23 - 157 - TUBERCULOSIS AND INFECTIONS WITH ATYPICAL MYCCOBACTERIA

Question 1

2 most frequent forms of skin tuberculosis

Answer 1

1. Lupus vulgaris
2. Scrofuloderma

Question 2

Common in the tropics

Answer 2

Srcofuloderma , verrucous

Question 3

LV is more than twice as common in what gender

Answer 3

Women

Question 4

tuberculosis verrucosa cutis is more often found in what gender

Answer 4

Male

Question 5

miliary tuberculosis common in what age group

Answer 5

children, adults w/ AIDS/immunocompromised

Question 6

Scrofuloderma usually occurs in what age groups

Answer 6

Adolescents and elderly

Question 7

Occurs in all age groups

Answer 7

Lupus vulgaris

Question 8

Cutaneous TB caused by exogenous infection

Answer 8

1. Primary inoculation tuberculosis
2. Tuberculosis verrucosa cutis

Question 9

Cutaneous Tuberculosis caused by endogenous spread with high host immune status

Answer 9

Lupus vulgaris
Scrofuloderma

Question 10

Question 11

Mode of transmission-
Scrofuloderma -
Lupus vulgaris -
Acute miliary tuberculosis-

Answer 11

Scrofuloderma - Direct extension
Lupus vulgaris - Lymphatics, Hematogenous, Contiguous spread
Acute miliary tuberculosis- Hematogenous

Question 12

most common cause of disseminated bacterial infections in patients with AIDS in the United States,

Answer 12

Mycobacterium avium-intracellulare complex

Question 13

In AIDS patients, ___________ is more common than M. tuberculosis.

Answer 13

Mycobacterium kansasii

Question 14

T/F. Populations that have been in longstanding contact with tuberculosis are, in general, less susceptible than those who have come into contact with mycobacteria more recently

Answer 14

TRUE

presumably reflecting widespread immunity from subclinical infection.

Question 15

Local tuberculin reaction reaches maximum intensity after __ , consist of ___

Answer 15

48 hours
Sharply circumscibed area of erythema and induration

Question 16

Tuberculin sensitivity usually develops how many weeks after infection?

Answer 16

2 to 10 weeks after infection and persists throughout life.

Question 17

T/F

In patients with clinical tuberculosis, an increase in skin sensitivity usually indicates a worse prognosis, and in tuberculous skin disease accompanied by high levels of skin sensitivity, the number of bacteria within the lesions is large

Answer 17

FALSE

In patients with clinical tuberculosis, an increase in skin sensitivity usually indicates a FAVORABLE prognosis, and in tuberculous skin disease accompanied by high levels of skin sensitivity, the number of bacteria within the lesions is SMALL

Question 18

Quantify tuberculin reaction, measure specific antgen-driven interferon y synthesis by whole blood cells approved by FDA in 2005

Answer 18

QuantiFERON-TB Gold (QFT-G)

Question 19

Specimen for QuantiFERON-TB Gold (QFT-G)

Answer 19

Blood

Question 20

Results based on anount of IFN-y released in response to antigens

Answer 20

QuantiFERON-TB Gold (QFT-G)

Question 21

More sensitive than tuberculin skin test

Answer 21

QuantiFERON-TB Gold (QFT-G)

Question 22

QuantiFERON-TB Gold (QFT-G) negative in ____
Indeterminate in ____

Answer 22

early tuberculosis
immunocompromised

Question 23

measures the number of IFN-γ–producing T cells

Answer 23

T-SPOT.TB test

Question 24

For QFT-G, the antigens include mixtures of synthetic peptides representing 2 M. tuberculosis proteins:

Answer 24

ESAT-6 and CFP-10

After incubation of the blood with antigens for 16 to 24 hours, the amount of interferon (IFN)-γ is measured.

If the patient is infected with M. tuberculosis, their white blood cells will release IFN-γ in response to contact with the TB antigens. The QFT-G results are based on the amount of IFN-γ that is released in response to the antigens.

Question 25

indicated in diagnosing both TB disease and latent TB infection

Answer 25

QuantiFERON-TB Gold (QFT-G)

Question 26

hallmark of tuberculosis and infections with some of the slow-growing atypical mycobacteria

Answer 26

tubercle: an accumulation of epithelioid histocytes with Langhans-type giant cells among them and a varying amount of caseation necrosis in the center, surrounded by a rim of lymphocytes and monocytes

Question 27

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

Answer 27

Isoniazid alone for up to 12 monhs

Question 28

Define Extensively multidrug-resistant TB

Answer 28

resistance to at least rifampicin and isoniazid from among the first-line anti-TB drugs (which is the definition of multidrug resistant TB) in addition to resistance to any fluoroquinolone, and to at least 1 of the 3 injectable second-line anti-TB drugs used in TB treatment (capreomycin, kanamycin, and amikacin).

Question 29

Define multidrug-resistant TB

Answer 29

resistance to at least rifampicin and isoniazid from among the first-line anti-TB drugs

Question 30

Incubation period of primary inoculation tuberculosis

Answer 30

2 - 4 weeks

Question 31

Sites of predilection of PRIMARY INOCULATION TUBERCULOSIS (TUBERCULOUS CHANCRE, TUBERCULOUS PRIMARY COMPLEX)

Answer 31

face, including the conjunctivae and oral cavity, as well as the hands and lower extremities

Question 32

Is the ulcer in inoculation tuberculosis painless or painful?

Answer 32

Painless

Question 33

Slowly progressive, regional lymphadenopathy develops how many weeks after infection

Answer 33

3 - 8 weeks

Question 34

Most prominent histopathologic features of TVC

Answer 34

pseudoepitheliomatous hyperplasia with marked hyperkeratosis, a dense inflammatory infiltrate, and abscesses in the superficial dermis or within the pseudoepitheliomatous rete pegs

Question 35

T/F. Typical tubercles or tuberculoid granuloma are uncommon in TVC

Answer 35

TRUE

Question 36

postprimary, paucibacillary form of tuberculosis caused by hematogenous, lymphatic, or contiguous spread from elsewhere in the body

Answer 36

LUPUS VULGARIS /TUBERCULOSIS LUPOSA

Question 37

Most prominent histopathologic feature of lupus vulgaris

Answer 37

Formation of typical tubercles

Question 38

Apple jelly nodules seen in diascopy are highly characteristic of which cutaneous TB?

Answer 38

Lupus vulgaris

Question 39

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

Answer 39

Scrofuloderma

Question 40

represents contiguous involvement of the skin overlying another site of infection (eg, tuberculous lymphadenitis, tuberculosis of bones and joints, or tuberculous epididymitis)

Answer 40

Scrofuloderma

Question 41

Most common locations of scrofuloderma

Answer 41

parotideal, submandibular, and supraclavicular regions

Question 42

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

Answer 42

ORIFICIAL TUBERCULOSIS (TUBERCULOSIS ULCEROSA CUTIS ET MUCOSAE, ACUTE TUBERCULOUS ULCER)

Question 43

Most frequently affected area in orificial tuberculosis

Answer 43

tongue is most frequently affected, particularly the tip and the lateral margins

Question 44

What entities belong as tuberculids

Answer 44

Lichen scrofulosorum Papulonecrotic tuberculid

Question 45

Entities that are considered facultative tuberculids

Answer 45

Nodular vasculitis/ erythema induratum of Bazin Erythema nodosum

Question 46

Question 47

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

Answer 47

LICHEN SCROFULOSORUM

Question 48

symmetric eruption of necrotizing papules, appearing in crops and healing with scar formation that occurs preferentially in children or young adults

Answer 48

PAPULONECROTIC TUBERCULID

Question 49

Cardinal histopath finding of papulonecrotic tuberculid is the involvement of _____________

Answer 49

Blood vessels and consists of an obliterative and sometimes granulomatous vasculitis leading to thrombosis and complete occlusion of the vascular channels.

Question 50

third most frequent mycobacterial pathogen

Answer 50

M. Ulcerans

Question 51

The painless nature of the ulcer in M. Ulcerans/ Buruli ulcer disease has been attributed to nerve damage and tissue destruction caused by wha toxin?

Answer 51

Mycolactone toxin

Question 52

Buruli ulcer is caused by what Mycobacterial species?

Answer 52

M. Ulcerans

Question 53

atypical Mycobacterium most closely related to M. tuberculosis

Answer 53

M. Kansasii