Mycobacterium Flashcards
Which of the following is false with respect to BCG vaccine
Select one:
BCG vaccination confers partial protection against Tuberculosis
BCG vaccination is associated with a reduction in all cause mortality in developing countries
BCG vaccine is made from attenuated Mycobacterium bovis
The BCG vaccine offers 90% protection from TB meningitis.
BCG vaccine is safe for all neonates
BCG vaccine is safe for all neonates
(babies from HIV + mothers)
A healthy 30 year old Indonesian nurse recently had an interferon gamma release assay (quantiferon) test for occupational health and safety assessment. The test is positive. He has no symptoms of TB. His chest x-ray is normal. TB disease has been excluded. He A has agreed to be treated for his infection. Which of the following options is INCORRECT?
Select one:
Without treatment, it is highly likely that patient A will develop TB disease sometime in his life.
Patient A has TB infection but cannot spread TB to others unless the disease progresses to active TB
Supplementation with vitamin B6 is recommended for neurological side effects of the medications.
The 9-month treatment regimen is more effective than the 6-month regimen.
Possible side effects of treatment for this condition include hepatitis
Without treatment, it is highly likely that patient A will develop TB disease sometime in his life. (Only 5-10% will get it)
Yin Ling, a 22 year old woman, has come to see her GP (you) with a six week history of a productive cough. Upon questioning, you learn that she has lost 4 kg and is experiencing night sweats. She has recently immigrated to NZ from China where she was treated for TB as a child. You perform a sputum culture which is positive and susceptibility testing reveals it is multi-drug resistant mycobacterium tuberculosis. What does this mean for her treatment?
Select one:
The tuberculosis will not respond to isoniazid, rifampicin or fluoroquinolones. This is associated with a 50% mortality.
The tuberculosis will not respond to isoniazid or rifampicin. Second line drugs (including fluoroquinolones) should be used. It is important to use 5 different agents.
This kind of tuberculosis can only be treated with injectable agents such as capreomycin. 5 agents are required.
Rifampin, ethambutol, pyrazinamide and isoniazid should be used for two months. Rifampin and isoniazid should be used for a further four months.
The tuberculosis will not respond to isoniazid or rifampicin. Second line drugs (including fluoroquinolones) should be used. It is important to use 5 different agents.
Multi-drug-resistant tuberculosis (MDR-TB) is becoming more and more of an issue worldwide, accounting for 4.1% of new TB diagnoses. This is despite decreasing incidence for TB overall. Which of the following is likely the most significant driver of drug-resistant tuberculosis strains?
Select one:
Incorrect or inadequate treatment of existing TB cases
Increasing incidence of HIV
Increased incarceration
Climate change
Incorrect or inadequate treatment of existing TB cases
What are the first line treatments for tuberculosis
Select one:
isoniazid Rivastigmine Ethylene glycol benzylpenicillin
Benzylpenicillin Rivastigmine ethambutol pyrazinamide
isoniazid rifampin ethambutol pyrazinamide
Fluclocycillin Amoxicillin Ethambutol Pyrazinamide
Isoniazid Rifampin Flucloxicillin Amoxicillin
isoniazid rifampin ethambutol pyrazinamide
A 28 year old man presents to your general practice with three weeks of cough. The cough is purulent and occasionally blood stained. He has fevers and night sweats. He is originally from India. On examination Hr 73, BP 128/76, Sats 98%, comfortable. No clubbing. Chest resonant with very little to hear on auscultation. What is your first step in managing this patient?
Select one:
Chest X-Ray
IV antibiotics
Respiratory isolation
Sputum culture
Starting course of rifampicin and isoniazid
Respiratory isolation (u need the others but bro probably has TB)
A 45 year old man of Indian descent presents to your practice because he has been unwell for the last 3 months. He was treated with amoxicillin for a productive cough and fever 2 months ago. The cough is ongoing although, not productive, he also has also been feeling tired with generalized tenderness in his abdomen. He noticed 8kg of weight loss since the start of the 3 months.M. Tuberculosis was detected by culture. What is the standard regimen for treatment?
Select one:
Ethambutol, Rifampin, Pyrazinamide, and Isoniazid, for 2 months, Rifampin and Isoniazide for a further 3 months.
Rifampin, Isoniazid, Ethambutol and Pyrazinamide for 2 months, Rifampin and Isoniazide for a further 4 months.
Ethambutol, Pyrazinamide, Isoniazide for 3 months, Isonizide and Ethambutol for a further 2 months.
Pyrazinamide, Isoniazide and Rifampin for 3 months, Pyrazinamide and Rifampin for a further 3 months
Rifampin, Isoniazid, Ethambutol and Pyrazinamide for 2 months, Rifampin and Isoniazide for a further 4 months
Eden, a 22 y/o student from Wellington, returns following a year working in a medicines san frontier (MSF) Tuberculosis clinic. She starts to feel unwell on her trip home and visits her GP a week later with a history of a cough, fevers, slight weightloss of 6 kgs which she put down to dietary changes and a diet of lentils for the last year. She notes that her cough had been lingering for the last 3-4 weeks, often with a productive sputum, but she had thought nothing of it as had been enjoying the remaining weeks of her trip and dreading coming back to uni. Her GP suspects she may TB. Which of the following is INCORRECT regarding the diagnosis and treatment of Tuberculosis?
Select one:
CXR can resemble pneumonia in acute TB, however in advanced disease has characteristic signs such as fibrosis and cavities
Extrapulmonary signs can also help with diagnosis eg. lymphadenopathy, pleural effusions, spinal problems, meningitis
If there is a clinical suspicion of TB, isolation and appropriate testing is important. Testing for TB is best achieved by a singular sputum smear.
A latent infection would be diagnosed using the Tuberculin skin test or interferon gold (gamma release assay).
The standard treatment regimen includes taking Isoniazid, Rifampin,Pyrazinamide,Ethambutol for 2 months, and thenRifampin andIsoniazid for a further 4 months
If there is a clinical suspicion of TB, isolation and appropriate testing is important. Testing for TB is best achieved by a singular sputum smear. (Do multiple smears)
It is your first day working as a Doctor in Palmerston North Hospital in the Emergency Department. Your first patient is a 28 year old male that has been living in Russia for the past 6 months. He comes in presenting with a productive cough, weight loss, fever and a lump in his neck. You are suspicious of tuberculosis (TB) so you place the patient in airborne isolation. Which of the following is not routinely required in the work up of pulmonary TB?
Select one:
three induced sputa for smears (microscopy) and culture
Chest x-ray
start treatment for tuberculosis with Rifampin Isoniazid Pyrazinamide and Ethambutol
Interferon gamma release assay
GeneXpert
IGRA (that’s for latent disease this is active)
