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Philippine TB Guidelines Flashcards

1
Q

Primary diagnostic test for TB

A

Direct sputum smear microscopy

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2
Q

Method of sputum collection

A

Spot-spot 1 hour apart or spot-early AM

Spontaneous expectoration is preferred

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3
Q

Positive DSSM defined as

A

One positive smear

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4
Q

TB culture primarily used in ruling out

A

NTM

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5
Q

When to do drug susceptibility testing?

A

People living with HIV and MDRTB exposed

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6
Q

When should Xpert MTB/Rif be requested?

A

In patients with smear-negative, CXR positive disease with no known risk for MDRTB

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7
Q

Radiologic findings specific for TB

A

None

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8
Q

Diagnosis of someone with PTB on CXR

A

Presumptive PTB

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9
Q

Role of Chest CT scan

A

Used to rule out alternative diagnoses but cannot be recommended routinely

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10
Q

Sensitivity and specificity of GeneXpert as an initial diagnostic test

A

89% and 99%

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11
Q

Sensitivity and specificity of GeneXpert as an initial diagnostic test for drug-resistant TB

A

95% and 99%

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12
Q

Role of NAATs other than GeneXpert

A

No role as standalone test

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13
Q

Role of IGRAs in diagnosing TB

A

No role

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14
Q

Tests to request for in patients before starting TB treatment

A

ALT and Crea

in resource-limited settings, for those 60 and older

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15
Q

Recommendation for serum uric acid level measurements before treatment

A

Not recommended

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16
Q

Comorbids to screen for before initiating TB treatment

A

HIV

DM

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17
Q

Definition: New PTB Case

A

No previous treatment or less than one month of treatment

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18
Q

Definition: Retreatment

A

Received one month of treatment (excluding prophylaxis and latent TB treatment)

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19
Q

Definition: Relapse

A

Patient declared cured then diagnosed again either bacteriologically or clinically

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20
Q

Definition: Treatment after Loss to Follow Up

A

Interruption of treatment for at least two consecutive months and now positive bacteriologically or clinically

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21
Q

Definition: Treatment After Failure

A

Previously treated but still positive

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22
Q

Definition: Previous Treatment Outcome Unknown

A

Unknown result of TB treatment

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23
Q

Treatment regimen

A

I - 2HRZE/4HR for new cases except bone, meninges and joints
Ia - 2HRZE/10HR
II - 2HRZES/1HRZE/5HRE for retreatment cases except bone, meninges and joints
IIa - 2HRZES/1HRZE/9HRE

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24
Q

Recommendation for Rif sensitivity testing

A

All patients prior to TB treatment initiation

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25
Monitoring of treatment in new patients
1 DSSM at end of 2nd, 5th and 6th months (bacteriologic) and at the end of 2nd month (clinical)
26
Recommendation for non-converters
Do not extend intensive phase Start with continuation phase after two months Do DSSM after 3rd month Test for Rif sensitivity if still positive
27
Treatment failure if smear positive after
5th month of treatment
28
Monitoring of treatment in retreatment cases
1 DSSM at end of 3rd, 5th and 8th months for both | If smear positive after 3rd month, do GeneXpert
29
Recommendation for liver function test monitoring
Not routine in asymptomatic patients
30
When to check LFTs again after abnormal baseline
2 - 4 weeks after
31
When to stop TB treatment when abnormal liver enzymes are present?
> 3x ULN ALT with symptoms or > 5x ULN if without symptoms
32
Reintroduction of TB drugs
< 2x ULN ALT Rifampin (with or w/o ethambutol) then INH 3 - 7 days later Pyrazinamide permanently discontinued
33
Food intake and anti TB drugs
Affects bioavailability
34
Management of generalized rash, fever and mucous involvement due to TB drugs
Stop all drugs at once!
35
Reintroduction of drugs in cutaneous drug events
One by one in 3 - 7 day intervals Reintroduced when cutaneous symptoms have improved Rifampicin introduced last to PLHIV
36
Recommended vitamins
Vitamin B complex
37
To-do before ethambutol initiation
Baseline Snellen visual acuity assessment and color perception testing
38
Treatment of miliary tuberculosis
Follows that for new and retreatment PTB cases
39
CXR only used for
Monitoring co-existing conditions and treatment complications
40
Role of lymph node excision in TB lymphadenitis
Not routinely recommended
41
TB pericardial effusion treatment
Open drainage
42
Surgery in pleural TB
Pigtail catheter drainage and decortication
43
Surgery in GITB
Ulceration, gut obstruction or fistula formation
44
Surgery in liver TB
Percutaneous aspiration of abscesses Hepatectomy if with risk of malignancy Biliary decompression if with obstructive jaundice
45
Treatment of INH-associated neuropathy
50 - 100 mg pyridoxine | Vitamin B6 10 mg daily with anti-TB meds as prophylaxis
46
Treatment of ethambutol toxicity
Discontinue drug and refer to Ophtha
47
Streptomycin toxicity and management
Ototoxicity | Cease drug and refer to ENT
48
When to request serum UA
When patients are symptomatic on pyrazinamide | Discontinue then resume treatment once symptoms abate
49
Drugs to discontinue in nephrotoxicity
Streptomycin and rifampicin
50
When are patients considered non-infectious
14 days of treatment with clinical improvement if bacteriologically confirmed 5 days of treatment with clinical improvement if clinically diagnosed
51
Corticosteroids in TB meningitis and pericarditis
TB meningitis Dexamethasone 0.4 mg/kg/24 hours over 6 - 8 weeks TB pericarditis Prednisolone 60 mg for 4 weeks, 30 mg for weeks 5 - 8, 15 mg for weeks 9 - 10 and 5 mg for week 11
52
Diagnosis of DR-TB
Drug Susceptibility Testing GeneXpert Line Probe Assay
53
Risk factors for presumptive drug resistant TB
1. Contacts of confirmed DR-TB cases 2. Non-converters of Category I 3. Persons living with HIV (PLHIV) with signs and symptoms of TB 4. All retreatment cases
54
Definition of Cured DR-TB
18 months of treatment without evidence of failure AND three or more consecutive negative cultures taken 30 days apart after intensive phase.
55
Definition of Treatment Failure in DR-TB
Treatment terminated Permanent regimen change of at least 2 anti-TB drugs because fo lack of conversion by end of intensive phase, bacteriological reversion in the continuation phase after conversion to negative, evidence of additional acquired resistance to fluoroquinolones or second-line injectable durgs or ADRs.
56
HIV and TB
All PLHIV should be screened for TB.
57
Initial diagnostic test in PLHIV suspected of having TB
GeneXpert
58
P. jireoveci prophylaxis in HIV
Cotrimoxazole 800/160 for ANY CD4 count.
59
Treatment of TB when liver cirrhosis is present
COMPENSATED 2HRES/6HR 2HSE/10HE 9HRE
60
Treatment of TB when renal dysfunction is present
2HRZE/4HR (adjusted) Given after HD Given regardless of time in PD
61
When to start treatment if patient has both HIV and TB
After second week of TB treatment regardless of CD4 count. For TB meningitis, ARV after intensive phase of TB treatment
62
Preferred NNRTI for HIV patients on TB treatment
Efavirenz | Nevirapine causes drug-drug interaction
63
Routine screening for these high risk groups
PLHIV Solid organ and hematologic transplant recipients RA patients on biologicals Chronic dialysis patients T1 or T2 DM with poor glycemic control or exposed to TB patients Pregnant TB patients, IV drug users or immunocompromised
64
Method of screening high risk groups
TST | Add IGRA if RA with biologicals use
65
Recommended treatment for LTBI
INH 300mg for 6 months
66
Recommendations for face mask user around TB patients
Use surgical masks around presumed TB until deemed non infectious No benefit for double mask N95 the best!
67
Screening for household contacts of known TB cases
At least a CXR
68
High risk populations for TB
Smokers Alcoholics (> 40 g/day) Underweight (BMI < 20)
69
BCG re-vaccination
Not recommended
70
Definition of recent TB infection
Less than two years ago
71
Periodic monitoring
CXR after 4 - 6 months
72
When to put a patient in isolation
1. Bacteriologically confirmed TB not started treatment | 2. Cases of DR/MDR/XDR TB
73
Patient with both PTB and EPTB classified as?
PTB
74
Age cut-off for adults in TB guidelines
15 and up
75
How long cough for evaluation of TB?
2 weeks
76
Factors independently associated with risk of household contacts of developing TB
Old age History of TB > 10 years of cohabitation
77
Combination of CXR with this for a more sensitive and accurate test
Symptom screening
78
Gold standard and reference for mycobacterial confirmation
TB culture
79
Diagnostic yield of sputum when spontaneously expectorated
15%
80
Diagnostic yield of sputum when induced
21%
81
Percentage of disease detected by a third sputum collection
2.8%
82
Preferred diagnostic microscopy for DSSM
LED microscopy

Preresidency (17 decks)

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