pulm mycobacterial infxns

Question 1

where are nontuberculosus mycobacteria usu found?

Answer 1

water sources - natural water surface or from heating system

Question 2

in what populations does progressive lung disease due to nonTB mycobacteria typically occur?

Answer 2

COPD + bronchiectasis

Question 3

what are the typical nonTB mycobacteria? (3)

Answer 3

1. MAC
2. M. Kansasii
3. M Abessus

Question 4

Fibrocavitary disease in older male smokers with COPD and upper lobe predominance on x-ray-looks and acts like typical TB

Answer 4

MAC

Question 5

Fibronodular disease is typically seen in nonsmoking women over age 50 and without underlying lung disease-interstitial infiltrates and bronchiectasis

Answer 5

MAC

Question 6

what organism is found in tap water in cities, but not soil/natural water sources?

Answer 6

M. kansasii

Question 7

name that mycobacteria: Clinical characteristics include Caucasian, female, and median age 58, imaging has interstitial infiltrates w/ involvement of multiple lobes, rapid growing organisms (3)

Answer 7

M. fortuitum, M. chelonae, and M. absessus

Question 8

how to confirm dx of nonTB mycobacteria

Answer 8

2 pos sputum cultures

Question 9

how to tx MAC or m kansasii

Answer 9

Clarithromycin or azithromycin PLUS Rifampin PLUS ethambutol

Question 10

how long to tx someone with MAC of M kanasii?

Answer 10

12-18 mon

Question 11

which type of TB occurs with immediate onset of active disease?

Answer 11

priamry TB

Question 12

bilateral complex with lymphadenopathy on x-ray seen with?

Answer 12

ghon complex in primary TB

Question 13

what is the most frequent source of TB infxn?

Answer 13

latent TB

Question 14

how is latent TB dx’d?

Answer 14

1. pos PPD

2. IFN gamma release assay (quantiferon gold testing)

Question 15

should PPD be injected subcutaneously or intradermally?

Answer 15

intradermal

Question 16

the results of a PPD test are based on the size of the induration or the redness?

Answer 16

the size of the induration

Question 17

T or F: a positive TB skin tests documents active infxn

Answer 17

FALSE, a positive TB skin test documents infxn

Question 18

how is active TB dx’d?

Answer 18

clinical and radiographic findings

Question 19

can quantiferon gold test determine if TB infection is active or latent?

Answer 19

NOOO

Question 20

what ages should be given prophylactic tx when have a +PPD test?

Answer 20

prophylactic tx should be given regardless of age to +PPD

Question 21

what tx is given for prophylaxis?

Answer 21

isoniazid for 9 months

Question 22

fever, chills, cough, SOB, sputum, abnormalities on xray

Answer 22

high suspicion of TB

Question 23

to tx TB, must use at least ____drugs with documented acivity against the strain of TB

Answer 23

2

Question 24

what is included in the initial phase of TB tx?

Answer 24

8 weeks of daily INH, ethambutol, rifampin, and pyrazinamide

Question 25

if patient has negative sputum samples after 8 weeks of tx?

Answer 25

continue only rifampin+ INH for 4-7 months

Question 26

what is the phase of tx called that goes for 4-7 months after the initial 8 weeks of 4 drug regimen?

Answer 26

continuation phase follows the initial phase

Question 27

how is MDR TB defined?

Answer 27

lab confirmed resistance to 1st line drugs INH +RIF

Question 28

how is extensively drug resistant TB (XDR-TB) defined?

Answer 28

lab confirmed resistance to INH, RIF, quinolone resistance to at least 1 drug, and resistance to any of the injectable drugs amikacin/capreomycin/kanamycin