T4 - TB

Question 1

Which geographical areas have the highest prevalence of TB?

Answer 1

subsaharan africa and indian subcontinent

Question 2

which geographical areas have the highest prevalence of drug resistant TB?

Answer 2

russia and eastern europe

Question 3

what % of people will develop active TB within 5 years of exposure?

Answer 3

50%

Question 4

what are TB droplets deposited after they are inhaled from the air?

Answer 4

in the terminal air spaces

Question 5

what type of organism is TB described as?

Answer 5

acid fast bacillus

Question 6

what are two pathological appearances of TB?

Answer 6

• granulomatous inflammation

- central necrosis with caseation

Question 7

what cells are found in TB patients due to fusion of central infected macrophages?

Answer 7

giant cells

Question 8

what cytokines are secreted in TB and what do they do?

Answer 8

IFN gamma - activate macrophages to kill bacteria

Question 9

what two stains can be used for mycobacteria TB?

Answer 9

Ziehl neelsen stain or aura mine rhodamine stain

Question 10

how many more times are HIV patients at for developing TB?

Answer 10

x10

Question 11

what does smear positive TB indicate?

Answer 11

• can be seen down the microscope
• high disease burden
• high risk of transmission

Question 12

Is TB found only in the LNs transmissible?

Answer 12

no

Question 13

is TB found in the lungs and larynx transmissible?

Answer 13

yes

Question 14

what type of immune therapy can suppress the immune system that stop reactivation of TB?

Answer 14

Anti TNF therapy

Question 15

what is looked for when diagnosing latent TB?

Answer 15

immune response to TB proteins or specific antigens

Question 16

what two tests can be used to detect TB?

Answer 16

• tuberculin skin test (Mantoux)

- IFN gamma release assays

Question 17

what cells does the Mantoux test require to work?

Answer 17

circulating memory T cells

Question 18

what two things could cause a false negative on a Mantoux test?

Answer 18

immunosupression or being generally unwell

Question 19

what precedes an IFN release assay?

Answer 19

stimulation with TB specific antigens

Question 20

which TB test has a good correlate with TB exposure?.

Answer 20

IFN release assay

Question 21

does an IFN release assay differentiate between active and latent TB?

Answer 21

no

Question 22

what % of TB is pulmonary?

Answer 22

55%

Question 23

what are the main symptoms of pulmonary TB and how is it diagnosed?

Answer 23

Symptoms: cough, haemoptysis, chest pain, weight loss, fever, night sweats

Diagnosed: CXR and sputum sample

Question 24

what is seen on CXR in pulmonary TB?

Answer 24

upper lobe changes

Question 25

what may be seen on CXR in extra pulmonary TB?

Answer 25

hilar lymphadenopathy

Question 26

what are the three main things associated with TB lymphadenitis?

Answer 26

- gets worse on treatment - can form sinus tracts with chronic discharge - cold abscess formation

Question 27

what diagnostic test can be done for military TB with GI/CNS symptoms?

Answer 27

lumbar puncture to look for TB in the CSF

Question 28

what liver symptom is seen in 50% of miliary TB patients?

Answer 28

hepatomegaly

Question 29

is miliary TB usually acute or chronic onset?

Answer 29

acute

Question 30

what is seen on CXR for a patient with miliary TB?

Answer 30

nodular change and dots in lung fields

Question 31

what are the phases and duration of standard TB drug therapy?

Answer 31

- initial phase of quadruple therapy = 2 months | - followed by 4 months of dual therapy

Question 32

what are the phases and duration of CNS involved TB drug therapy?

Answer 32

- initial phase quadruple therapy = 2 months | - followed by 10 months of dual therapy

Question 33

what drugs make up quadruple therapy in TB?

Answer 33

isoniazid, rifampicin, pyraxinamide & ethambutol

Question 34

what drugs make up dual therapy in TB?

Answer 34

isoniazid and rifampicin

Question 35

what can be used to observe compliance to TB therapy?

Answer 35

video observed therapy or hospital admission if necessary

Question 36

what are the main treatment side effects caused by all drugs in quadruple therapy?

Answer 36

Nausea and vomiting and skin rashes

Question 37

what TB drug should not be given in ITU and why?

Answer 37

ethambutol as it can cause blindness which cannot be monitored if patient is in ITU