173 - Tuberculosis Flashcards
Latent TB is more common in >_, __, __, and __
65
blacks
HIV
immigrants
TB transmission is via __ from a patient with a __ involvement (__,__,__).
air pulmonary cough talk sneeze
The risk to get infected depends on the __ of contact with the patient, __, __ etc.
duration
distance
ventilation
Patients with + __ and pulmonary __ disease, or involvement of the __ are the __ contagious.
sputum smear
cavitary
larynx
most
Patients with positive __ and negative __ or non cavitary __ patients are still contagious but less than the above.
cultures
sputum smear
HIV
Patients with a __ disease with negative __, or extra pulmonary disease are usually non ___
pulmonary
cultures
contagious
Clinical symptoms appearing shortly after being exposed to TB is considered __ TB. More common in __ and __
primary
children
immunocompromised
Primary TB tends to be more __ but less__
severe
infective
Reactivation of TB (__/__) will be less __ but more __ due to pulmonary __
secondary/tertiary
severe
infective
cavitation
__% of people with TB will eventually develop an active disease. __% of them will show symptoms within the first __ months post infection.
10
50
18
List 6 of the highest relative risk factors to suffer from active TB:
post transplantation period jejunoileal bypass HIV infection IVDU chronic renal failure/hemodialysis silicosis
Without treatment, _ of patients will die within a year, and >_% within 5 years. From the survivors, _% will go through spontaneous remission while the rest become ___.
1/3
50
60
infective
What are the 2 reactions of the host’s to TB 2-4 weeks post infection?
Remember that the equilibrium between the two will determine if the TB will progress or be eradicated.
macrophage activating cell mediated inflammatory response
tissue damaging response
TST=__
tuberculin skin test
TST is based on attracting sensitized __ cells to the relevant site on the skin.
CD4
Primary TB appears __ post infection and can be __ or with __/__ pain
quickly
asymptomatic
fever/pleuritic pain
Primary TB involves mostly the __ and __ lubes since they are the most active in the breathing process.
lower
middle
What is the name of the primary TB pulmonary lesions? They usually found in the __ of the lung and tend to __.
Ghon focus
periphery
heal
What will Ghon process include?
hilar/peritracheal lymphadenopathy
pleural effusion
pleural thickening
Lymphadenopathy may lead to a __ of the pulmonary airways with distal __, giving rise to __ or ball in a socket which gives ends in hyper __
blockage
collapse
wheezing
inflation
Tear of the LN into the airway may cause __ with __ and __. With time __ pneumonia may lead to __.
pneumonia necrosis cavitation caseating bronchiectasis
Some of the patients with primary TB may present __ and __ (conjunctiva nodules)
erythema nodosum
Phlyctenular conjunctivitis
Children/immunocompromised with primary TB may develop __- the primary lesion will grow and include central __ which will end up as __.
progressive primary TB
necrosis
cavitation
Post primary disease=___
secondary/tertiary/reactivation
Post primary disease lesions are found usually at the __ of the lung where the oxygen high pressure promotes growth.
peaks
Post primary expression could be anything between a __ to __. The latter, when combines with other lesions, ends up as __ pneumonia.
small infiltration
large cavitation
caseating
What are the clinical presentation of post primary TB? 5
B symptoms productive cough hemoptysis pleuritic pain dyspnea->ARDS
Extra pulmonary TB is present in -% of patient, while in the case of comorbidity with HIV- _ of patients.
20-40
2/3
What are the top 6 locations extra pulmonary TB spreads to?
LN pleura upper airways GU skeletal CNS
Which LN are most commonly involved in TB?
posterior neck
supraclavicular
_%< of patients with LN TB have __ TB. Diagnosis is made with __/__- extracting it completely.
50
pulmonary
FNA/surgical biopsy
Pleural TB will present with either __ or __
effusion
empyema
Pleural effusion can be __ or __. When puncturing: 5
light-severe straw color protein>50% of serum glucose- low/normal pH around 7.3 leukocytes (more neutrophils followed by more lymphocytes)
Pleural effusion with TB usually produce negative __ and __, but high __ and __.
culture
smear
ADA
IFN- gamma
It is recommended to perform __ in pleural effusion TB. We might find __ or manage to grow __.
biopsy
granulomas
tissue culture
TB pleural effusion responds __ to treatment. __ does not __.
well
steroids
TB pleural empyema is more __. It is the result of a __ tear. __ and __ will usually be positive.
rare
cavitation
culture
smear
Treating pleural TB empyema involves surgical __ + normal medical treatment.
drainage
Upper respiratory TB involves the __/__/__ and is the result of a severe __ disease.
larynx/pharynx/epiglottitis
cavitary
Upper respiratory TB clinical symptoms include: 5
hoarseness dysphonia dysphagia productive cough ulcers
Upper respiratory TB treatment is done with __ and sometimes even __.
sputum smear
biopsy
Pott’s disease/ tuberculous spondylitis=__
skeletal TB
Pott’s in children usually involves the 2 upper ___ vertebrae. In adults Pott’s involves the lower __ or upper __ vertebrae.
thoracic
thoracic
lumber
What are the two manifestations of CNC TB?
meningitis
tuberculoma
Spread TB= __
Miliary tuberculosis
The origin of miliary TB is from __ spread.
hematogenic
Miliary tuberculosis will involve __, and more specific-location related symptoms
B symptoms
Miliary tuberculosis physical examination may show: 5
hepatosplenomegaly
lymphadenopathy
choroidal tubercles (eye examination-pathognemonic)
meningismus
When trying to diagnose miliary TB, __ is usually negative. Instead we use __ or transbronchial __.
smear
BAL
biopsy
TB complications leads to an increased risk for __ or chronic pulmonary __. The best treatment will be __ for >6 months, rather than surgical (very dangerous)
aspergilloma
aspergillus
itraconazole
HIV accelerates the progression of an active __. When CD4
TB
200
primary
Why is it more difficult to diagnose TB with HIV comorbidity? 5
sputum smear are usually negative atypical radiological findings no granulomas negative TST similar HIV symptoms imitating TB
IRIS=__
immune reconstitution inflammatory syndrome
IRIS is a __ in general state (__ and __) or __ (__ and __) together with lab/radiological expressions.
decline
lymphadenopathy/fever
respiratory
empyema/infiltration
IRIS appears - months after starting __ treatment.
1-3
ART
What are the main microbiological lab diagnosis available?
nucleic acid amplification technology (Xpert MTB/RIF assay)
AFB microscopy
culture
What is the best way to diagnose TB in HIV patients?
Xpert MTB/RIF assay
__ is a good imaging test for subclinical disease in HIV patients
PET-CT
What are the two examinations for latent TB?
TST
IGRA (IFN- Gamma Release Assays)
Both __ and __ are less accurate in populations with high frequency of TB or HIV
TST
IGRA
TB treatment first line: 4
isoniazid + rifampin + pyrazinamide + ethambutol
Isoniazid may cause __, so supplement in risk patients (5) with __
neuropathy
alcohol abuse/malnutrition/pregnant/HIV/diabetic)
pyridoxin
Second line drugs should be used only for __ TB
resistant
What are 2 line drugs for treating TB? A- \_\_\_ B- \_\_\_ C- \_\_\_ D- \_\_\_
A- quinolones
B- aminoglycosides
C- PO drugs
D- add on
In TB patients with localized disease + sufficient residual lung tissue __ or __ are also optional.
wedge resection/lobectomy
The initial protocol is __, the symptoms __ and the patients become __. It lasts for _ months and include all _ drugs on a daily dose.
bacteriocidic decrease noninfective 2 4
The second phase of treatment is to __. The goal is to prevent __. It lasts for _ months and includes __ and __ on a daily dosage
sterilized reinfection 4 isoniazid rifampin
What are the common S/E for TB treatment? 5
hepatitis hypersensitivity hyperuricemia arthralgia gout thrombocytopenia optic neuritis
Which S/E will require stopping the treatment?
gout and thrombocytopenia in pyrazinamide
optic neuritis in ethambutol
hepatitis if 5-6 times the normal
hypersensitivity- stop all and resume each separately to find out which one is the problem and switch only that
When receiving ART and anti TB in HIV patients, there is an increase in risk for __.
IRIS
For HIV patients with TB, rifampin can be replaced with ___ if interaction exist.
rifabutin
TB meningitis should be treated for - months in the second phase of the treatment protocol.
7-10
Pregnant women should be treated with __. Breath feeding women are allowed.
streptomycin
In CRF with severe failure which is not treated with dialysis- reduce 3, and avoid __
isoniazid
rifampin
pyrazinamide
aminoglycoside
In liver disease monitor- 2, and avoid __
lionized
rifampin
pyrazinamide
LTBI=__
latent TB
Who must be screened for LTBI? 5
HIV relatives of patients prior to transplantation silicosis dialysis/anti TNF
Who are recommended to be screened for LTBI? 5
inmates health workers immigrants homeless IVDU
