PPS Tb Guidelines

Question 1

MDR-Tb

Answer 1

Resistant to at least isoniazid and rifampin

Question 2

XDR-Tb

Answer 2

Resistant to HR + Fluoroquinolone + at least 1 second-line injectable agent (amikacin, kanamycin, and/or capreomycin)

Question 3

Primary mode of transmission of Tb bacilli

Answer 3

Airborne droplet nuclei

Question 4

Tb transmission from children aged less than ___ is rare, since most children cannot expectorate sputum

Answer 4

10

Question 5

Associated with virulence of Tb bacilli

Answer 5

1) Trehalose dimycolate (cord factor) 2) Sulfatides

Question 6

Responsible for morphologic appearance of cell serpentine cords of Tb bacilli in close, parallel arrangements

Answer 6

Cord factor

Question 7

Peripherally located glycolipids that inhibit fusion secondary lysosomes with Tb bacilli-containing phagosomes within a macrophage, possibly promoting INTRACELLULAR SURVIVAL of the organisms

Answer 7

Sulfatides

Question 8

Gold standard for diagnosis of Tb

Answer 8

Demonstration/isolation of the organism by culture

Question 9

Doubling time of Tb bacilli

Answer 9

18-24 hours

Question 10

Cells responsible for containment of Tb bacilli as local pulmonary infiltrates and hilarity adenopathy

Answer 10

Th1 cells

Question 11

Progression from Tb infection to Tb disease occurs in ___% of affected individuals

Answer 11

10

Question 12

Key risk factors for Tb (4)

Answer 12

1) Household contact with a newly diagnosed smear (+) case 2) Age less than 5 years 3) HIV infection 4) Immunocompromised state

Question 13

Size of the infective droplet nucleus of Tb

Answer 13

5 micra

Question 14

5 stages of pulmonary pathology of Tb

Answer 14

1) Scavenging non activated alveolar macrophages digest tb bacillus 2) (Symbiosis) Macrophage fails to destroy the bacillus undergoing replication destroying the macrophage; other macrophages are attracted leading to development of GRANULOMA 3) Increase in number of tubercle bacilli inhibited by development of CELL-MEDIATED IMMUNITY and DELAYED-TYPE HYPERSENSITIVITY 4a) Enlargement of tubercle and its caseous center with hematogenous spread in weak immunity 4b) Stabilization or regression of tubercle in hosts with strong immunity 5) CASEOUS CENTER LIQUEFACTION, extracellular bacillary growth, cavity formation, and bronchial dissemination

Question 15

Lung lesion of primary Tb

Answer 15

Ghon focus

Question 16

Most frequent site of scrofula

Answer 16

Nodes in the ANTERIOR TRIANGLE of the neck

Question 17

MCC of mortality from Tb in children below 3 years of age

Answer 17

Tb meningitis

Question 18

T/F Tb men is ALWAYS secondary to a tuberculous process elsewhere in the body

Answer 18

T

Question 19

Tb of the long bones usually start as

Answer 19

Area of endarteritis in the metaphysis of the long bone

Question 20

Pott’s disease has a predilection for

Answer 20

Lower thoracic, upper lumbar and lumbosacral vertebrae

Question 21

Tb of the joints is rare in children; it has a predilection for

Answer 21

Joints of the upper extremities with monoarticular involvement

Question 22

Initial radiographic picture of primary tb

Answer 22

Parenchymal infiltration accompanied by ipsilateral LN enlargement

Question 23

LN in this area appear to be the ones most often affected in Tb lymphadenopathy

Answer 23

Right upper paratracheal area

Question 24

Why the right upper paratracheal LN are most often affected in Tb lymphadenopathy

Answer 24

Lymphatic drainage of the lungs occurs predominantly from left to right

Question 25

Radiologic finding that clearly differentiates primary from post primary/reactivation tb

Answer 25

Hilar or paratracheal LN enlargement

Question 26

MC radiographic manifestation of reactivation pTB

Answer 26

Focal or patchy heterogeneous calcification in the apical and posterior segments of the upper lobes and superior segments of the lower lobes

Question 27

Radiologic hallmark of reactivation TB

Answer 27

Cavities

Question 28

Phemister triad

Answer 28

1) Juxtaarticular osteoporosis 2) Peripherally located osseous erosions 3) Gradual narrowing of interosseous space

Question 29

What is the Phemister triad

Answer 29

Characteristic radiologic finding in tuberculous arthritis

Question 30

Most specific finding in diagnosis of CNS Tb

Answer 30

Basal cistern hyperdensity

Question 31

MC complication of TB meningitis

Answer 31

Communicating hcp

Question 32

Vaccine category that may suppress tuberculin reaction

Answer 32

Live virus vaccine

Question 33

DOH HTP recommends that TST be delayed for ___ after a bout of measles, mumps, chicken pox, or whooping cough

Answer 33

2 months

Question 34

An induration of ___ is considered a (+) TST

Answer 34

≥10 mm

Question 35

An induration ≥5mm is considered a positive TST in the presence of

Answer 35

1) History of close contact with a known or suspected infectious case of TB 2) Clinical findings suggestive of Tb 3) CXR suggestive of TB 4) Immunocompromised condition

Question 36

Clinical manifestations which, when taken together, are most suggestive of childhood Tb disease

Answer 36

History of recent weight loss or failure to gain weight

Question 37

Spectrum of TB

Answer 37

1) Exposure 2) Infection 3) Disease

Question 38

Spectrum of TB: Exposed but no signs/symptoms, negative TST CXR sputum AFB and other diagnostics

Answer 38

Exposure or Class I

Question 39

Spectrum of TB: Only one with signs and symptoms

Answer 39

Disease or Class III

Question 40

Spectrum of TB: TST may be positive but negative in most children

Answer 40

Infection or Class II

Question 41

Anti Tb drugs: Bactericidal

Answer 41

H, R, Z (weakly), S

Question 42

Anti Tb drugs: Bacteriostatic

Answer 42

Ethambutol

Question 43

Anti Tb drugs: Inhibits nucleic acid synthesis

Answer 43

H, R

Question 44

Anti Tb drugs: Potent sterilizing activity within macrophages

Answer 44

Z

Question 45

Anti Tb drugs: Dose

Answer 45

HRZES in order: 10-15mg/kg, 10-20, 20-40, 15-25, 20-40

Question 46

Anti Tb drugs: Max dose

Answer 46

HRZES in order: 300mg, 600, 2g, 1.2g, 1g

Question 47

D/C INH if transaminase levels is ___ from normal or with hepatitis

Answer 47

>3.5x

Question 48

Adverse reactions to Streptomycin

Answer 48

1) Sterile abscess 2) Auditory function impairment

Question 49

Algorithm for Preventive Therapy of Childhood TB: TB exposure, less than 5 years old

Answer 49

INH x 3 months

Question 50

Algorithm for Preventive Therapy of Childhood TB: TB exposure ≥ 5 years old

Answer 50

Mantoux test, if (+) with radiologic findings plus signs and symptoms, treat as TB disease; if (+) with no radiologic findings, signs or symptoms, treat as latent TB infection; if (-) with no BCG scar, give BCG after 2 weeks

Question 51

After 3 months INH for TB exposure less than 5 years old

Answer 51

Repeat Mantoux test, if (-) with no BCG scar, give BCG after 2 weeks; if (+) with radiologic findings plus signs and symptoms, treat as TB disease; if (+) with no radiologic findings, signs or symptoms, treat as latent TB infection

Question 52

Treatment for latent TB infection

Answer 52

9-12 months INH including 3 months initially given for exposure

Question 53

Standard treatment for TB in pregnant women

Answer 53

HRZE

Question 54

Can a woman breastfeed while treating for TB

Answer 54

Breastfeeding is encouraged because only minimal amounts of the drug are excreted in breastmilk

Question 55

Treatment for mothers with latent TB infection

Answer 55

INH IMMEDIATELY WITHOUT DELAY

Question 56

T/F The mother who has current TB disease but has undergone treatment for 2 weeks or more is presumed to be no longer contagious at the time of delivery

Answer 56

T

Question 57

Management of newborn of mother with TB disease

Answer 57

Give INH for 3 months then TST; if TST (-) D/C INH and give BCG; if TST (+) with no radiographic findings, signs, and symptoms, complete 9 months of INH

Question 58

Recommended for infants whose mothers have TB disease and has not yet undergone treatment

Answer 58

1) Separation from mother 2) Give INH or rifampicin if INH-resistant for 3 months 3) Do TST, if (+) but CXR (-) complete 9 months of INH or RIF; if (-), repeat after 3 months

Question 59

Recommended for infants if CXR and TST of mother are negative and has completed treatment

Answer 59

Give BCG and D/C INH

Question 60

Treatment for congenital TB

Answer 60

2 HRZS, 4-7 HR