the body as a consequence of hematogenous spread from a latent tuberculous focus

A

Lupus postexanthematicus

42
Q

Often the only symptom of early nasal LV

A

Dry rhinitis

43
Q

Longstanding LV may lead to the development of

A

SCC

44
Q

Subcutaneous tuberculosis leading to cold abscess and a secondary breakdown of the overlying skin

A

Scrofuloderma

45
Q

Scrofuloderma prevalence is higher among

A

Children, adolescents, and the aged

46
Q

Scrofuloderma most often occurs in the _____ regions

A

Parotideal, submandibular, supraclavicular

47
Q

Y/N: In scrofuloderma, tuberculin sensitivity is usually pronounced

A

Yes

48
Q

Rare form of tuberculosis of the mucous membranes and orifices that is caused by autoinoculation of mycobacteria from progressive tuberculosis of internal organs

A

Orificial tuberculosis

49
Q

Most frequently affected in orificial tuberculosis

A

Tongue

50
Q

Y/N: Orificial tuberculosis is a symptom of advanced internal disease and usually portends a fatal outcome

A

Yes

51
Q

In the normal course of BCG vaccination, an infiltrated papule develops after approximately _____, ulcerates, and then slowly heals, leaving a scar

A

2 weeks

52
Q

Tuberculin sensitivity appears _____ after vaccination

A

5 to 6 weeks

53
Q

Y/N: Antituberculosis drugs are beneficial in all cases of tuberculids

A

No - beneficial in some cases but not all

54
Q

Uncommon lichenoid eruption ascribed to hematogenous spread of mycobacteria in an individual strongly sensitive to M. tuberculosis

A

Lichen scrofulosorum

55
Q

Lichen scrofulosorum lesions are usually confined to the

A

Trunk

56
Q

Lichen scrofulosorum occur most often in

A

Children and adolescents with active tuberculosis

57
Q

Symmetric eruption of necrotizing papules, appearing in crops and healing with scar formation

A

Papulonecrotic tuberculid

58
Q

Papulonecrotic tuberculid occurs preferentially in

A

Children or young adults

59
Q

Sites of predilection of papulonecrotic tuberculid

A

Extensor aspects of the extremities, buttocks, and lower trunk

60
Q

Atypical mycobacteria are usually acquired from

A

Environmental sources such as water or soil

61
Q

Y/N: MOTT seem more likely to disseminate than M. tuberculosis, and infections usually run a more aggressive and chronic course

A

No - less likely to disseminate; more benign and limited course

62
Q

Y/N: MOTT are much less responsive to antituberculosis drugs

A

Yes

63
Q

MOTT that affects skin, subcutis, lymph nodes and other organs

A

Mycobacterium kansasii

Mycobacterium avium-intracellulare complex (including Mycobacterium scrofulaceum)

64
Q

Only 2 MOTT produce a characteristic clinical picture

A

M. ulcerans

M. marinuum

65
Q

Third most frequent mycobacterial pathogen, after M. tuberculosis and M. lepra

A

M. ulcerans

66
Q

M. ulcerans causes

A

Buruli ulcer disease

67
Q

Buruli ulcer disease is found most often in

A

Children and young adults

Females more often than males

68
Q

Y/N: Buruli ulcer disease is deeply undermined, and necrotic fat is exposed. The preceding nodule, as well as the ulcer, is painless

A

Yes

69
Q

The painless nature of Buruli ulcer disease has been attributed to nerve damage and tissue destruction caused by the toxin

A

Mycolactone

70
Q

Occurs in freshwater and saltwater, including swimming polls and fish tanks

A

Mycobacterium marinum infection

71
Q

Atypical Mycobacterium most closely related to M. tuberculosis

A

Mycobacterium kansasii

72
Q

Skin disease caused by M. kansasii usually occurs in

A

Adults, and is more common in individuals with underlying immunosuppression

73
Q

Most commonly affected organ by M. kansasii

A

Lung

74
Q

Usual manifestation is cervical lymphadenitis, frequently unilateral, in children, mainly between the ages of 1 and 3 years

A

Mycobacterium scrofulaceum infection

75
Q

Lymph nodes typically involved in Mycobacterium scrofulaceum infection

A

Submandibular

Submaxillary

76
Q

M. scrofulaceum is usually grouped together with

A

Mycobacterium-avium intracellulare

77
Q

Whereas M. scrofulaceum produces only a benign, self-limited lymphadenopathy with no organ involvement, M. avium-intracellulare infection usually causes

A

Lung disease or, less frequently, osteomyelitis

78
Q

3 species of fast-growing, facultative pathogenic mycobacteria

A

M. fortuitum
M. chelonae
M. abscessus

Fitz 9th (108 decks)

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