Pulmo Flashcards
Innervation of the diaphragm
Phrenic nerve
Nerve roots of origin of phrenic nerve
C3,4,5
Most common location of Morgagni hernia
Right anterior
Most common site of Bochdalek hernia
Left posterior
Most common congenital diaphragmatic hernia
Bochdalek
Neutrophil-derived elastase that destroy lung parenchyma is inhibited by
α1-antitrypsin
Source of resistance in inspiration that is being reduced by surfactant
Compliance resistance
Pathology of adult RDS
Diffuse alveolar damage
Most common cause of adult RDS
Sepsis
Type of pneumocytes affected in adult RDS
Type I pneumocytes
Lung volumes (4)
1) IRV
2) TV
3) ERV
4) RV
Lung capacities
1) Inspiratory capacity
2) Functional residual capacity
3) Vital capacity
4) Total lung capacity
Capacity-associated volumes: Inspiratory capacity
IRV + TV
Capacity-associated volumes: Functional residual capacity
ERV + RV
Capacity-associated volumes: Vital capacity
IRV + TV + ERV
Equilibrium point at which the elastic recoil of the lungs is equal and opposite to the outward force of chest wall
FRC
Best zone of ventilation in children
Mid to lower lung fields
Ghon’s focus is usually found at which lung fields
Mid to lower lung fields
States that partial pressure exerted by a gas in a mixture of gases is proportional to the fractional concentration of that gas
Dalton’s law
Most common cause of V/Q mismatch
Hypoxemia
Fick’s law of diffusion states that diffusion rate of oxygen across pulmonary membrane depends on
1) Pressure gradient
2) Surface area
3) Diffusion distance
Processes that impair O2 diffusion
1) Decreased O2 gradient (high altitude)
2) Decreased surface area (emphysema)
3) Increased diffusion distance (pulmonary fibrosis)
Cardiac output at rest
5L/min
V/Q ratio at zone 1
3.3
V/Q ratio at zone 2
1.0
V/Q ratio at zone 3
0.6
CO2 is converted to carbonic acid: Inside the RBC vs outside the RBC
Inside
Direction of flow of Cl in chloride shift
Into RBC
Direction of flow of HCO3 in chloride shift
Out of RBC
Dorsal and ventral respiratory groups are found in
Medulla
Pneumotaxic and apneustic centres are found in
Pons
Controls basic rhythm of respiration
DRG
Stimulates expiratory muscles
VRG
Most preventable cause of death among hospitalized patients
Pulmonary embolism
Embolus that occlude the main pulmonary artery, impact across bifurcation
Saddle embolus
Embolus that pass through inter arterial and inter ventricular defect to gain access to the systemic circulation
Paradoxical embolus
Most common cause of PE
Proximal leg DVT
T/F Majority of deep leg vein thrombi are clinically silent
T
% of deep leg vein thrombi that cause infarction
10
Lobe most commonly affected by PE
Lower lobe
% of pulmonary circulation that has to be obstructed to cause sudden death
> 60
% chance of having a second embolus in PE survivors
30
Virchow’s triad
SHE
1) Stasis
2) Hypercoagulability
3) Endothelial injury
Natural anticoagulants in the body
1) Protein C
2) Protein S
3) AT III
Most commonly inherited thrombophilic condition
Factor V Leiden mutation
Major risk factors for PE (5)
1) Post op
2) Prior VTE
3) CVA
4) Estrogen treatment
5) APAS
PE: Most common history
Unexplained breathlessness
PE: Most common symptom
Dyspnea
PE: Most common sign
Tachypnea
Symptoms of massive PE (4)
1) Dyspnea
2) Hypotension
3) Cyanosis
4) Syncope
Symptoms of small PE (3)
1) Pleuritic pain
2) Cough
3) Hemoptysis
Most common history of DVT
Cramp in the lower calf
Most common signs and symptoms of DVT (4)
1) Swelling
2) Pain
3) Erythema
4) Warmth
Classic findings/signs in PE (3)
1) Homans sign
2) Moses sign
3) Palpable cord sign
Pain elicited when calf muscle is compressed against the tibia but none when compressed from side to side
Moses sign or Bancroft sign
Pain of the calf muscle on compression either by squeezing or forced dorsiflexion
Homans sign
Asymmetry in tolerance to pressure of 180mmHg applied on each calves simultaneously
Lowenberg sign
Gold standard for diagnosis of DVT
Contrast venography
Most reliable criterion for DVT on contrast venography
Constant intraluminal filling defect
Natural history of DVT (3)
1) Progressive proximal extension
2) Complete/partial dissolution
3) Embolization
PE on ECG
S1Q3T3
PE: Most common ECG abnormality
T wave inversion in leads V1-V4
Primary criterion for DVT on venous ultrasonography
Loss of vein compressibility
PE on x-ray: Focal oligemia
Westermark sign
PE on x-ray: Peripheral wedge-shaped density above the diaphragm
Hampton hump
PE on x-ray: Enlarged right descending pulmonary artery
Palla sign
PE on x-ray: Prominent central artery
Fleischner sign
Principal imaging test for diagnosis of PE
Chest CT with IV contrast
RV enlargement on chest CT with contrast indicates
Increase likelihood of death within the next 30 days
Most common radiographic abnormalities of PE (2)
1) Atelectasis
2) Pulmonary opacities
PE on ABG
1) Hypoxemia
2) Hypocarbia
PE on 2D echo
RV pressure overload
The Great Masquerader
PE
Virchow’s triad is a predisposing factor to
DVT
PE: Prevention
Heparin
PE: Acute management
Unfractionated heparin
PE: Long-term prevention of recurrence
Warfarin
Substance used in lung scanning
Albumin-labeled gamma-emitting radionuclide
PE: High-probability lung scan
2 or more segmental perfusion defects in the presence of normal ventilation
Best known indirect sign of PE on 2D Echo
McConnell sign
Hypokineses of RV free wall with normal motion of RV apex
McConnell sign
Definitive diagnosis of PE
Pulmonary angiography
Finding of PE on pulmo angio
Intraluminal filling defect in more than 1 projection
Target aPTT in unfractionated heparin therapy for PE
2-3x upper limit of laboratory normal value
Major disadvantage of unfractionated heparin therapy
Repeated blood sampling for dose adjustment every 4-6 hrs
Unfractionated heparin therapy for PE increases the risk for
Heparin-induced thrombocytopenia
Advantage of low molecular weight heparin over unfractionated heparin
No monitoring or dose adjustment needed unless patient is markedly obese or has CKD
Monotherapy for symptomatic VTE patients with cancer
Dalteparin
Anti-Xa
1) Fondaparinux
2) Rivaroxaban
Advantages of Fondaparinux (2)
1) Once-daily subcutaneous injection
2) No lab monitoring
Novel drugs for prevention of VTE after total hip and total knee replacement
1) Rivaroxaban
2) Dabigatran
Dabigatran MOA
Direct thrombin inhibitor
Most serious complication of anticoagulation
Hemorrhage
Management for life-threatening or intracranial haemorrhage due to heparin or LMWH
Protamine sulfate
Anticoagulant for patients with renal insufficiency
Argatroban
Anticoagulant for patients with hepatic failure
Lepirudin
2 principal indications for IVC filter insertion
1) Active bleeding that precludes anticoagulation
2) Recurrent venous thrombosis despite intensive anticoagulation
Lower rate of death and recurrent PE
Fibrinolysis
Preferred fibrinolytic regimen for PE
100mg rtPA as continuous IV infusion over 2 hours
Patient with PE respond to fibrinolytics up to ___ after PE has occurred
14 days
Contraindications to fibrinolysis
1) Intracranial disease
2) Recent surgery
3) Trauma
Mode of transmission of pTB
Droplet nuclei
Most common and important agent of human disease
MTb
T/F Majority of inhaled MTb bacilli reach the alveoli
F
Survival of MTb in macrophages depend on
Reduced acidification due to lack of accumulation of proton-adenosine triphosphate
Why MTb do not die in macrophages
Inhibits intracellular release of Ca resulting in impaired Ca/calmodulin pathway that lead to phagosome-lysosome fusion
T/F Primary PTB may be asymptomatic
T
Lesion formed in PTb after initial infection that heals spontaneously into a small calcified nodule
Ghon focus
The Ghon focus is pathologically
Subpleural granuloma
Most common site of extra pulmonary TB in children
Hilar LN
Clinical finding of PTb in young children and impaired immunity
Pleural effusion
Most common population of post primary disease
Public school teachers
Responsible for the acid-fastness of MTb
Mycolic acid
Caseous necrosis in MTb infection is due to
Phosphatides
Common location of secondary PTb lesion
1) Apical and posterior segment of upper lobes
2) Superior segments of lower lobes
Pneumonia in PTb that results from massive involvement of pulmonary segments or lobes
Caseating pneumonia
Gold standard for diagnosis of PTb
Mycobacterial culture
Duration required for expected growth in mycobacterial culture
4-6 weeks
Medium for PTb culture
Egg- or agar-based medium, Lowenstein-Jensen or Middlebrook 7H10
Temp for PTb culture
37C
CO2/O2 for Middlebrook medium in PTb culture
5% CO2
Decreases the time for bacteriologic confirmation of TB to 2-3 weeks
Immunochromatographic lateral flow assay
Most useful for the rapid confirmation of TB in persons with AFB-positive, AFB-negative, and extrapulmonary smears
Nucleic acid amplification
MTb isolates should be tested for susceptibility to which drugs to detect MDR Tb
1) Isoniazid
2) Rifampin
When MDR-Tb is found, expanded susceptibility testing should be done against which drugs
Fluoroquinolones and injectable drugs
Tuberculin reaction is what type of hypersensitivity
Type IV
Positive tuberculin reaction size in mm: HIV infected
> =5
Positive tuberculin reaction size in mm: On immunosuppressive therapy
> =5
Positive tuberculin reaction size in mm: Low risk persons
> =15
Positive tuberculin reaction size in mm: High-prevalence ares
> =10
Positive tuberculin reaction size in mm: Malnutrition
> =10
Positive tuberculin reaction size in mm: Steroids
> =10
Positive tuberculin reaction size in mm: Close contact with Tb patients
> =5
Positive tuberculin reaction size in mm: Fibrotic lesions on chest radiography
> =5
Positive tuberculin reaction size in mm: Recently infected persons (2 years)
> =10
Positive tuberculin reaction size in mm: Persons with high-risk medical conditions
> =10
Recommended daily dose: INH
5 mg/kg, max 300 mg
Recommended daily dose: RIF
10 mg/kg, max 600 mg
Recommended daily dose: PYR
25 mg/kg, max 2g
Recommended daily dose: Ethambutol
15 mg/kg
First pulmonary infection to set in in patients with HIV infection
PTb
PTB treatment regimens: New smear- or culture-positive
2HRZE/4HR (6 months)
PTB treatment regimens: New culture-negative
2HRZE/4HR (6 months)
PTB treatment regimens: Pregnancy
2HRE/7HR (9 months, no pyrazinamide)
PTB treatment regimens: Relapse
2HRZES/1HRZE/5HRE (8 months, with S during induction)
PTB treatment regimens: Treatment default
3 HRZES/5HRE (8 months, 3 months induction with S)
PTB treatment regimens: Treatment failure, resistance or intolerance to H
6RZE
PTB treatment regimens: Treatment failure, resistance or intolerance to R
12-18 mos HZEQ
PTB treatment regimens: Treatment failure, resistance or intolerance to H and R
20 mos ZEQ + S or another injectable
PTB treatment regimens: Resistance to all first line drugs
20 mos 1 injectable + 3 of cycloserine, ethionamide, Q, PAS
PTB treatment regimens: Intolerance to Z
2 mos HRE, 7 mos HR
Duration of cough to suspect PTb
2 weeks
Initial work-up of choice for PTB
Sputum AFB
At least how many sputum specimens should be sent for sputum AFB
2
Preferred number of sputum specimens to be sent for sputum AFB
3
Most efficient way of identifying cases of PTB
Sputum AFB
Diagnostic modality for PTB that correlated with infectiousness
Sputum AFB
TB culture with drug susceptibility testing (DST) is primarily recommended for what population of patients
High risk for drug resistance
TB culture is recommended for which population of smear positive patients (5)
1) Retreatment
2) Treatment failure
3) MDR-TB suspect
4) Household contacts of patients with MDR-TB
5) HIV
PTB drugs: Dosing during initial phase
Daily
PTB drugs: Dosing during continuation phase
3x a week
PTB relapse case is defined as
Previously treated with 1 full course under DOT and declared cured or treatment completed and has become smear positive again
T/F Relapses after a previous regimen under DOT have the same drug susceptibilities as initial isolates
T
Management for symptomatic patients who were not on DOTS in the previous treatment (2)
1) TB culture with DST
2) 2HRZES/1HRZE/5HRE
PTB treatment failure case is defined as
While on treatment, remained or became smear (+) again at 5th month of treatment or later OR smear (-) at the start and becomes smear (+) at the 2nd month
T/F BCG vaccination is recommended for adults to confer protection
F
T/F Empiric treatment with various anti-TB drugs is recommended for suspected MDR-TB cases
F
Recommended management for MDR-TB cases
Immediate referral to PMTM program
Preferred mode of administration of anti-TB drugs
FDC
Recommended adjunctive therapy for PTB (3)
1) Arginine
2) Vitamin A
3) Zinc
MDR-TB is defined by the WHO as
In vitro resistance to both HR
PTB case definitions: New
Never had treatment or previous anti-Tb for less than 4 weeks
PTB case definitions: Return to treatment after default
Stopped taking meds for >=2 mos and comes back smear (+)
PTB case definitions: Transfer-in
Management started from another area and now transferred to a new clinic
Management for PTB treatment failure case
2HRZES/1HRZE/5HRE
PTB case definitions: Chronic case
Became or remained smear (+) after completing a fully-supervised RETREATMENT regimen
WHO case definitions of TB: Latent TB
TB infection, no evidence of disease
WHO case definitions of TB: Active TB
Clinically active TB
PTB case definitions: 2 weeks or more of cough with or without accompanying symptoms
TB symptomatic
3-specimen collection for AFB smear
1-Spot at time of consultation
2-Early morning
3-Second spot specimen when the patient comes back the next day
Recommended for patients who are unable to spontaneously bring up sputum for AFB
Sputum induction with nebulisation of a hypertonic saline
T/F After a TB symptomatic is found to be smear positive, no further tests are required to confirm the diagnosis of PTB
T
T/F T/F After a TB symptomatic is found to be smear positive, no further tests are required to initiate anti-TB therapy
T
T/F Chest radiographs are routinely necessary in the management of TB symptomatic patient who is smear positive
F
TB radiograph description: Minimal vs extensive - all or the greater portion of a lobe
Extensive
TB radiograph description: Minimal vs extensive - 4-cm cavity
Extensive
TB radiograph description: Minimal vs extensive - Multiple cavitations measure up to 4 cm
Extensive
TB radiograph description: Minimal vs extensive - Cavities less than 4cm
Extensive
Status asthmatics is defined as
Severe obstruction persisting for days or weeks
Asthma: Single largest risk factor
Atopy
Asthma: Most atopic patients have allergic sensitisation to
Dust mite
Major risk factors for asthma deaths (3)
1) Poorly controlled disease
2) Lack of corticosteroid therapy
3) Previous admissions to hospital with near-fatal asthma
Chronic inflammatory disease of airways characterised by increased responsiveness of the tracheobronchial tree to various stimuli
Asthma
Most severe form of asthma
Status asthmaticus
Asthma: Peak age
3
Asthma: Male-to-female ratio
M
Asthma: Sex ratio equalises by
30 y/o
Asthma: Drug implicated as a risk factor for asthma
Acetaminophen
Asthma: Relation between breastfeeding during infancy and risk of childhood asthma
Reduces risk
Hallmark of asthma
Airway hyperresponsiveness to both specific and nonspecific stimuli
Types of asthma
1) Allergic/extrinsic
2) Idiosyncratic/intrinsic
Allergic vs idiosyncratic asthma: Associated with personal and/or family history of allergic diseases
Allergic
Allergic vs idiosyncratic asthma: No defined immunologic mechanism
Idiosyncratic
Allergic vs idiosyncratic asthma: Precipitated by upper respiratory infections
Idiosyncratic
Allergic vs idiosyncratic asthma: Precipitated by exercise
Idiosyncratic
Allergic vs idiosyncratic asthma: IgE-mediated
Allergic
Allergic vs idiosyncratic asthma: Precipitated by GER
Idiosyncratic
Allergic vs idiosyncratic asthma: Precipitated by cold air
Idiosyncratic
Allergic vs idiosyncratic asthma: Precipitated by tobacco smoke
Idiosyncratic
Allergic vs idiosyncratic asthma: Precipitated by dust mites
Allergic
Allergic vs idiosyncratic asthma: Precipitated by Cockroaches
Allergic
Allergic vs idiosyncratic asthma: Precipitated by animal dander especially CATS
Allergic
Allergic vs idiosyncratic asthma: Precipitated by pollutants
Idiosyncratic
Allergic vs idiosyncratic asthma: Precipitated by sulfites in food
Idiosyncratic
Allergic vs idiosyncratic asthma: Precipitated by emotional stress
Idiosyncratic
Allergic vs idiosyncratic asthma: Precipitated by pharmacologic agents
Idiosyncratic
Allergic vs idiosyncratic asthma: Precipitated by seasonal pollen
Allergic
Most common trigger for allergic asthma
Atopy
Most common trigger for idiosyncratic asthma
Pulmonary infection
Ciliated columnar cells sloughed from bronchial linings seen in sections of lungs of asthmatic patients
Creola bodies
Characteristic physiologic abnormality of asthma
Airway hyperresponsiveness
The only asthma stimulus that can produce constant symptoms
Respiratory viruses
Common agents of viral pneumonia in children
1) RSV
2) Parainfluenza
Common agents of viral pneumonia in older children and adults
1) Rhinovirus
2) Influenza
Classic triad of asthma
1) Wheezing
2) Dyspnea
3) Cough
Typical attack of asthma occurs
At night
Characteristic INITIAL wheeze
Expiratory
2 signs that are very valuable in indicating severity of obstruction in asthma
1) Accessory muscles become visibly active
2) Paradoxical pulse
Second wave of bronchoconstriction in 30-50% of allergic asthma cases occurs when
6-10 hours later
Heart rate in asthmatic patients with IMPENDING RESPIRATORY FAILURE
Relative bradycardia
T/F Heart rate in asthma increases with severity
T
Pulsus paradoxus is defined as
Markedly decreased pulse during inhalation
Pulsus paradoxus in moderate episode of asthma
10-25 mmHg
Pulsus paradoxus in severe episode of asthma
> 25 mmHg
Absence of wheezing in asthma indicates
Impending respiratory failure
Indicators of asthma severity
1) Heart rate
2) Respiratory rate
3) Pulsus paradoxus
4) Use of accessory muscles
Most useful measures (pulmonary function test parameters) to show initial airflow obstruction and reversibility with bronchodilator
1) Peak flow
2) FEV1
Curschmann spirals and Charcot Leyden crystals are seen in what specimen
Sputum
Typical acid-base imbalance seen with asthma
Respiratory alkalosis
Acid-base imbalance in asthma that indicates impending respiratory collapse
Metabolic acidosis
ECG findings in asthma
1) Right axis deviation
2) RBBB
3) Right ventricular hypertrophy with depolarisation abnormalities
Reversiblity of asthma is seen on PFT as
> =12% and 200 mL increase in FEV1 15 minutes after 2 puffs of SABA
Asthma: Assessment of symptom control is assessed over what duration
4 weeks
Asthma: Parameters to assess control
1) Daytime symptoms >2x a week
2) Night awakenings
3) Use of reliever >2x a week
4) Activity limitation
Asthma: Comorbidities
1) Rhinitis
2) Rhinosinusitis
3) GERD
4) Obesity
5) Obstructive sleep apnea
6) Depression
7) Anxiety
Asthma: Well-controlled if
None of 4 control parameters present
Asthma: Partly-controlled if
1-2 of control parameters present
Asthma: Uncontrolled if
Asthma: 3-4 of control parameters present
Asthma execerbation, mild/mod vs severe vs life-threatening: Talks in words
Severe
Asthma execerbation, mild/mod vs severe vs life-threatening: RR less than 30
Mild/mod
Asthma execerbation, mild/mod vs severe vs life-threatening: Pulse 100-120
Mild/mod
Asthma execerbation, mild/mod vs severe vs life-threatening: Peak expiratory flow >50% predicted or best
Mild/mod
Asthma execerbation, mild/mod vs severe vs life-threatening: Use of accessory muscles
Severe
Asthma execerbation, mild/mod vs severe vs life-threatening: Drowsy
Life-threatening
Asthma excerbation, management: Mild/mod (3)
1) SABA q20 x 1hr
2) Prednisolone
3) Controlled O2
Asthma excerbation, management: Target O2 sat
93-95%
Asthma excerbation, management: Severe asthma
Admit to acute care facility
Disease state characterised by airflow limitation that is not fully reversible
COPD
Anatomically defined condition characterised by destruction and enlargement of lung alveoli
Emphysema
Clinically defined condition with chronic cough and phlegm
Chronic bronchitis
Significant risk factor for emphysema in both smokers and non-smokers
Coal mine dust
Most common form of severe α1 antitrypsin deficiency
2 z alleles or 1 z and 1 null allele
COPD susceptibility determinants (2)
1) Hedgheog interacting protein gene on chromosome 4
2) Cluster of genes on chromosome 15
Portions of lung affected by emphysema
Distal to the terminal bronchioles
Emphysema: Most common type associated with smoking
Centriacinar
Emphysema: Type most commonly associated with α1 antitrypsin
Panacinar
Emphysema, type: Distal alveoli spared; affects central/proximal parts of acini
Centrilobular
Emphysema, type: Affects all structures from acini to terminal alveoli
Panacinar
Emphysema, type: Most often associated with spontaneous pneumothorax
Paraseptal
Emphysema, type: Associated with scarring
Irregular
Emphysema, type: Target O2 sat
88-92%
Emphysema, type: When to repeat ABG after starting O2 supplementation
30-60 mins after
Best diagnostic procedure for lymph node Tb
Excisional biopsy
Portion of lung affected by bronchiectasis
Proximal to terminal bronchioles
Characteristic sign in bronchiectasis
Foul-smelling purulent sputum
Honeycomb lung
??? Bronchiectasis
Bronchiectasis: Most common location
Lower lobes bilaterally
Phases of ARDS: Hyaline membranes
Exudative phase (first 7 days)
Phases of ARDS: Interstitial inflammation
Proliferative phase
Phases of ARDS: Fibrosis
Fibrotic phase
Pneumonia: 2 types
1) Bronchopneumonia2) Lobar pneumonia
Pneumonia, CXR finding: Bronchopneumonia
Patchy consolidation
Pneumonia: Accounts for majority of lobar pneumonia
S. pneumonia
Pneumonia: Most common etiology of atypical pneumonia
M. pneumonia
Particle size: Deposited in areas with largely turbulent airflow (nose and upper airways)
> 10mm
Particle size: Deposited in trachea and bronchi
3-10mm
Particle size: Deposited in terminal airways and alveoli
1-5mm
Particle size: Remain suspended in inspired air
Less than 1mm
Pores implicated in spread of pneumonia within an entire lobe
Pores of Kohn
Stages of pneumonia in order
1) Congestion2) Red hepatization3) Gray hepatization4) Resolution
Stage of pneumonia characterised by enzymatic digestion
Resolution
Stage of pneumonia characterised by red vascular engorgement
Congestion
Stage of pneumonia characterised by few neutrophils and macrophages
Congestion
Stage of pneumonia characterised by disintegration of red cells
Gray hepatization
Stage of pneumonia characterised by exudation of RBCs
Red hepatization
Stage of pneumonia characterised by red, firm, airless, liver-like consistency
Red hepatization
Stage of pneumonia characterised by fibrinosuppurative exudate
Gray hepatization
Stage of pneumonia characterised by dry surface
Gray hepatization
Atypical pneumonia is characterized by
Lack of alveolar exudate and presence of interstitial pneumonitis
Atypical pneumonia is aka
Walking pneumonia
Causative agents of atypical pneumonia
1) M. pneumonia2) Chlamydia psittaci3) Coxiella burnetti4) Legionella pneumophila
Causative agent of Q fever
Coxiella burnetti
Agent of SARS
SARS coronavirus
Superbugs are susceptible only to
1) Polymyxins2) Tigecycline
Enzyme present in superbugs
NDM-1 (New Delhi metallo-beta lactamase 1
NDM-1 was first isolated in an isolate of
K. pneumoniae
T/F Tuberculous intra-thoracic lymphadenopathy (mediastinal and/or hilar) or tuberculous pleural effusion, without radiographic abnormalities in the lungs, constitutes a case of extrapulmonary TB
T
T/F PTB can be classified based on HIV status
T
Tb classification based on drug resistance: Monoresistance
Resistance to one first-line anti-TB drug only
Tb classification based on drug resistance: Polydrug resistance
Resistance to more than one first-line anti-TB drug (other than both isoniazid and rifampicin)
Tb classification based on drug resistance: Multidrug resistance
Resistance to at least both isoniazid and rifampicin
Tb classification based on drug resistance: Extensive drug resistance
Resistance to any fluoroquinolone and to at least one of three second-line injectable drugs (capreomycin, kanamycin and amikacin), in addition to multidrug resistance
Tb classification based on drug resistance: Rifampicin resistance
Resistance to rifampicin detected using phenotypic or genotypic methods, with or without resistance to other anti-TB drugs. It includes any resistance to rifampicin, whether monoresistance, multidrug resistance, polydrug resistance or extensive drug resistance
Treatment outcomes for TB: Cured
A pulmonary TB patient with bacteriologically confirmed TB at the beginning of treatment who was smear- or culture-negative in the last month of treatment and on at least one previous occasion
Treatment outcomes for TB: Treatment completed
A TB patient who completed treatment without evidence of failure BUT with no record to show that sputum smear or culture results in the last month of treatment and on at least one previous occasion were negative, either because tests were not done or because results are unavailable
Treatment outcomes for TB: Treatment failed
A TB patient whose sputum smear or culture is positive at month 5 or later during treatment
Treatment outcomes for TB: Died
A TB patient who dies for any reason before starting or during the course of treatment
Treatment outcomes for TB: Lost to follow-up
A TB patient who did not start treatment or whose treatment was interrupted for 2 consecutive months or more
Treatment outcomes for TB: Not evaluated
A TB patient for whom no treatment outcome is assigned. This includes cases “transferred out” to another treatment unit as well as cases for whom the treatment outcome is unknown to the reporting unit.
Treatment outcomes for TB: Treatment success
The sum of cured and treatment completed
