Pleural Effusion and PTB

Question 1

The membrane covering the lungs

Answer 1

Visceral pleura

Question 2

The membrane covering the surface of the chest wall

Answer 2

Parietal pleura

Question 3

Are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing

Answer 3

Pleura

Question 4

The inflammation of both layers of the pleurae

Answer 4

Pleurisy/ Pleuritis

Question 5

A collection of fluid in the pleural space

Answer 5

Pleural effusion

Question 6

The normal pleural fluid amount

Answer 6

10-20 ml

Question 7

Why is there a need to have a small amount of fluid in the pleural space?

Answer 7

That fluid acts as a lubricant that allows the pleural surfaces to move without friction

Question 8

Is performed to remove fluid, to obtain a specimen for analysis, and to relieve dyspnea and respiratory compromise caused by pleural effusion

Answer 8

Thoracentesis

Question 9

Mode of transmission of PTB

Answer 9

Airborne, through an infected person’s cough, sneeze, laugh

Question 10

An infectious disease caused by M.tuberculosis that primarily affects the lung parenchyma but can also affect the meninges, kidneys, bones, and lymph nodes

Answer 10

Pulmonary Tuberculosis

Question 11

The causative agent of PTB

Answer 11

Mycobacterium tuberculosis

Question 12

Risk factors of PTB

Answer 12

TBRISK- CPH
Tight living quarters
Below or at the poverty line
Refugee (immigrant)
Immune system compromised
Substance abusers
Kids below 5 years old
Close contact
Pre-existing med condition
Health worker

Question 13

Signs and Symptoms of PTB

Answer 13

Low- grade fever
night sweats
cough more than 3 weeks
weight loss

Question 14

Initial host defense against PTB

Answer 14

Mucociliary System (mucus and cilia)
Mucus catches the foreign substance, the cilia navigates the mucus and its entrapped particles upward for removal

Question 15

Immune system reacting on PTB

Answer 15

Alveolar macrophages- engulf the bacteria
Mycobacterial Lipoarabinomannan- macrophage receptor
Complement protein C3- binds with the cell wall and enhances recognition of the mycobacteria by macrophages

Question 16

Are readily available phagocytic cells that combat many pathogens without requiring previous exposure to the pathogens

Answer 16

Macrophages

Question 17

How long is the bacterial cell division after being ingested by macrophages?

Answer 17

25 to 32 hours

Question 18

Produced by macrophages in an attempt to degrade the bacteria (in PTB)

Answer 18

proteolytic enzymes

cytokines

Question 19

Assessment and Diagnostic Findings for PTB

Answer 19

History, physical examination
Mantoux test/ Tuberculin skin test
Chest x-ray
Acid-fast bacillus smear
Sputum culture and sensitivity

Question 20

A tool for screening for TB and for TB diagnosis. Named after Charles Mantoux

Answer 20

Mantoux test/ tuberculin skin test

Question 21

An inactivated purified protein fraction obtained from a human strain of mycobacterium tuberculosis and antigen that induces a delayed hypersensitivity response after a few hours following administration

Answer 21

PPD- purified protein derivatives

Question 22

Determines if someone has developed an immune response to the bacterium that causes tuberculosis

Answer 22

PPD test

Question 23

Interpretation of results of the tuberculin test

Answer 23

0-4 mm- not significant
5 mm greater- positive for patients, does not necessarily mean that active disease is present in the body
10mm greater- patient exposed to m.tuberculosis or has been vaccinated with BCG vaccine,

Question 24

Does positive result PPD indicate active TB?

Answer 24

No, not always. Need to perform cxr and sputum culture

Question 25

Classifications of TB

Answer 25

Class 0: no exposure; no infection
Class 1: exposure; no evidence of infection
Class 2: latent infection; no disease (positive PPD but no clinical evidence of active TB)
Class 3:disease; clinically active
Class 4: disease; not clinically active
Class 5: suspected disease; diagnosis pending

Question 26

Resistance to one of the first- line anti tuberculosis agents in a person who has not had previous treatment

Answer 26

Primary drug resistance

Question 27

Resistance to one or more anti tuberculosis agents in a patient undergoing therapy

Answer 27

Secondary or acquired drug resistance

Question 28

Resistance to two agents: INH and rifampin

Answer 28

Multidrug resistance

Question 29

Where do you put a patient with possible TB?

Answer 29

Private room with negative pressure

Question 30

COntinue isolation until sputum smears are negative for ______.

Answer 30

3 consecutive determinations; usually after approximately every 2-4 weeks

Question 31

The five first-line medications for PTB

Answer 31

PERIS
Pyrazinamide
Ethambutol
Rifampin
Isoniazid (INH)
Streptomycin

Question 32

After 8 weeks of this medication regimen, _______ can be discontinued and _____ and ______ are administered for an additional 4 months.

Answer 32

Pyrazinamide

INH and rifampin