Fouty- Mycobacteria and TB

Question 1

acid fast stain for mycobacteria

Answer 1

Ziehl-Neelsen

Question 2

India, China, Africa, Indonesia

Answer 2

highest rate of TB

Question 3

slow growing
waxy outer coat
acid fast
aerobic bacilli

Answer 3

mycobacterium

Question 4

part of cell wall structure that is stained with Z-N stain

Answer 4

Mycolic acid

Question 5

mycobacteria infection in HIV patients consists of what

Answer 5

MAC (M.avium)

Question 6

slow growing
non-pigmented

Answer 6

MTB complex

Question 7

develop slowly and elicit a granulomatous response

Answer 7

Mycobacterial infection

Question 8

Mycobacteria infection elicits what 2 host responses

Answer 8

delayed type hypersensitivity
cell-mediated immunity

Question 9

host response with non-activated macrophages

Answer 9

delayed type hypersensitivity

Question 10

host response with activated macrophages

Answer 10

cell-mediated immunity

Question 11

human host only
most common cause of mycobacterial infection

Answer 11

M. tuberculosis

Question 12

can be transmitted to humans by milk; basis of MTB vaccine

Answer 12

M. bovis

Question 13

spread from person to person by aerosol

Answer 13

M. tuberculosis

Question 14

has evolved to evade innate immune response (escapes to replicate in cytoplasm through non-activated alveolar macrophages)

Answer 14

M. tuberculosis

Question 15

Infects tissue monocytes; widespread inflammation; get into lymph nodes and disseminate to other parts of the body

Answer 15

MTB

Question 16

in most cases, activation of ____ immune response eventually controls initial MTB infection

Answer 16

adaptive

Question 17

control of TB is mostly a _____ immune response

Answer 17

adaptive (Th1)

Question 18

____ release IFNgamma that activate infected macrophages and help them kill TB bacilli

Answer 18

Th1 cell

Question 19

_____ immune response leads to formation of granulomas that controls initial infection but rarely totally clears all infection

Answer 19

adaptive

Question 20

Most common cause of calcified granuloma in the US

Answer 20

Histoplasmosis

Question 21

Most common cause of calcified granuloma in the world

Answer 21

TB

Question 22

aka calcified granuloma, indicates site of primary infection

Answer 22

Ghon Focus

Question 23

calcified granuloma + Ipsilateral lymph node calcification

Answer 23

Ranke Complex

Question 24

Immediate clearance of inhaled MTB bacilli without activating adaptive response

Answer 24

no TB infection

Question 25

Uncontrolled Primary infection Primary infection (active disease) seen in who

Answer 25

in children and immunocompromised

Question 26

Delayed control of infection after induction of adaptive immune response:

Answer 26

latent infection

Question 27

bilateral hilar adenopathy HIV, children, immunocompromised

Answer 27

primary TB infection

Question 28

2 outcomes with latent TB infections

Answer 28

lifelong dormancy reactivation

Question 29

reactivation of latent disease usually w=in what lobes of lung

Answer 29

upper lobes

Question 30

_____ disease is most contagious (due to reactivation of latent disease)

Answer 30

cavitary disease

Question 31

Answer 31

miliary tuberculosis (hematogenous spread)

Question 32

Initially infection was controlled in granuloma; then the immune response dropped for whatever reason; bacilli broke through and disseminated into blood stream

Answer 32

miliary TB

Question 33

due to drop in immunity cough and night sweats most commonly in lungs

Answer 33

MTB reactivation

Question 34

In people co-infected with M. tuberculosis and HIV the rate they will develop tuberculosis is ____% per year.

Answer 34

10%

Question 35

diagnose latent TB infection

Answer 35

TB skin test IFN-gamma assay

Question 36

diagnose active TB

Answer 36

positive culture NAAT

Question 37

_____ staining can indicate presence of Mycobacterium but cannot discriminate between species

Answer 37

Zieh-Neelsen

Question 38

Rx active TB

Answer 38

Begin with 2 months of Isoniazid, ethambutol, pyrazinamide, rifampin Followed by 4-6 months of isoniazid and rifampin

Question 39

how to treat active TB

Answer 39

watch patient take the medicine everyday

Question 40

inhibits mycolic acid synthesis; give with pyridoxine (vitamin B6)

Answer 40

Isoniazid (INH)

Question 41

inhibits RNA polymerase SE: orange colored body fluids induces CYP450 enzymes

Answer 41

Rifampin

Question 42

____ + oral contraceptive = baby

Answer 42

Rifampin

Question 43

inhibits transferases of cell wall SE: retrobulbar neuritis CI in children too young to notice vision problems

Answer 43

Ethambutol

Question 44

disrupts cell membrane metabolism and transport

Answer 44

Pyrazinamide (PZA)

Question 45

MTB drug resistance that causes problems

Answer 45

resistant to INH and Rifampin

Question 46

found in soil and water mycobacterial disease in HIV patients inhaled or swallowed

Answer 46

M. avium complex (MAC)

Question 47

most common mycobacterial disease in AIDS patients in the US

Answer 47

MAC

Question 48

Recommended treatment regimen: clarithromycin or azithromycin combined with ethambutol and rifampin

Answer 48

MAC

Question 49

Slowly evolving cavitary disease that resembles tuberculosis on chest radiography

Answer 49

MAC pulmonary disease

Question 50

observed in elderly, female non-smokers chronic cough, shortness of breath, fatigue and other less specific symptoms lingular or middle lobe infiltrates with a patchy, nodular appearance on radiography and associated bronchiectasis (chronically dilated bronchi)

Answer 50

Lady Windermere syndrome (MAC pulmonary disease)

Question 51

formation of a solitary pulmonary nodule

Answer 51

MAC pulmonary disease

Question 52

can sometimes clear on its own + PPD test may result from this infection

Answer 52

M. kansasii

Question 53

____ and ____ are critical in controlling TB infection

Answer 53

Th1 CD4 cells and INF gamma

Question 54

main risk factor for TB

Answer 54

immunocompromised

Question 55

main thing to remember to treat TB

Answer 55

multiple drugs for a prolonged period of time