Chapter 67: Tuberculosis

Question 1

The 2nd leading infectious cause of death

Answer 1

Tuberculosis

Question 2

Who is the most high risk with PTB infection

Answer 2

1st immigrants from high-prevalence countries
2nd HIV
3rd prisons or shelters for the homeless
4th alcoholism and drug user
5th elderly

Question 3

How many percent develops TB after exposure to TB droplets?

Answer 3

30%

Question 4

This is a sign of primary infection and may progress to caseation necrosis and calcification

Answer 4

Tubercles

Question 5

When is the skin test becomes positive after initial exposure to TB

Answer 5

1-2 months

Question 6

What dose of corticosteroids is at high risk of reactivation of latent TB

Answer 6

≥15 milligrams/d for ≥4 weeks of prednisone or its equivalent

Question 7

The most common extrapulmonary site of tuberculosis is the ____

Answer 7

Lymphatic system

Question 8

The most common method for screening for exposure to M. tuberculosis is

Answer 8

Skin test or Mantoux test (purified protein derivative)

Question 9

When is the best time to read the skin test?

Answer 9

48-72 hours

Question 10

Can give false-negative skin test

Answer 10

• MMR vaccine
• Improper administration
• Improper test reading
• Very early in the disease
• Profound immmunocompromised

Question 11

In immunocompromised patients with a negative test but recent close contact to infectious tuberculosis, retest in ____

Answer 11

In immunocompromised patients with a negative test but recent close contact to infectious tuberculosis, retest in 8 weeks and consider treatment.

Question 12

This is indirect assess for TB. it trigger the release of interferon-y by the infected host

Answer 12

Interferon-y release assays (IGRAs)

Question 13

The most common findings in chest radiograph with TB patient

Answer 13

Normal chest radiograph, especially in immunocompromised patient

Question 14

True or False
During primary infection of TB, younger patients are more likely to have enlarged hilar lymph nodes, whereas adults more frequently have parenchymal abnormalities and effusions

Answer 14

True
During primary infection of TB, younger patients are more likely to have enlarged hilar lymph nodes, whereas adults more frequently have parenchymal abnormalities and effusions.

Question 15

Amount of phlegm need s to improve yield of TB

Answer 15

5-10ml

Question 16

True or False
Negative smears are found in approximately 60% of culture-positive cases of tuberculosis, with higher false-negative smear results in children and HIV patients (approaching 80%)

Answer 16

False
Negative smears are found in approximately 60% of culture-positive cases of tuberculosis, with higher false-negative smear results in children and HIV patients (approaching 80%)

Question 17

The World Health Organization endorses this for diagnosis of pulmonary and extrapulmonary tuberculosis

Answer 17

Nucleic acid amplification test (NAAT) - can detect within 1 day

Question 18

It is best used for the diagnosis of Tuberculosis

Answer 18

NAAT

Question 19

The recommended Centers for Disease Control and Prevention regimens for Tuberculosis

Answer 19

• Daily four-drug (INH, RIF, pyrazinamide, and ethambutol) therapy for 8 weeks, followed by either INH/RIF or INH/rifapentine for 18 weeks
• Daily four-drug therapy for 2 weeks, followed by two times per week for 6 weeks, with subsequent INH/RIF or INH/rifapentine for 18 weeks or
• Three times weekly four-drug therapy for 8 weeks, followed by INH/ RIF three times weekly for 18 weeks or
• Daily three-drug therapy (INH, RIF, and ethambutol) for 8 weeks fol- lowed by INH/RIF for 31 weeks

Question 20

Major adverse effect of Isoniazid?

Answer 20

Hepatotoxicity

Question 21

When to stop INH in patient who has TB?

Answer 21

If serum transaminases are greater than five times the upper limit of normal or if serum bilirubin is >3 milligrams/dL

Question 22

Paradoxical reaction or immune reconstitution syndrome

Answer 22

A portion of patients treated for tuberculosis worsen after the initia- tion of antituberculous medications. Seen in CD4<50

Question 23

Unique findings in paradoxical reactions

Answer 23

Hypercalcemia

Question 24

Treatment for latent TB

Answer 24

Isoniazid for 9 months

Rifampicin and pyrazinamide for 9 months

Question 25

The strongest known risk factor for tuberculosis?

Answer 25

HIV infection

Question 26

Replacement of Rifampicin in TB patient with HIV

Answer 26

Rifabutin

Question 27

Multidrug-resistant tuberculosis

Answer 27

Multidrug-resistant tuberculosis is tuberculosis with isolates that demonstrate resistance to at least INH and RIF, with approximately 20% of M. tuberculosis isolates meeting this definition

Question 28

Extensive drug-resistant tuberculosis

Answer 28

Extensive drug-resistant tuberculosis occurs when resistance to INH, RIF, any fluoroquinolone, and at least one injectable second-line medication exists

Question 29

The “Global Plan to Stop Tuberculosis” calls for better compliance and new medications to fight against the problem of multidrug-resistant tuberculosis, especially ____

Answer 29

Delamanid

Question 30

IGRA and NAAT are not recommended for children less than what age? as the immune response differs in this age group, making the tests less reliable

Answer 30

IGRA and NAAT are not recommended for children less than 5 years old as the immune response differs in this age group, making the tests less reliable

Question 31

True or False
Miliary disease during Latent tuberculosis is generally more rapid and severe, often presenting with multiorgan failure, shock, and acute respiratory distress syndrome

Answer 31

False
Miliary disease during primary tuberculosis is generally more rapid and severe, often presenting with multiorgan failure, shock, and acute respiratory distress syndrome

Question 32

Found on ocular exam are pathognomonic for miliary tuberculosis.

Answer 32

Choroidal tubercles

Question 33

How does tuberculous meningitis differ from other meningitis?

Answer 33

No neck stiffness and irritation seen

Question 34

CSF findings in patients with tuberculous meningitis?

Answer 34

• Lymphocytic pleocytosis
• Elevated protein
• Increased opening pressure
• Cerebrospinal fluid–to–protein ratio of <0.5