Nelson Ch. 215

Question 1

Specialized culture medium for M. tuberculosis

Answer 1

Lowenstein-Jensen

Question 2

Lowenstein-Jensen: Carbon source

Answer 2

Glycerol

Question 3

Lowenstein-Jensen: Nitrogen source

Answer 3

Ammonium salts

Question 4

Hallmark of all mycobacteria

Answer 4

Acid fastness

Question 5

Capacity to form stable mycolate complexes with aryl methane dyes and resist decoloration with ethanol and hydrochloric acids

Answer 5

Acid fastness

Question 6

Hallmark of latent Tb

Answer 6

Reactive tuberculin test and absence of clinical and radiographic manifestations

Question 7

Primary complex or Ghon complex is the combination of

Answer 7

1) Parenchymal pulmonary lesion 2) Lymph node site

Question 8

PTb that occurs >1 year after the primary infection, usually caused by endogenous REGROWTH of bacilli persisting in partially encapsulated lesions

Answer 8

Reactivation Tb

Question 9

MC form of reactivation Tb

Answer 9

Infiltrate or cavity in the apex of the upper lobes, where O2 tension and blood flow are great

Question 10

MC result of female genital tract Tb

Answer 10

Infertility

Question 11

Reason why congenital Tb is rare

Answer 11

Because MC result of female genital tract Tb is infertility

Question 12

MC infectious route of neonatal Tb infection

Answer 12

POSTNATAL airborne transmission from adult with infectious PTb

Question 13

Conditions that adversely affect ___ immunity predispose to progression from Tb infection to disease

Answer 13

Cell-mediated

Question 14

TST is what type of hypersensitivity

Answer 14

Delayed type or Type IV

Question 15

Approximately ___% of infants who receive a BCG vaccine never develop a reactive TST

Answer 15

50

Question 16

Usually, reactivity to TST of infants who receive a BCG vaccine wanes in ___ years

Answer 16

2-3

Question 17

Most crucial risk factor for development of tuberculosis in children

Answer 17

Possible exposure to an adult with or at high risk for infectious PTb

Question 18

Preferred test in determining patient’s T cell response to specific M. tb antigens in cases where specificity is important as in patients who received a BCG vaccination

Answer 18

IFN-γ release assays

Question 19

Hallmark of primary PTb

Answer 19

Relatively large size of regional lymphadenitis compared with relatively small size of the initial lung focus

Question 20

Sequence of primary PTb lesion

Answer 20

Hilar lymphadenopathy > focal hyperinflation > atelectasis (collapse-consolidation) or segmental tuberculosis

Question 21

The presence of calcification implies that a Tb lesion has been present for at least ___

Answer 21

6-12 months

Question 22

MC symptoms of pulmonary tuberculosis

Answer 22

Nonproductive cough, mild dyspnea, and CLADs

Question 23

Reactivation Tb or Chronic PTb is uncommon in this age group

Answer 23

Healed Tb infection acquired less than 2 years

Question 24

Reactivation Tb or Chronic PTb is more common in those who acquire the initial infection > ___ years of age

Answer 24

7

Question 25

MC pulmonary sites of reactivation Tb

Answer 25

1) Original parenchymal focus 2) Lymph nodes 3) Apical seedings

Question 26

Apical seedings of Tb established during the hematogenous phase of the early infection

Answer 26

Simon foci

Question 27

MC radiographic presentations of reactivation Tb

Answer 27

Extensive infiltrates or thick-walled cavities in the upper lobes

Question 28

Pleural fluid findings in tuberculous pleurisy (6)

Answer 28

1) Yellow 2) SG 1.012-1.025 3) Protein 2-4 g/dL 4) Glucose low to normal (20-40 mg/dL) 5) Hundreds to thousands of WBCs per mm3 with early predominance of PMNs followed by a high percentage of lymphocytes 6) AFB RARELY POSITIVE

Question 29

MC form of cardiac Tb

Answer 29

Tb pericarditis

Question 30

Most clinically significant form of disseminated Tb

Answer 30

Miliary Tb

Question 31

MC form of extra pulmonary Tb in children

Answer 31

Scrofula or Tb of the SUPERFICIAL LNs

Question 32

Scrofula: Unilateral vs Bilateral

Answer 32

Unilateral

Question 33

Most serious complication of Tb in children

Answer 33

Tb of the CNS

Question 34

Tb of the CNS: Often the site of greatest involvement

Answer 34

Brainstem

Question 35

3 stages of CNS Tb

Answer 35

St 1 (stage of irritability) - nonspecific, St 2 (pressure or convulsive stage) - generalized and focal neurologic signs, St 3 (paralytic or terminal stage) - Coma, hemiplegia or paraplegia, hen, decerebrate posturing, deterioration of vital signs and death

Question 36

Most important lab test for diagnosis of Tb men

Answer 36

CSF studies

Question 37

CSF findings in Tb men

Answer 37

1) WBC 10-500 cells/mm3 with PMNs predominant in the early phase and lymphocytes later in the disease process 2) CSF glucose less than 40 but rarely less than 20 mg/dL 3) Protein markedly high 400-5000 mg/dL

Question 38

Brain CT or MRI findings in Tb meningitis

Answer 38

1) Basilar enhancement 2) Communicating hcp 3) Cerebral edema 4) Early focal ischemia

Question 39

MC location of brain tuberculoma in children

Answer 39

Infratentorial or at the base of brain near the cerebellum

Question 40

Classic manifestation of Tb spondylitis

Answer 40

Pott's disease

Question 41

Tb enteritis usually involves

Answer 41

Jejunum and ileum near Peyer patches and the appendix

Question 42

Standard therapy for intrathoracic Tb in children

Answer 42

2 HRZE, 4 HR

Question 43

Adverse reactions to commonly used Tb drugs: Ethambutol

Answer 43

1) Reversible optic neuritis 2) Decreased red-green color discrimination 3) GI disturbances 4) Hypersensitivity

Question 44

Adverse reactions to commonly used Tb drugs: INH

Answer 44

1) Hepatitis 2) Peripheral neuritis 3) Hypersensitivity 4) Optic neuritis

Question 45

Adverse reactions to commonly used Tb drugs: Pyrazinamide

Answer 45

1) Hepatotoxicity 2) Hyperuricemia 3) Arthralgias 4) GI tract upset

Question 46

Adverse reactions to commonly used Tb drugs: Rifampin

Answer 46

1) Orange discoloration of secretions 2) Vomiting/GI intolerance 3) Hepatitis, increased if given with INH 4) Influenza-like reaction 5) Thrombocytopenia 6) Pruritus 7) Oral contraceptives may be ineffective

Question 47

Duration of treatment for bone and joint, disseminated and CNS Tb

Answer 47

9-12 months

Question 48

Interaction of some antiretrovirals and rifampin

Answer 48

1) Subtherapeutic blood levels of protease inhibitors and non-nucleoside reverse transcriptase inhibitors 2) Toxic levels of rifampin

Question 49

Corticosteroids are beneficial in patients with what types of Tb

Answer 49

1) Meningitis 2) Endobronchial 3) Acute tb pericardial effusion 4) Miliary tb

Question 50

Highest priority of any Tb control program

Answer 50

Case finding and treatment

Question 51

Official recommendation of WHO for BCG in high risk Tb populations

Answer 51

Single dose BCG during infancy

Question 52

Best use of BCG vaccination

Answer 52

Prevention of life-threatening forms of Tb in infants and young children