TB

Question 0

TB bacteria usually affect…

Answer 0

Lungs, but can can attack any part of the body

Question 1

TB is caused by…

Answer 1

Mycobacterium tuberculosis

Question 2

Define Latent TB

Answer 2

Asymptomatic
Neg. Chest X-ray
Still at risk for progressing to active TB

Question 3

Define multi drug resistant TB

Answer 3

TB resistant to at least 2 of the preferred TB drugs

Question 4

RF’s for TB…

Answer 4

Early adulthood (25-44 y/o)
Low socioeconomic status 
Non-white males
Prolonged contact with infectious source
***HIV is the most important RF for Active TB

Question 5

Describe the TB pathogen

Answer 5

Mycobacterium tuberculosis is an AEROBIC, GRAM POSITIVE bacteria with an unusual waxy coating on cell surface making it impervious to gram staining.
Acid-fast bacilli

Question 6

Progression to active TB depends on what 3 factors?

Answer 6

of M. tuberculosis orgs inhaled
Virulence of the orgs
Host’s cell mediated immune response

Question 7

Skin test for TB:

Answer 7

Purified Protein Derivative (PPD)
Measures presence of cellular immunity by assessing delayed-type hypersensitivity
Downfalls:”Booster” effect, BCG interferes, multiple visits req’d, subjective interpretation

Question 8

Blood test for TB:

Answer 8

Interferon-gamma release assay (IGRA)
Assays QuantiFERON Gold and T-Spot
Advantages: quick, specific results, no “booster” effect or BCG interference, unbiased

Question 9

What can be given with INH to help with neurotoxic ADEs?

Answer 9

Pyridoxine

Question 10

Monitoring for INH…

Answer 10

LFTs, peripheral neuropathy

Question 11

Monitoring for Rifampin…

Answer 11

LFTs

Question 12

PC for Rifampin

Answer 12

Give on empty stomach

Question 13

Initial TB regimen

Answer 13

4 drugs (RIPE) x 2 months, repeat smears and cultures

Question 14

Continuation drugs for active TB Infxn…

Answer 14

INH/RIF

Question 15

Which 1st line agent has the highest risk of resistance?

Answer 15

INH

Question 16

If an isolate is resistant to ____, it often is MDR TB

Answer 16

RIF

Question 17

____ resistance most likely infers resistance to INH, RIF, and streptomycin

Answer 17

Pyrazinamide (PZA)

Question 18

Which 1st line agent has the lowest incidence of resistance?

Answer 18

ETB

Question 19

ADE with ETB?

Answer 19

Visual disturbances

Question 20

Monitoring response to TB tx…

Answer 20

• Sputum smears/cultures repeated monthly until 3 negatives
• obtain chest X-ray at end of tx for future reference
• follow up at 6mo and 1yr after tx

Question 21

TB drug to avoid in pregnancy…

Answer 21

PZA

Question 22

BL monitoring for PZA?

Answer 22

Uric acid - causes gout

Question 23

BL monitoring of ETB?

Answer 23

Eye exam