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8th > Chapter 157 - Tuberculosis and Infections With Atypical Mycobacterium > Flashcards

Chapter 157 - Tuberculosis and Infections With Atypical Mycobacterium Flashcards

1
Q

Main cause of death of patients infected with HIV

A

Tb

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2
Q

TB is currently ranked ___ leading cause from an infectious agent,ranking higher than HIV/AIDS

A

9th

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3
Q

The highest burden of TB was in 5 countries

A 
India
Indonesia
China
Philippines
Pakistan
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4
Q

In contrast to obligate pathogens, ___ do not cause disease by person to person spread

A

Facultative pathogens

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5
Q

2 most frequent forms of skin tuberculosis

A

Lupus vulgaris

Scrofuloderma

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6
Q

Most common cause of disseminated bacterial infection in patients with AIDS in the US

A

Mycobacterium kansasii

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7
Q

Incidence of TB in patients with AIDS is almost ____ than that in the general population

A

500 times

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8
Q

Local ID injection leads to delayed hypersensitivity reaction with macimum intensity by 48 hours

A

Tuberculin reaction aka Koch phenomenon

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9
Q

Tuberculin sensitivity is necessary for immunity.

True or False

A

False

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10
Q

For Quantiferon Tb GOLD test, (2) proteins are incubated for 16 to 24 hours and the amount of ___ produced by T cells are measured

A

ESAT-6 and CFP-10

IFN gamma

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11
Q

Histopath hallmark of TB

A

Tubercle - accumulation of epithelioid histiocytes with Langhans giant cells and caseation necrosis in the center

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12
Q

Only ___% of PCR positive patients respond to antiTB therapy

A

80%

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13
Q

TVC and localized forms of LV may be treated with ___

A

INH alone for up to 12 months

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14
Q

Extensively multidrug resistant TB is defined as

A 
Resistance to at least Rifampicin + INH
\+ 
Resistance to any fluoroquinolone
\+ 
Resistance to second line anti Tb drugs
(Capreomycin, Kanamycin, Amikacin)
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15
Q

First line drugs of AntiTb (4)

A

Rifampin/ Rifapentine/Rifabutin
Isoniazid
PZA
Ethambutol

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16
Q

Second line anti Tb drugs (9)

A 
Amikacin/Kanamycin
P-Aminosalicylic acid
Capreomycin
Cycloserine
Ethionamide
Gatifloxacin
Levofloxacin
Moxifloxacin
Streptomycin
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17
Q

Introduced into tissue via minor wounds eg. Unpasteurized milk, tooth extraction, mucosal trauma.

A

Primary inoculation Tb/ Tb Chancre/ Tb Primary Complex

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18
Q

Ulcer with little or no tendency to heal with unilateral regional LN in a child arousing suspicion

A

Primary inoculation Tb/ Tb Chancre/ Tb Primary Complex

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19
Q

PPD of Primary inoculation Tb/ Tb Chancre/ Tb Primary Complex

A

‘-‘ —> ‘+’

20
Q

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

A

Tuberculosis verrucosa cutis aka Wart tuberculosis aka Prosecutor’s wart aka Lupus verrucosis

21
Q

Histopath feature of tuberculosis verrucosa cutis

A

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

22
Q

Typical tubercles are common in tuberculosis verrucosa cutis.
True or False

A

False, uncommon

23
Q

Lupus vulgaris is an extremely chronic, progressive form of cutaneous Tb occurring in individuals with ___ immunity and a ___ degree of tuberculin sensitivity.

A

Moderate; high

24
Q

On diascopy, LV shows

A

Apple jelly color

25
Q

HPx feature of lupus vulgaris

A

Formation of typical tubercles.

Acid fast bacilli are not found

26
Q

PPD result of LV

A

‘+’ —> ‘-‘ —> ‘+’

27
Q

LV may lead to development of ff carcinoma

A

SCC > BCC

28
Q

Pulmonary TB is ___ times more frequent in parients with LV than in the general population

A

4 to 10 times

29
Q

Subcutaneous TB leading to cold abscess formation and secondary breakdown of overlying skin

A

Scrofuloderma/ Tuberculosis verrucosa cutis

30
Q

Areas most commonly affected by scrofuloderma (3)

A

Parotideal
Submandibular
Supraclavicular

31
Q

Frequently affected site of orificial tb

A

Tongue (tip and lateral margins)
Soft & hard palate
Lips

32
Q

In normal course of BCG vaccine, an infiltrated papule develops after approximately ___ weeks, attains a size of 10 mm by ___ weeks

A

2; 6 to 12

33
Q

Tuberculin sensitivity occurs ___ weeks after vaccination

A

5 to 6

34
Q

Conditions in which Mycobacterium tuberculosis/ Mycobacterium bovis appears to play a significant role

A

Tuberculids

  1. Lichen scrofulosorum
  2. Papulonecrotic tuberculid
35
Q

Conditions in which Mycobacterium tuberculosis/Mycobacterium bovis may be one of several pathogenic factors

A

Facultative tuberculids

  1. Nodular vasculitis/ erythema induratum of Bazin
  2. Erythema nodosum
36
Q

No relationship to tuberculosis

A

Nontuberculids

  1. Lupus miliaris disseminatus faciei
  2. Rosacea-like tuberculid
  3. Lichenoid tuberculid
37
Q

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

A

Lichen scrofulosorum

38
Q

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

A

Papulonecrotic tuberculid

39
Q

Cardinal feature of papulonecrotic tuberculid

A

Involvement of the blood vessels

40
Q

Treatment for patients with extrapulmonary Tb

A

Initiation: RIP 5 days for 8 weeks
Continuation:
A- RI 5 days for 18 weeks

41
Q

If PZA cannot be used, treatment for extrapulmonary TB consists of

A

Initial: RIE 5 days x 8 weeks
Continuation: RI 5 days x 31 weeks

42
Q

Daily dosage for antiTb drugs

A

R 10 mkday (600mg)
I. 5mkday (300mg)
P. 25 mkday (2000mg)
E. 18 mkday (1600mg)

43
Q

Patients who received 2 months of antiTb drugs but still has cavitation on CXR and positive cultures at completion should receive ___ month continuation phase

A

8 mos

44
Q

DOT is given ___ times per week and is not recommended for HIV positive patients with CD4 count less than ___ ceels/ml

A

5

100

45
Q

___ should not be given to HIV + patients

A

INH + Rifapentine

46
Q

Tuberculin sensitivity develops ___ after infection and persists throughout life

A

2-10 weeks

47
Q

PCR testing showed 100% sensitivity and specificity in multibavillary disease and 55% sensitivity in paucibacillary disease.
True or False

A

True

8th (28 decks)

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