OnlineMedEd: Infectious Disease - "TB"

Question 1

Primary TB typically presents with ___________ on CXR.

Answer 1

cavitations

Question 2

Secondary TB presents with ___________ on CXR.

Answer 2

Ghon complexes (calcifications)

Question 3

TB presents with symptoms similar to lung cancer: _____________.

Answer 3

night sweats, weight loss, and hemoptysis

Question 4

When a PPD comes back positive, you then get a _________________.

Answer 4

CXR

Question 5

If a chest x-ray comes back negative in a person with a positive PPD, what should you do?

Answer 5

Treat with isoniazid for latent TB.

Question 6

What do you do if a chest x-ray is positive?

Answer 6

Get an AFB smear:

• If negative, treat with INH for latent TB.
• If positive, treat with RIPE for active TB.

Question 7

Review the PPD induration tiers and who goes into each.

Answer 7

• ≥ 5 mm:

• Immunocompromised (e.g., AIDS, on immunosuppressants, or anergy)
• Close contacts (e.g., dad at home has TB)

•≥10 mm:
- Those with brief contacts with TB (healthcare workers, homeless people, and those in prison)

•≥15 mm:
- Those without any of the above characteristics

Question 8

For those who have had latent PPD in the past (treated), how do you screen them?

Answer 8

Yearly CXRs

Question 9

Describe the workup of active TB.

Answer 9

Patient: presents with night sweats, hemoptysis, and fevers

1) Get a CXR
2) If CXR is positive, isolate the patient and get an AFB smear and cultures to confirm. If the CXR is negative, don’t isolate the patient but get the AFB and cultures to confirm.
3) If the CXR and AFB are both negative but you’re still suspicious (as with a patient with classic symptoms and an exposure), then get a NAAT to rule out.

Question 10

Review the treatments for active TB and the side effects of each.

Answer 10

• Rifampin: orange/red body fluids
• Isoniazid: peripheral neuropathy if no B6
• Pyrazinamide: gout
• Ethambutol: red/green color blindness