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Preresidency > Philippine TB Guidelines > Flashcards

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
Q

Monitoring of treatment in new patients

A

1 DSSM at end of 2nd, 5th and 6th months (bacteriologic) and at the end of 2nd month (clinical)

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26
Q

Recommendation for non-converters

A

Do not extend intensive phase
Start with continuation phase after two months
Do DSSM after 3rd month
Test for Rif sensitivity if still positive

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27
Q

Treatment failure if smear positive after

A

5th month of treatment

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28
Q

Monitoring of treatment in retreatment cases

A

1 DSSM at end of 3rd, 5th and 8th months for both

If smear positive after 3rd month, do GeneXpert

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29
Q

Recommendation for liver function test monitoring

A

Not routine in asymptomatic patients

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30
Q

When to check LFTs again after abnormal baseline

A

2 - 4 weeks after

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31
Q

When to stop TB treatment when abnormal liver enzymes are present?

A

> 3x ULN ALT with symptoms or > 5x ULN if without symptoms

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32
Q

Reintroduction of TB drugs

A

< 2x ULN ALT
Rifampin (with or w/o ethambutol) then INH 3 - 7 days later
Pyrazinamide permanently discontinued

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33
Q

Food intake and anti TB drugs

A

Affects bioavailability

34
Q

Management of generalized rash, fever and mucous involvement due to TB drugs

A

Stop all drugs at once!

35
Q

Reintroduction of drugs in cutaneous drug events

A

One by one in 3 - 7 day intervals
Reintroduced when cutaneous symptoms have improved
Rifampicin introduced last to PLHIV

36
Q

Recommended vitamins

A

Vitamin B complex

37
Q

To-do before ethambutol initiation

A

Baseline Snellen visual acuity assessment and color perception testing

38
Q

Treatment of miliary tuberculosis

A

Follows that for new and retreatment PTB cases

39
Q

CXR only used for

A

Monitoring co-existing conditions and treatment complications

40
Q

Role of lymph node excision in TB lymphadenitis

A

Not routinely recommended

41
Q

TB pericardial effusion treatment

A

Open drainage

42
Q

Surgery in pleural TB

A

Pigtail catheter drainage and decortication

43
Q

Surgery in GITB

A

Ulceration, gut obstruction or fistula formation

44
Q

Surgery in liver TB

A

Percutaneous aspiration of abscesses
Hepatectomy if with risk of malignancy
Biliary decompression if with obstructive jaundice

45
Q

Treatment of INH-associated neuropathy

A

50 - 100 mg pyridoxine

Vitamin B6 10 mg daily with anti-TB meds as prophylaxis

46
Q

Treatment of ethambutol toxicity

A

Discontinue drug and refer to Ophtha

47
Q

Streptomycin toxicity and management

A

Ototoxicity

Cease drug and refer to ENT

48
Q

When to request serum UA

A

When patients are symptomatic on pyrazinamide

Discontinue then resume treatment once symptoms abate

49
Q

Drugs to discontinue in nephrotoxicity

A

Streptomycin and rifampicin

50
Q

When are patients considered non-infectious

A

14 days of treatment with clinical improvement if bacteriologically confirmed
5 days of treatment with clinical improvement if clinically diagnosed

51
Q

Corticosteroids in TB meningitis and pericarditis

A

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
Q

Diagnosis of DR-TB

A

Drug Susceptibility Testing
GeneXpert
Line Probe Assay

53
Q

Risk factors for presumptive drug resistant TB

A
  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
Q

Definition of Cured DR-TB

A

18 months of treatment without evidence of failure AND three or more consecutive negative cultures taken 30 days apart after intensive phase.

55
Q

Definition of Treatment Failure in DR-TB

A

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
Q

HIV and TB

A

All PLHIV should be screened for TB.

57
Q

Initial diagnostic test in PLHIV suspected of having TB

A

GeneXpert

58
Q

P. jireoveci prophylaxis in HIV

A

Cotrimoxazole 800/160 for ANY CD4 count.

59
Q

Treatment of TB when liver cirrhosis is present

A

COMPENSATED
2HRES/6HR
2HSE/10HE
9HRE

60
Q

Treatment of TB when renal dysfunction is present

A

2HRZE/4HR (adjusted)
Given after HD
Given regardless of time in PD

61
Q

When to start treatment if patient has both HIV and TB

A

After second week of TB treatment regardless of CD4 count.

For TB meningitis, ARV after intensive phase of TB treatment

62
Q

Preferred NNRTI for HIV patients on TB treatment

A

Efavirenz

Nevirapine causes drug-drug interaction

63
Q

Routine screening for these high risk groups

A

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
Q

Method of screening high risk groups

A

TST

Add IGRA if RA with biologicals use

65
Q

Recommended treatment for LTBI

A

INH 300mg for 6 months

66
Q

Recommendations for face mask user around TB patients

A

Use surgical masks around presumed TB until deemed non infectious
No benefit for double mask
N95 the best!

67
Q

Screening for household contacts of known TB cases

A

At least a CXR

68
Q

High risk populations for TB

A

Smokers
Alcoholics (> 40 g/day)
Underweight (BMI < 20)

69
Q

BCG re-vaccination

A

Not recommended

70
Q

Definition of recent TB infection

A

Less than two years ago

71
Q

Periodic monitoring

A

CXR after 4 - 6 months

72
Q

When to put a patient in isolation

A
  1. Bacteriologically confirmed TB not started treatment

2. Cases of DR/MDR/XDR TB

73
Q

Patient with both PTB and EPTB classified as?

A

PTB

74
Q

Age cut-off for adults in TB guidelines

A

15 and up

75
Q

How long cough for evaluation of TB?

A

2 weeks

76
Q

Factors independently associated with risk of household contacts of developing TB

A

Old age
History of TB
> 10 years of cohabitation

77
Q

Combination of CXR with this for a more sensitive and accurate test

A

Symptom screening

78
Q

Gold standard and reference for mycobacterial confirmation

A

TB culture

79
Q

Diagnostic yield of sputum when spontaneously expectorated

A

15%

80
Q

Diagnostic yield of sputum when induced

A

21%

81
Q

Percentage of disease detected by a third sputum collection

A

2.8%

82
Q

Preferred diagnostic microscopy for DSSM

A

LED microscopy

Preresidency (17 decks)

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