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clin med pulmonology > TB > Flashcards

TB Flashcards

1
Q

What is the most common presentation of TB

A

pulmonary disease (arguably most concerning)

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2
Q

Which patient population is particularly vulnerable to death from TB

A

HIV patients

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3
Q

Is TB gram negative or gram +

A

Neither… “ghost cell”
*weakly positive sometimes seen on gram stain

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4
Q

What allows for TB to have such high infectivity

A

High lipid content of cell wall allows it to survive under extreme conditions

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5
Q

What are major risk factors for TB

A

Socio-economic factors
Immunosuppression
Occupation (mining/ construction)

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6
Q

How is TB spread

A

inhalation of infected aerosolized droplets

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7
Q

Who can spread TB

A

Only those with active TB
-spread via cough, speaking, or singing

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8
Q

What determines whether a person who comes in contact with TB can fight it off

A

Persons immune status
Genetic factors
Primary vs. secondary exposure

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9
Q

What are first line TB medications

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol
rifapentine

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10
Q

What are second line TB medications

A

Streptomycin
Amikacin
Levofloxacin

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11
Q

What meds are used with MDR-TB

A

Linezolid
Pretomanid
Bedaquiline
Delamanid

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12
Q

What type of organism is TB

A

alcohol and acid-fast bacillus

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13
Q

If a patient is prescribed isoniazid, what also needs to be prescribed

A

pyridine (Vitamin b-6)

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14
Q

What are the side effects of rifampin

A

orang discoloration of body fluids

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15
Q

What are the side effects of isoniazid

A

AST/ALT elevations, clinical hepatitis, peripheral neurotoxicity

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16
Q

What are the side effects of Pyrazinamide

A

Hepatotoxicity
polyarthralgias
acute gout
rash
photosensitive dermatitis

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17
Q

What is a major cause of TB becoming drug resistant

A

failure to complete full course of treatment

18
Q

Where does primary TB usually settle in the lungs

A

middle portion (Ghon focus of primary TB)

19
Q

What is the only form of TB that is contagious

20
Q

What does Ghon focus TB do

A

enter latent phase

21
Q

If a patient develops the active disease after the first TB exposure, what kind of disease do they have

A

Primary progressive TB
Active TB

22
Q

What will be seen on CXR with primary TB

A

Middle lung zones but lacks marked tissue damage or cavitation

23
Q

What are cavitation lesions in the lungs

A

Granuloma: an aggregation of multinucleate giant cells surrounding mycobacterium particles

24
Q

What is the diagnostic histopathological hallmark of TB

A

Granulomatous

25
What causes the granuloma to look cheese-like
mycotic acid concentration in the cell walls
26
What is caveating necrosis
central area of eosinophilia
27
Where does most of TB in the US come from
untreated latent TB infections
28
What is secondary TB
People who develop TB after a long latency period
29
What will a CXR look like on secondary TB
lesions in lung apices and cavitation
30
What are symptoms of active TB
cough for a minimum of 3 weeks pleuritic pain hemoptysis nocturnal sweating no appetite
31
What is military TB
Pulmonary or systemic dissemination of tubercles in active disease CXR: millet shaped lesions
32
What is disseminated TB
may also be seen in the spine, CNS or bowel
33
When is IGRA TB test preferred
If BCG vaccine has been revieved Unable to make second TST appt.
34
What is high priority for TB treatment
Postive IGRA positive TST >5mm & immunosuppressed, recent TB contact, fibrotic CXR changes Positive TST >10mm & from endemic area, recent TB contact, kids<4y/o
35
What is the preferred TB test for children <5
PPD
36
What are the common latent TB treatment regimens
1) isoniazid + rifapentine 1/wk x3mo 2) Rifampin 1/day x4months 3)Isoniazid + rifampin 1/day x 3mo
37
What TB treatment have lower risk for hepatotoxicity
Shorterrifampin treatment
38
What are differentials. for TB
pneumonia malignancy non-TB mycobacterium fungal infections histoplasmosos sarcoidosis
39
Who should NOT have RPT-MOX treatment regimen for TB
<12 y/o <40kg pregnant or breast feeding prolonged QT syndrome known/suspected drug resistance
40
What TB treatment is category A for pregnancy
isoniazid

clin med pulmonology (12 decks)

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