DISORDERS OF THE RESPIRATORY SYSTEM PART 3.4 (based on T) Flashcards
Most common form of extrapulmonary TB in children. What is this form called?
Cervical Lymph Nodes (Scrofula)/TB Adenitis
What are the most frequent sites for cervical lymph node involvement in TB?
The nodes in the anterior triangle of the neck.
What happens to the cervical lymph nodes if left untreated?
They may either resolve or progress to necrosis and caseation, potentially rupturing and causing a draining sinus tract.
What is the most common type of TB affecting the nervous system?
TB Meningitis
How do tubercle bacilli reach the CNS in TB meningitis?
Through the bloodstream during lymphohematogenous spread.
What are the 3 stages of TB meningitis?
Early stage (irritability),
pressure or convulsive stage, and
paralytic or terminal stage.
What is the most common affected area in TB of the spine?
The vertebrae, especially the lower thoracic, upper lumbar, and lumbosacral vertebrae.
What are the common signs of TB of the spine (Pott’s Disease)?
Night cries, restless sleep, daily low-grade fever, and peculiar position or gait.
What physical exam finding is associated with TB of the spine?
Marked guarding due to dorsal spasm, gibbus, or reflex changes including clonus.
What is TB enteritis and how does it occur?
TB enteritis occurs after ingestion of tubercle bacilli or as part of generalized lymphohematogenous spread.
How common is TB of the pancreas?
It is a rare condition, occurring secondarily to generalized TB or in advanced cases.
Which skin lesion is associated with primary complex TB?
Scrofuloderma, which involves TB of the skin overlying a caseous lymph node.
What are the characteristics of erythema nodosum in TB?
Large, deep, painful, indurated nodules on the skin, particularly on thighs, elbows, and forearms.
What parts of the eye are often involved in ocular TB?
The conjunctiva and the cornea, resulting in conjunctivitis and phlyctenular keratoconjunctivitis.
What are common symptoms of ocular TB?
Pain and photophobia, with lesions that may recur affecting one or both eyes.
What is the typical presentation of genitourinary tract TB?
Persistent painless sterile pyuria, albuminuria, hematuria, with a history of destructive pulmonary TB.
How does TB affect the middle ear?
It can cause chronic tympanic membrane perforation, ear drainage, and progressive hearing loss, often with facial nerve paralysis.
What is congenital TB associated with?
TB of the placenta or acquired in utero during labor or delivery.
What are the stages in the spectrum of tuberculosis?
TB Exposure, TB Infection, and TB Disease.
How is TB exposure defined?
A child has TB exposure if they have close contact with a TB source case but no signs or symptoms of TB, with negative TST and no radiologic findings.
How is TB infection defined?
A child with a positive TST but no symptoms or radiologic/laboratory evidence suggestive of TB.
How is TB disease defined?
A child who is symptomatic for TB with positive TST and/or radiologic or laboratory evidence suggestive of TB.
What should you ask in a careful history for diagnosing TB?
Family history of TB treatment, personal history, environmental history (including overcrowding), social history, and history of TB contact.
What are symptoms highly suggestive of TB?
Chronic, unremitting symptoms persisting for more than 2 weeks without improvement or resolution.
What are physical exam signs that suggest extrapulmonary TB?
Gibbus, non-painful enlarged cervical lymphadenopathy with or without fistula.
What clinical signs require investigation to exclude extrapulmonary TB?
Meningitis not responding to antibiotics, pleural effusion, pericardial effusion, and distended abdomen with ascites.
What is the role of the Tuberculin Skin Test (TST) in diagnosing TB?
It measures immune response and is used as an adjunct in diagnosing TB in children with symptoms and in conjunction with other tests.
What are the indications for a positive TST in children?
For immunosuppressed children, >5mm induration; for healthy children, >10mm induration.
What is the primary method for bacteriological confirmation of TB?
Sputum, gastric aspirates, or other specimens depending on the site of TB disease.
Why is HIV testing recommended for TB patients?
To offer appropriate care and management, as HIV can complicate TB treatment and outcomes.
Why is chest radiography important in diagnosing TB?
It helps identify lung opacification, enlarged hilar or subcarinal lymph nodes, and pleural effusions in respiratory TB cases.
What is Xpert MTB/RIF?
A fully automated DNA-based test that detects TB and rifampicin resistance in less than 2 hours.
What are the benefits of blood tests like IGRA in TB diagnosis?
They measure the immune response to TB infection but do not confirm TB disease.
What is the role of computerized chest tomography and bronchoscopy in TB diagnosis?
They are not recommended for routine diagnosis of TB in children.
What is the most potent and best tolerated first-line oral TB agent?
Isoniazid
What are the adverse effects of Isoniazid?
Mild hepatic enzyme elevation, hepatitis, peripheral neuritis, and hypersensitivity.
What is the typical dose of Isoniazid for children?
10-15 mg/kg daily or 20-30 mg/kg twice-weekly.
What is the maximum daily dose of Rifampin for TB treatment?
600 mg
What is an adverse effect of Rifampin?
Orange discoloration of secretions or urine, staining of contact lenses, vomiting, hepatitis, influenza-like reaction, and thrombocytopenia.
Which TB drugs are routinely used for MDR-TB treatment?
Pyrazinamide, Streptomycin, Kanamycin, Amikacin, and Capreomycin.
What is the recommended treatment for TB contacts in households?
Chest X-ray screening for DS-TB contacts, Xpert test for DR-TB contacts, and TB preventive treatment (TPT) for DS-TB contacts.
What volume is required for respiratory specimens for Xpert MTB/RIF?
1-4 mL
What volume is needed for cerebrospinal fluid for Xpert MTB/RIF testing?
0.5-4 mL
What does ‘RR’ indicate in Xpert MTB/RIF results?
MTB detected, rifampicin resistance detected.
How is TB classified in the diagnostic phase?
TB Exposure, TB Infection, and TB Disease.
What are the chest X-ray findings strongly suggestive of PTB in children under 10 years old?
Right hilar lymphadenopathy,
Chronic pneumonia,
Miliary pattern
What are the signs and symptoms of PTB in children under 10 years of age?
Persistent fever, weight loss, cough, and irritability
What are the chest X-ray findings strongly suggestive of PTB in children aged 10–18 years?
Pulmonary cavitations & pleural effusion
What are the signs and symptoms of PTB in children aged 10–18 years?
Persistent fever, adynamia, and expectoration (bloody sputum)
What are the physical examination findings of pleural effusion?
Dull on percussion, and decreased lung sounds upon auscultation. Crackles or wheezing may also be present.
What is a characteristic feature on chest X-ray for pleural effusion?
Blunting of the costophrenic angle
What is a miliary pattern on chest X-ray?
It resembles millet seeds.
What is the definition of Bacteriologically confirmed rifampicin-resistant TB (BC RR-TB)?
Positive for MTB using rapid diagnostic modalities (i.e. Xpert MTB/RIF) with resistance to rifampicin.
What is the definition of Bacteriologically confirmed multidrug-resistant TB (BC MDR-TB)?
Positive for MTB complex with resistance to at least both isoniazid and rifampicin from an NTP-recognized laboratory.
What is the definition of Bacteriologically confirmed extensively drug-resistant TB (BC XDR-TB)?
Positive for MTB complex with resistance to any fluoroquinolone (FQ) and to at least one second-line injectable drug, in addition to multidrug resistance.
What is the definition of Clinically diagnosed multidrug-resistant TB (CD MDR-TB)?
A patient with clinical deterioration and/or radiographic findings consistent with active TB, with no response to empiric antibiotics.
What is the definition of Other DR-TB: monoresistant TB?
Resistance to one first-line anti-TB drug, except rifampicin, requiring a mono drug-resistant TB regimen.
What is the definition of Other DR-TB: polydrug-resistant TB?
Resistance to more than one first-line anti-TB drug, other than both isoniazid and rifampicin.
What is the treatment regimen for DS-TB with MTB, RIF sensitive or indeterminate?
2HRZE/4HR for PTB or EPTB (except CNS, bones, joints).
What is the treatment regimen for DS-TB with MTB, RIF sensitive or indeterminate, EPTB of CNS, bones, joints?
2HRZE/10HR for new or retreatment cases.
What are the management steps for minor adverse reactions due to Rifampicin?
Reassure the patient about the orange-colored urine.
What is the management for gastrointestinal intolerance due to Rifampicin, Isoniazid, or Pyrazinamide?
Give drugs at bedtime or with small meals.
What is the management for mild or localized skin lesions due to any of the first-line anti-TB drugs?
Give antihistamines.
What is the management for burning sensation in the feet (peripheral neuropathy) due to Isoniazid?
Give pyridoxine (Vit B6) 50–100 mg daily for treatment, or 10 mg daily for prevention.
What is the management for arthralgia due to hyperuricemia caused by Pyrazinamide?
Give aspirin or NSAID; if persistent, consider gout and request uric acid determination.
What is the management for flu-like symptoms due to Rifampicin?
Give antipyretics.
What is the management for severe skin rash due to hypersensitivity from any TB drug?
Stop anti-TB drugs and refer to specialist.
What is the management for jaundice (hepatitis) caused by Isoniazid, Rifampicin, or Pyrazinamide?
Stop anti-TB drugs and refer to specialist; resume treatment if symptoms subside.
What is the management for optic neuritis (visual acuity and color vision impairment) due to Ethambutol?
Stop ethambutol and refer to ophthalmologist.
What is the management for renal disorder (oliguria, albuminuria) due to Rifampicin?
Stop anti-TB drugs and refer to specialist.
What is the management for psychosis and convulsions caused by Isoniazid?
Stop Isoniazid and refer to specialist.
What is the management for thrombocytopenia, anemia, and shock caused by Rifampicin?
Stop anti-TB drugs and refer to specialist.
What defines a Cured outcome in DS-TB treatment?
A patient with bacteriologically confirmed TB at the beginning of treatment who becomes smear- or culture-negative in the last month of treatment.
What defines Treatment completed in DS-TB treatment?
A patient who completes treatment without evidence of failure, but no sputum smear negative results in the last month of treatment.
What defines Treatment failed in DS-TB treatment?
A patient whose sputum smear or culture is positive at five months or later during treatment or shows no clinical improvement.
What defines a Died outcome in DS-TB treatment?
A patient who dies for any reason during the course of treatment.
What defines Lost to follow-up (LTFU) in DS-TB treatment?
A patient whose treatment was interrupted for at least two consecutive months.
What defines Not Evaluated outcome in DS-TB treatment?
A patient for whom no treatment outcome is assigned, including patients transferred to another facility.
What are the exclusion criteria for SSOR treatment?
Disseminated TB, confirmed resistance to fluoroquinolone, exposure to specific drugs for more than 1 month, or risk of toxicity due to heart disease, liver, kidney issues.
What are the exclusion criteria for SLOR FQ-S treatment?
Confirmed resistance to fluoroquinolone, exposure to specific drugs for more than 1 month, or risk of toxicity due to heart disease, liver, kidney issues, or severe anemia.
What is the TB preventive and treatment regimen for latent tuberculosis infection (LTBI) in patients who are eligible for the 6H regimen?
“6H (isoniazid daily) - Currently available under the program.”
What is the TB preventive and treatment regimen for LTBI in patients eligible for the 3HP regimen?
“3HP (isoniazid.rifapentine weekly) - Weekly dosing for three months. Contraindicated in pregnant patients and children under 2 years old.”
What is the TB preventive and treatment regimen for LTBI in children when 3HP is not available?
“3HR (isoniazid.rifampicin daily) - Preferred for children if 3HP is not available.”
What is the TB preventive and treatment regimen for LTBI in adults when 3HP is not available?
“4R (rifampicin daily) - Preferred for adults if 3HP is not available.”
What is the effect of rifampicin on calcium channel blockers?
“Rifampicin markedly reduces levels of calcium channel blockers (nifedipine ,amlodipine, verapamil)
What effect does rifampicin have on B-blockers?
“Rifampicin reduces levels of B-blockers (propranolol ,carvedilol)
Does rifampicin interact with ACE inhibitors?
“Rifampicin has isolated reports of interaction with ACE inhibitors (captopril.enalapril.lisinopril) but the clinical significance is minor.”
Does rifampicin interact with diuretics?
“No interactions are found with diuretics (thiazides.spironolactone.furosemide).”
How does rifampicin interact with paracetamol?
“Rifampicin increases the clearance of paracetamol.but the clinical importance is not yet established.”
How does rifampicin affect diclofenac?
“Rifampicin decreases levels of diclofenac.”
Does rifampicin interact with aspirin or ibuprofen?
“No interaction with aspirin and ibuprofen; however. rifampicin reduces opioid levels (morphine.codeine).”
How does rifampicin interact with antifungals like ketoconazole and itraconazole?
“Rifampicin reduces serum levels of antifungals (ketoconazole.itraconazole).”
What is the effect of rifampicin on antiretroviral agents?
“Rifampicin reduces the levels of Efavirenz (EFV) . ritonavir and nevirapine. It increases clearance of Zidovudine. No interactions are found with Didanosine and Lamivudine.”
How does rifampicin interact with anti-epileptic drugs?
“Rifampicin reduces levels of phenytoin and valproic acid. One report indicated increased levels and toxicity of carbamazepine when rifampicin is given together with isoniazid.”
How does isoniazid interact with antacids?
“Isoniazid absorption is reduced with concurrent use of the antacid aluminium hydroxide. It is recommended to give isoniazid at least one hour before the antacid.”
How does isoniazid interact with carbamazepine?
“Isoniazid markedly and rapidly increases levels of carbamazepine.”
How does isoniazid interact with oral contraceptives?
“Few cases of contraceptive failures have been reported but the risk of failure with concurrent use of isoniazid is low.”
What is the potential effect of isoniazid on paracetamol?
“Isoniazid may cause potential toxicity of paracetamol even at normal doses.although more studies are needed.”
How does isoniazid interact with phenytoin?
“Isoniazid increases levels of phenytoin with concurrent use.”
How does isoniazid interact with theophylline?
“Isoniazid may increase plasma levels of theophylline.”
How does ethambutol interact with thiazide diuretics?
“Ethambutol and pyrazinamide may interact with thiazide diuretics to cause elevated serum uric acid levels.”
How does pyrazinamide interact with allopurinol and probenecid?
“Pyrazinamide may interact with allopurinol and probenecid to cause elevated uric acid levels.”
What is the risk when using streptomycin with ototoxic or nephrotoxic drugs?
“The risk of ototoxicity or nephrotoxicity is increased when streptomycin is used with ototoxic or nephrotoxic drugs.”
What are the precautions when using streptomycin with anesthetics and neuromuscular blocking agents?
“Exercise caution when using streptomycin with anesthetics and neuromuscular blocking agents as it can prolong neuromuscular blockade and potentially lead to respiratory depression.”
How do fluoroquinolones (second-line treatment) interact with theophylline?
“Fluoroquinolones increase serum theophylline levels.”
How do fluoroquinolones affect anticoagulant drugs?
“Fluoroquinolones increase the anticoagulant effect of Warfarin.”
How do fluoroquinolones interact with antacids?
“Concurrent use of fluoroquinolones with sucralfate and antacids containing aluminum. calcium or magnesium may reduce the absorption of quinolones.”
How does didanosine affect ciprofloxacin?
“The serum level of ciprofloxacin is reduced with concurrent use of didanosine.”
