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CPG > 2016 PTB > Flashcards

2016 PTB Flashcards

1
Q

Previously treated for TB, declared cured and is now diagnosed with TB

A

Relapse

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2
Q

Previously treated for TB and declared treatment failure at the end of most recent course of treatment

A

Treatment after failure

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3
Q

True or False: serum Uric acid should be taken before starting TB treatment

A

False. Serum Uric acid is not recommended before starting anti TB treatment. Asymptomatic hyperuricemia is not indication to hold pyrazinamide

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4
Q

What is the effective treatment regimen for new PTB cases?

A

2HRZE and 4HR (isoniazid + rifapicim)

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5
Q

Target: cell wall. Inhibits mycolic acid

A

Isonizid

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6
Q

Target: nucliec acid. Inhibits transcription by interfering the DNA dependent RNA polymerase

A

Rifampicin

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7
Q

Mechanism of resistance. Rifampicin

A

Mutation in rpoB gene

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8
Q

Target: intracellular. Targets essential membrane transport, in fatty acid synthesis

A

Pyrazinamide

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9
Q

Drug dose per Kg body weight HRZES.

A 
H 5
R 10
Z 25
E 15
S 15
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10
Q

Mechanism of resistance. Streptomycim

A

Mutation of ribosome target binding sites

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11
Q

Target: ribosome. Inhibits translation during protein synthesis

A

Streptomycin

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12
Q

Target: cell wall. Affects Lipid and cell wall metabolism. Inhibits RNA synthesis.

A

Ethambutol

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13
Q

Mechanism of resistance. Ethambutol

A

Mutation of embCAB gene

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14
Q

Mechanism of resistance. Pyrazinamide

A

Mutation in pncA gene

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15
Q

Gold standard of PTB diagnosis

A

TB culture

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16
Q

LED vs Zeihl Neelsen microscopy

A

LED is preferred. More sensitive and more specific

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17
Q

Indications for Drug sensitivity testing

A

ALL cases of re treatment, treatment failure, MDR suspects; Also for known contacts of MDR-TB, PLHIV

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18
Q

Additional work up for smear negative patients

A

CXR for all smear negative presumptive PTB. If available, Xpert MTB/Rif should be requested for CXR positive presumptive PTB

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19
Q

Pre-treatment tests prior to initiating TB treatment

A

SGPT, Creatinine, FBS

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20
Q

Indications for the use of corticosteroids as aadjuntive therapy

A

TB meningitis and TB pericarditis

21
Q

Recommended regimen for corticosteroids for TB meningitis

A

Dexamethansone 0.4 mg/kg/24 hours over 6-8 weeks

22
Q

Recommended regimen for corticosteroids for TB pericarditis

A

Prednisone 60 mg for the first 4 weeks, 30 mg for weeks 5-8, 15 mg for weeks 9-10 and 5 mg for week 11

23
Q

Drug which can cause asymptomatic jaundice without evidence of hepatitis

A

Rifampicin

24
Q

Management of interrupted cases. Less than 1 month

A

Continue treatment and prolong to compensate

25
Q

Management of interrupted cases. More than 1 month but less than 2 months

A

Positive DSSM and less than 5 months on treatment: continue treatment and prolong to compensate
Positive DSSM and more than 5 months on treatment: Treatment failure

26
Q

Management of interrupted cases. More than 2 months/

A

Classify as lost to follow up. Repeat DSSM

27
Q

Monitoring PTB treatment response. New cases

A

At least 1 sputum smear microscopy after 2 months for new cases and end of 3 months for retreatment cases
If at 2 months, speciment is smear -positive, repeat DSSM at end of 3rd month.

28
Q

Monitoring PTB treatment response. If specimen obtained at end of 3rd month is still smear-positive

A

Do Xpert MTB/Rif, sputum culture and DST

29
Q

Monitoring PTB treatment response. New smear posiitve TB patient

A

Sputum specimen at end of 5th or 6th month should be obtained for smear positive TB patients. If still positive, do culture and DST

30
Q

When is a patient on TB treatment considered non infectious?

A

Bacteriologically confirmed: 14 daily doses, with sputum conversion and clinical improvement
Clinically diagnosed: 5 daily doses with clinical improvement

31
Q

Major adverse reactions and all drugs must be discontinued

A

Severe skin rash due to hypersensitivity
Jaundice due to depatitis
Impairment of visual acuity and color vision
Hearing impairment, ringing of the ears, dizziness
Oliguria or albuminuria
Psychosis and convulsion
Thrombocytopenia, anemia, shock

32
Q

When to discontinue anti TB drugs?

A

SGPT 5x ULN or3x ULN and symptomatic

33
Q

When to resume anti TB drugs if with elevated SGPT?

A

SGPT less than 2x ULN in stepwise reintroduction

34
Q

Prevention of peripheral neuropathy in PTB

A

vitamin B6 at 50- 100 mg daily

35
Q

Treatment of latent TBI

A

isoniazid 300 mg daily

36
Q

Tuberculin reaction size. Who gets treated?

A

More than 5 mm: PLHIV, organ transplant recipients, recent contacts of a patient with TB, immunosuppresed, fibrotic lesion on CXR
More than 10 mm: recent immigrants from high prevalence countries, injection drug users, children less than 5 years old

37
Q

What is Sputum induction and when is it done?

A

Sputum induction (15-20 minutes of nebulization with 15mL 2.5-5% hypertonic saline) should be done for individuals who are unable to expectorate, provided it is done by trained staff in well-equipped facilities, with special caution for patients with history of asthma.

38
Q

True or false. Tuberculin skin test (TST) be used in diagnosing active pulmonary tuberculosis (PTB)

A

False

39
Q

Why is Rifampicin used to test for resistance?

A

Dictum: Rif resistant then it is also Isoniazid resistance.

40
Q

What is the sensitivity of GeneXpert?

A

Sputum negative: specificity 99% sensitivity 67

Spumum positive: specificity sensitivity

41
Q

On Sputum microscopy, how do you interpret the result?

A

In Sputum result, number before the plus sign signifies more organism then that wiht plus sign followed by number
(3+)>(+9)

42
Q

What is the recommended treatment regimen for PTB among PLHIV?

A

Same as general population for PTB among PLHIV

Co-trimoxazole prophylaxis at a total daily dose of 800 mg sulfamethoxazole + 160 mg trimethoprim should also be given to prevent Pneumocystis jirovecii pneumonia among PLHIV regardless of CD4 count.

43
Q

What is the role of CXR?

A 
Always ask for old chest xray films to compare
CXR changes seen 4-6 months
PTB scar: fibroliner densities
PTB new: reticulu nodular
Good screening for Presumptive PTB
Good for years as long as it is not wet
44
Q

How is tuberculin skin testing done? When is it positive?

A

Use 0.1 cc and inject intradermally
Low sensitivity.
Cannot differentiate from active vs latent TB
Positive in general population: more than 10 mm

45
Q

How is Presumptive PTB defined?

A

1.
2.
3. CXR showing PTB with or without symptoms

46
Q

Why not more than 5 tablets HRZE in patient wiht more than 70 kg?

A

In the fixed dose combination drug, max of Rifampicin is achieved at 4 tablets already.

47
Q

First line anti TB drug?

A

HRZE

48
Q

How should MDR TB?

A

Referred to PMDT or satellite

VSMMC and Eversely

49
Q

How to treat latent PTB?

A

Isoniazid 300 mg OD x 9 months

HR x 3-4 months

CPG (6 decks)

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