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Tuberculosis in Infancy and Childhood > Nelson Ch. 215 > Flashcards

Nelson Ch. 215 Flashcards

1
Q

Specialized culture medium for M. tuberculosis

A

Lowenstein-Jensen

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2
Q

Lowenstein-Jensen: Carbon source

A

Glycerol

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3
Q

Lowenstein-Jensen: Nitrogen source

A

Ammonium salts

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4
Q

Hallmark of all mycobacteria

A

Acid fastness

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5
Q

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

A

Acid fastness

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6
Q

Hallmark of latent Tb

A

Reactive tuberculin test and absence of clinical and radiographic manifestations

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7
Q

Primary complex or Ghon complex is the combination of

A

1) Parenchymal pulmonary lesion 2) Lymph node site

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8
Q

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

A

Reactivation Tb

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9
Q

MC form of reactivation Tb

A

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

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10
Q

MC result of female genital tract Tb

A

Infertility

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11
Q

Reason why congenital Tb is rare

A

Because MC result of female genital tract Tb is infertility

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12
Q

MC infectious route of neonatal Tb infection

A

POSTNATAL airborne transmission from adult with infectious PTb

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13
Q

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

A

Cell-mediated

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14
Q

TST is what type of hypersensitivity

A

Delayed type or Type IV

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15
Q

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

A

50

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16
Q

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

A

2-3

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17
Q

Most crucial risk factor for development of tuberculosis in children

A

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

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18
Q

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

A

IFN-γ release assays

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19
Q

Hallmark of primary PTb

A

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

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20
Q

Sequence of primary PTb lesion

A

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

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21
Q

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

A

6-12 months

22
Q

MC symptoms of pulmonary tuberculosis

A

Nonproductive cough, mild dyspnea, and CLADs

23
Q

Reactivation Tb or Chronic PTb is uncommon in this age group

A

Healed Tb infection acquired less than 2 years

24
Q

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

A

7

25
Q

MC pulmonary sites of reactivation Tb

A

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

26
Q

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

A

Simon foci

27
Q

MC radiographic presentations of reactivation Tb

A

Extensive infiltrates or thick-walled cavities in the upper lobes

28
Q

Pleural fluid findings in tuberculous pleurisy (6)

A

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

29
Q

MC form of cardiac Tb

A

Tb pericarditis

30
Q

Most clinically significant form of disseminated Tb

A

Miliary Tb

31
Q

MC form of extra pulmonary Tb in children

A

Scrofula or Tb of the SUPERFICIAL LNs

32
Q

Scrofula: Unilateral vs Bilateral

A

Unilateral

33
Q

Most serious complication of Tb in children

A

Tb of the CNS

34
Q

Tb of the CNS: Often the site of greatest involvement

A

Brainstem

35
Q

3 stages of CNS Tb

A

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

36
Q

Most important lab test for diagnosis of Tb men

A

CSF studies

37
Q

CSF findings in Tb men

A

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

38
Q

Brain CT or MRI findings in Tb meningitis

A

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

39
Q

MC location of brain tuberculoma in children

A

Infratentorial or at the base of brain near the cerebellum

40
Q

Classic manifestation of Tb spondylitis

A

Pott’s disease

41
Q

Tb enteritis usually involves

A

Jejunum and ileum near Peyer patches and the appendix

42
Q

Standard therapy for intrathoracic Tb in children

A

2 HRZE, 4 HR

43
Q

Adverse reactions to commonly used Tb drugs: Ethambutol

A

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

44
Q

Adverse reactions to commonly used Tb drugs: INH

A

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

45
Q

Adverse reactions to commonly used Tb drugs: Pyrazinamide

A

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

46
Q

Adverse reactions to commonly used Tb drugs: Rifampin

A

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

47
Q

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

A

9-12 months

48
Q

Interaction of some antiretrovirals and rifampin

A

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

49
Q

Corticosteroids are beneficial in patients with what types of Tb

A

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

50
Q

Highest priority of any Tb control program

A

Case finding and treatment

51
Q

Official recommendation of WHO for BCG in high risk Tb populations

A

Single dose BCG during infancy

52
Q

Best use of BCG vaccination

A

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

Tuberculosis in Infancy and Childhood (4 decks)

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