TB

Question 1

What is TB affected by? 3 things

Answer 1

Ventilation
Filtration
U.V. light

Question 2

What are some risk factors for getting TB?

Answer 2

Immune status
Previous infection
Age less than 4
malnutrition

Question 3

If you are exposed to TB, what are the chances that you will become infected?

Answer 3

30%

Question 4

If you are infected with TB, what are the chances that it will become contain or be in early progression?

Answer 4

5% early progression

95% containted

Question 5

If you were infected and the TB was contained, what are the chances that it will be continually contained or become a late progression?

Answer 5

10% late progression

90% continued containment

Question 6

Tell me about TB in terms of spread, incubation in the body, and the damage it does to the body.

Answer 6

Mycobacterium are inhaled, migrate throughout the body and end up (most commonly) in the apices. AEROBIC PLACES OXYGEN RICH
Granuloma results and causes Caseation

Question 7

What are the different forms of TB?

Answer 7

Primary/Latent, Active, Miliary, Extrapulmonary

Question 8

Tell me about latent or primary TB infecions

Answer 8

Infection is walled off by fibrosis, difficult to see on CXR
Bacteria lay dormant

The patient will have a +PPD
Evidence of previous infection, the immune system has been activated.

Question 9

Tell me about active TB infections

Answer 9

also called secondary or reactivation TB

happens when Age, malnutrition, alchoholism, diabetes, immunocompromised activates it

• infiltrate in upper lobes, granuloma turns into cavity, larger area with fibrosis / collapsed – evident on CXR

There is destruction of both the alveoli and blood vessels equally - Not a shunt disease

Question 10

Tell me about Miliary TB

Answer 10

Diffuse, spread out through the organs – Seed like on CXR all over

More common in immunocompromised and infants

Question 11

What is extrapulmonary TB

Answer 11

Can be seen in more than 50% of HIV pts infected with pulmonary TB

Commonly involves the lymph nodes (40%), pleura (4%) , eyes, and CNS – but can infect any organ

Question 12

Tell me about HIV and TB together

Answer 12

Asymptomatic / subclinical presentation may occur

TB increases HIV replication and accelerates progression of HIV infection

Question 13

What about the patient history is important in TB?

Answer 13

Foreign born
HIV infection 
Homeless or unstably housed
Residence in institution
Health care worker
Contact with infectious patient

Question 14

What are the clinical symptoms of TB?

Answer 14

Fatique
Low grade fever
Night sweats
Weight loss
Chronic Cough, sputum production and hemoptysis
Decreased appetite

Question 15

What should you do to collect sputum samples for AFB C and S?

Answer 15

coughing is good

if no cough, hypertonic saline

Protect yourself

Question 16

What should you do when bronching a TB patient?

Answer 16

Usa as little Lidocaine / xylocaine as possible, as this reduces viability or Mycobacterium

Question 17

What should you look for in a CXR in TB?

Answer 17

Infiltrates in apical- posterior segments, cavitations, atelectasis, pleural effusion

Question 18

Signs and symptoms of TB

Answer 18

Generally, Unless in severe active TB, Vitals are not helpful.
Labs like WBC are normal in primary but 15 to 20 in Miliary TB
ABG’s rarely helpful (respiratory acidosis and hypoxemia in end stage TB in respiratory failure)

Question 19

How do you Diagnose TB

Answer 19

PPB mantoux Skin test
Quantiferon Gold - Interferon Gamma Release Assay or T-spot
AFB C and S x 3 and Nucleic Acid Amplification
Radiology
Biopsy - Rare

Question 20

What can cause a false positive PPD?

Answer 20

those with the BCG vaccine

Question 21

What constitutes an active and infective case?

Answer 21

positive AFB smear with a positive NAA

Question 22

What happens with a Postive AFB smear and a Negative NAA

Answer 22

Treat patient as high risk but get a 2nd NAA to confirm

Question 23

What happens if you have a positive NAA but a negative AFB smear

Answer 23

Assume TB but get a 2nd NAA to confirm.

Question 24

What is the Prophylactic Treatment for TB?

Answer 24

Given to Healthcare workers with primary exposure
Its INH for 6-9 months
Rifampin and INH once weekly for three weeks (DOT) may be just as effective

Question 25

What do you have to assess when given INH as a treatment for TB?

Answer 25

Liver enzymes as Hepatitis is a side effect and can dictate the length of treatment
Take B6 with it.

Question 26

If the patient is being treated and the follow up AFB smear turns negative, what happens to the treatment?

Answer 26

Continue treatment but you can take the patient away from isolation

Question 27

If the patient is being treated and the follow up AFB smear turns positive again, what happens to the treatment?

Answer 27

Continue Treatment
Continue Isolation
Assess Adherence to regimen