Lec 16 Extrapulmonary Tuberculosis Flashcards
The most common misconception about the etiology of TB
A. bacteria B. fatigue C. smoking D. alcohol E. genetic
smoking
Enumerate the 5 pillars of DOTS (Directly Observed Treatment, Short-Course)
quality-assured smear microscopy uninterrupted supply of anti-TB drugs directly observed treatment (DOT) program and patient monitoring political will
The name of the UP TB DOTS clinic is
UP PRIME TB DOTS Clinic
What is the meaning of PRIME?
PGH Responsive Integrated Multidisciplinary Enhanced
Who is the head of UP PRIME TB DOTS?
Dr. Camilo Roa
TB is spread internally through what route?
hematogenous and lymphatic
Early caseous necrosis is first seen in what clinical stage of TB?
A. 1 B. 2 C. 3 D. 4a E. 5
Stage 1: onset
Stage 2: symbiosis
Stage 3: early caseous necrosis
Stage 4a & 4b: interplay of cell-mediated immunity and tissue-damaging delayed-type hypersensitivity
Stage 5: liquefaction and cavity formation
When is coughed sputum best collected?
early morning
How many samples of AFB (+) sputum are needed to confirm diagnosis?
2 samples
T/F: AFB smears are highly sensitive.
F, only 30-40% sensitive
40-50% in PGH due to immunofluorescence
T/F: (+) AFB is diagnostic for Mycobacterium tuberculosis.
F, all acid-fast bacilli look alike
What is the gold standard for TB diagnosis?
culture and identification of isolate
True of TB culture EXCEPT
A. usually takes 2-4 weeks B. signed out as negative until 6 weeks C. ID based on biochemical tests D. cannot distinguish among MTB complex E. NOTA
B
Do not sign out as negative until 8 weeks.
True of tuberculin skin test
A. (+) is not diagnostic of PTB
B. (-) excludes TB as possible diagnosis
C. AOTA
D. NOTA
A
(+) only SUPPORTS but not diagnostic
(-) result DOES NOT exclude TB
T/F: Interferon Gamma Release Assay (IGRA) is diagnostic of TB.
F, for screening only
ID: Newest TB test endorsed by WHO due to near 100% TB sensitivity and ~92% rifampicin resistance sensitivity.
Gene Xpert
ID: Findings in chest X-ray of TB patient.
infiltrates, nodular densities, cavities, with or without hilar lymphadenopathy
T/F: TB patients co-infected with HIV has higher load of bacteria.
T
T/F: TB patients co-infected with HIV has higher transmission risk and more infectious than TB patients w/o HIV.
F, HIV patients may have lesser cavitations in the lungs (due to poor immune response)
The standard regimen for TB is
HREZ x 2 months then HR x 4 months
Which first line TB drug is bacteriostatic?
A. isoniazid
B. rifampicin
C. ethambutol
D. pyrazinamide
C. ethambutol
All of the first line TB drugs are metabolized in the liver EXCEPT
A. isoniazid
B. rifampicin
C. ethambutol
D. pyrazinamide
C. ethambutol (renally excreted)
ID: Hearing loss is an adverse effect of what 2nd line TB drug?
streptomycin
T/F: There are fewer problems with anti-TB drug toxicity in children.
T
MDR TB is resistant to what drug/s?
A. isoniazid B. rifampicin C. ethambutol D. pyrazinamide E. AOTA
A & B
ID: XDR TB is resistant to what drug/s?
fluoroquinolones and any second line TB injectable drugs (amikacin, kanamycin, capreomycin)
What is the most important risk factor for MDR TB?
A. known contact with person proven with MDR TB
B. prior TB treatment
C. treated in program outside DOTS
D. sputum smear (+) at 2 months of treatment
E. co-morbidities (e.g. HIV)
B. any prior TB treatment
T/F: EPTB is usually less infectious than PTB.
T
T/F: There are more percent EPTB cases in PGH.
T
The most common site of EPTB
A. pleural B. lymphatic C. musculoskeletal D. genitourinary E. miliary
B. lymphatic
ID: Most fatal EPTB.
meningeal TB
Dr. Berba: What is the clinical implication of EPTB?
A. The Mycobacteria causing EPTB syndromes are usually resistant and more difficult to treat.
B. The Mycobacteria causing EPTB are usually more virulent so mortality rates are higher.
C. EPTB is less infectious and thus less a public health concern.
D. All EPTB should be treated for at least 12 months.
C. less infectious
Dr. Berba: What is the best practice to establish diagnosis of EPTB?
A. sputum AFB
B. tissue/fluid AFB smear and TB culture
C. tissue/fluid AFB, TB culture, and histopathology
D. serological tests for TB
C
What is the best practice of treatment for newly-diagnosed pleural EPTB?
A. 2HRZE/4HR
B. 2HRZE/4HRE
C. 2HRZ/4HRE
D. 2HRZE/6HE
A. same with PTB
Which EPTB are treated for more than 6 months?
CNS and MSK TB
True of TB lymphadenitis EXCEPT
A. peak age shifted from children to 20-40 y/o
B. Asians are among high risk groups
C. involves neck lymph nodes
D. with numerous pulmonary calcifications
D. LITTLE / FEW pulmonary calcifications
ID: TB lymphadenitis in the neck is more commonly known as what?
scrofula
T/F: Surgical incision and drainage of scrofula is recommended.
F
Did not say why.
Most common site of musculoskeletal TB
A. lumbar vertebrae B. thoracic vertebrae C. knee D. hip E. muscle
A. lumbar vertebrae
prevalence in same order as choices
Tuberculous spondylitis is also known as
Pott’s disease
True of TB osteomyelitis EXCEPT
A. painful
B. prefers diaphysis
C. single in adults
D. may extend to joint
B
It prefers METAPHYSIS
Most common sign and symptom of genitourinary tuberculosis.
A. microscopic hematuria B. sterile pyuria C. suprapubic pain D. urine pus cells E. testicular swelling
B. sterile pyuria
painless frequent micturition is also common
T/F: Steroids may be used in TB pericarditis.
T.
to dampen the inflammatory process
Most common site of gastrointestinal TB
A. spleen
B. liver
C. stomach
D. small intestine
B. liver
Cutaneous TB resulting from an endogenous source
A. tuberculous chancre
B. prosector’s wart
C. scrofuloderma
D. lupus vulgaris
C. scrofuloderma
A & B are exogenous
D is hematogenous
ID: Predilection (location) of tuberculous meningitis.
base of the brain (high oxygen)
True of CSF analysis in CNS TB EXCEPT.
A. elevated protein
B. elevated glucose
C. clear or slightly opalescent
D. may be (+) AFB
B.
There is LOW glucose.
T/F: Steroids may be used in TB meningitis.
T
also true for TB pericarditis
A previously treated drug-susceptible TB with CNS involvement (TB meningitis) is classified as
A. Category I B. Category Ia C. Category II D. Category IIa E. Category III
D. IIa
walang A = walang CNS or MSK involvement
cat II = previously treated
cat III = wala neto
MDR-TB is treated for at least how many months?
18 months
