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PPS 2018 > TB > Flashcards

TB Flashcards

1
Q

Refers to bacterial resistance in patients with some record of previous treatment

A

Acquired resistance

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2
Q

Infection associated with tuberculin hypersensitivity as show by a positive tuberculin skin test with no striking clinical or roentgenographic manifestations

A

Asymptomatic or latest tuberculosis infection (LTBI)

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3
Q

attenuated vaccine strain of M. bovis used to immunize against tuberculosis

A

Bacillus Calmette-Guerin

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4
Q

TB, usually pulmonary, excreting bacilli resistant to one or more antituberculosis drugs

A

Drug-resistant TB (DR-TB)

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5
Q

A person who has had a recent contact with another person with suspected or confirmed contagious pulmonary tuberculosis disease and who has a negative tuberculin (or IGRA) reaction, normal PE findings, and chest x-ray findings that are not compatible with TB

A

Exposed person

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6
Q

A subset of MDR-TB with a strain of M. tuberculosis complex that is resistant to isoniazid and rifampicin, any quinolone, and at least one of three second-line injectable drugs: kanamycin, capreomycin or amikacin

A

Extensively drug-resistant TB (XDR-TB)

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7
Q

Time interval from exposure to the mycobacterium to the development of delayed type hypersensitivity reaction as manifested by a positive TST (or IGRA)

A

Incubation period

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8
Q

Mycobacterium tuberculosis complex infection in a person who has a positive TST (or IGRA) result, with no clinical manifestations of disease and chest radiograph findings that are normal

A

Latent tuberculosis infection

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9
Q

Resistance to at least isoniazid and rifampicin

A

Multidrug-resistance (MTB)

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10
Q

Resistance to more than one antituberculosis drug, other than isoniazid and rifampicin

A

Poly-resistance

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11
Q

Composed of primary focus, lymphangitis, localized pleural effusion and regional lymphadenitis, demonstrable by radiographic study

A

Primary complex

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12
Q

Bacterial resistance present in patients who have received prior treatment with antituberculosis drugs

A

Secondary resistance

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13
Q

bacterial resistance present in patients who have not received prior treatment with antituberculosis drugs

A

Primary resistance

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14
Q

Aseptic reactive polyarthritis in TB

A

Poncet disease

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15
Q

Most common ocular manifestation of TB

A

choroiditis

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16
Q

Criteria for congenital TB

A

Any infant with a TB lesion and one more ore of the ff:

  1. Present within the first week of life
  2. A primary hepatic complex or caseating hepatic granuloma
  3. TB infection of the placenta or endometrial TB in the mother; or exclusion of the possibility of postnatal transmission by excluding TB in other contacts
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17
Q

A patient who has never had treatment for TB or who has taken anti-TB drugs for less than one month

A

New case

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18
Q

A patient who has been previously treated with anti-TB drugs for at least one month in the past

A

Retreatment case

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19
Q

Resistance to one first line anti-TB drug only

A

Monoresistant TB

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20
Q

Criteria for diagnosis of active TB infection

A

3 more of of the ff:

  1. Exposure to an adult/adolescent with active TB disease (epidemiologic)
  2. Signs and symptoms suggestive of TB (clinical)
  3. Positive tuberculin skin test (immunologic)
  4. Abnormal chest radiograph suggestive of TB (radiologic)
  5. Laboratory findings suggestive of TB (histological, cytological, biochemical, immunological and/or molecular) (Laboratory)
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21
Q

Presumptive TB for patients 15 years old and above

A

Cough at least 2 weeks duration with or without the ff:
- significant and unintentional weight loss
- fever
- hemoptysis
- chest/back pains not musculoskeletal
- easy fatigability or malaise
- night sweats
- shortness of breath or DOB
OR unexplained cough of any duration in:
- a close contact of a known active TB case
- high-risk clinical groups and high risk populations

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22
Q

Presumptive TB in patients below 15 years old

A

At least 3 of the ff:
- coughing/wheezing of 2 weeks or more, especially if unexplained
- unexplained fever of 2 weeks or more after common causes have been excluded
- weight loss/failure to gain weight/loss of appetite
- failure to respond to 2 weeks of appropriate antibiotic therapy for lower respiratory tract infection
- failure to regain previous state of health 2 weeks after viral infection or exanthema
- fatigue, reduced playfulness or lethargy
Or any 1 of the above in a child who is a close contact of a known active TB case

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23
Q

A negative TST obtained less than __ after exposure is unreliable for excluding TB infection

A

8 weeks

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24
Q

A repeat TST is done at __ after a negative TST in a TB symptomatic child or in children four years and below

A

3 months

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25
Q

Standard test dose of TST

A

5 TU

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26
Q

Site of TST

A

2 inches below the elbow joint in the volar aspect of the forearm

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27
Q

A pale wheal of __ in diameter should be evident after injection; otherwise repeat test on an area at least __ away from the original site

A

6-10 mm diameter

2 inches from the original site

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28
Q

Positive TST reactions can be measured accurately up to __, while negative TST reactions can be read accurately up to __

A

Positive TST - 7 days

Negative TST - 72 hours

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29
Q

Post BCG tuberculin reactions develop __ after vaccination and wanes after __

A

Develop 6-12 weeks after vaccination

Wanes after 5 years

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30
Q

TST should be postponed for __ from a live-vaccine administration, or at the same time with a live-vaccine on different sites

A

4-6 weeks

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31
Q

TST should be delayed for __ after a bout of measles, mumps, chickenpox or whooping cough

A

2 months

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32
Q

Storage temperature of tuberculin

A

2-8 degrees

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33
Q

TST positive cut-off size

A

10 mm or more
or 5 mm or more in the ff:
1. severely malnourished children
2. immunocompromised

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34
Q

TST positive cut-off size as defined by The American Thoracic Society

A

≥5 mm with high risk:
1. HIV-infected
2. Close contact with an infectious TB source
3. CXR consisted with TB
4. Organ transplant recipients
5. Immunosuppressed (taking equivalent of >15 mg/d of prednisone for 1 month or those taking TNF-a antagonists)
≥10 mm for populations with high risk of having TB infection and disease and for persons living in areas where TB is highly prevalent
≥ 15 mm for populations with no risk factors

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35
Q

TST is preferred over IGRA for children less than __

A

5 yr

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36
Q

Radiologic hallmark of reactivation TB

A

cavitation

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37
Q

Pulmonary lesions in TB exceeding __ should be resected

A

3 cm

38
Q

Preferred imaging modality in TB spondylitis

A

MRI

39
Q

Triad of juxtaarticular osteoporosis, peripherally located osseous erosions, gradual narrowing of interosseous space

A

Phemister triad, TB arthritis

40
Q

Thickening of the ileocecal valve lips or wide gaping of the valve with narrowing of the terminal ileum

A

Fleischner sign, GI TB

41
Q

The primary sign of tuberculous pericarditis is pericardial thickening of __ as seen on CT

A

more than 3 mm

42
Q

Minimum desired sputum volume

A

3 mL

43
Q

A patient previously treated for TB who has been declared cured, or completed treatment in their most recent treatment episode, and is presently diagnosed with bacteriologically-confirmed or clinically-confirmed TB

A

replapse

44
Q

A patient who has been previously treated for TB and whose treatment failed at the end of their most recent course. Includes:

  • sputum smear or culture positive at 5 months or later during treatment
  • clinically diagnosed patient for whom sputum examination cannot be done and who does not show clinical improvement anytime during treatment
A

Treatment after failure

45
Q

A patient who was previously treated for TB but was lost to follow-up ≥ 2 months in their most recent course of treatment and is currently diagnosed with either bacteriologically-confirmed or clinically-diagnosed TB

A

Treatment after lost to follow up

46
Q

Patients who have been previously treated for TB but whose outcomes after their most recent course of treatment are unknown o rundocumented

A

Previous treatment, outcome unknown

47
Q

Stains used for AFB smear microscopy

A

Ziehl-Neelsen

or Kinyoun carbol fuschin stains

48
Q

Solid culture media used in TB

A

Loewnstein-Jensen
Ogawa
Middlebrook

49
Q

In solid culture, isolation of MTB organisms require __ and another __ for susceptibility testing

A

4-6 weeks to isolate

another 2-4 weeks for susceptibility studies

50
Q

In TB, liquid culture systems provide results in __, up to __ for negative result

A

4-14 days

42 days for negative result

51
Q

Isoniazid preventive therapy is recommended for:

A
  1. all HIV-positive individuals
  2. Children less than 5 yr who are household contacts of a bacteriologically-confiremd TB case, regardless of TST result
  3. Children less than 5 yr who are household contacts of a clinically diagnosed TB case if TST is positive
52
Q

Isoniazid dose and duration of treatment for preventive therapy

A

10 mkday OD x 6 months

53
Q

In TB treatment, what is Cat I? Treatment regimen?

A

PTB, new;
Extrapulmonary TB, new, except CNS/bones or joints

2HRZE/4HR

54
Q

In TB treatment, what is Cat Ia? Treatment regimen?

A

Extrapulmonary TB, new, CNS/bones or joints

2HRZE/10HR

55
Q

In TB treatment, what is Cat II? Treatment regimen?

A

Pulmonary or extrapulmonary TB, previously treated drug-susceptible TB

  • relapse
  • treatment after failure
  • treatment after lost to follow-up
  • previous treatment unknown outcome

2HRZES/1HRZE/5HRE

56
Q

In TB treatment, what is Cat IIa? Treatment regimen?

A

Extrapulmonary, previously treated drug-susceptible TB, CNS/bones or joints

2HRZES/1HRZE/9HRE

57
Q

Corticosteroids are used in which forms of TB?

A

Meningitis, pericarditis, endobronchial, miliary

*pleural effusion, not routinely recommended

58
Q

Dose of prednisone given in TB

A

2-4 mkday (max 60 mg/day) for 4-6 weeks (11 weeks for pericarditis)

59
Q

Treatment completed as recommended by the national policy without evidence of failure and three or more consecutive cultures taken at least 30 days apart are negative after the intensive phase

A

Cured

60
Q

Treatment completed as recommended by the national policy without evidence of failure but no record that three or more consecutive cultures taken at least 30 days apart are negative after the intensive phase

A

Treatment completed

61
Q

Drugs in MDR-TB

A

At least 4, but 5 if possible and should include:
- any of the first line drugs to which the strain is susceptible
- injectable drug (given for 8 months)
- quinolone
Full treatment course can last for 20-24 months

62
Q

Management of XDR-TB

A
  • use any Group 1 that may be effective
  • use an injectable for at least 12 months or the whole treatment
  • later generation fluoroquinolone such as moxifloxacin
  • use all Group 4 agents that have not been used extensively in a previous regimen
  • use 2 or more agents from Group 5
  • consider high-dose isoniazid if low-level resistance is documented
  • consider adjuvant surgery if there is localized disease
  • ensure strong infection control measures
  • treat HV
  • provide comprehensive monitoring and full adherence support
63
Q

Group 1 drugs

A

First-line oral agents

isoniazid, rifampin, ethambutol, pyrazinamide

64
Q

Group 2 drugs

A

Injectable agents

kanamycin, amikacin, capreomycin, streptomycin

65
Q

Group 3 drugs

A

Fluoroquinolones

moxifloxacin, levofloxacin, ofloxacin

66
Q

Group 4 drugs

A

Oral bacteriostatic second-line agents

Ethionamide, prothionamide, cycloserine, terizidone, p-aminosalicylic acid (PAS)

67
Q

Group 5 drugs

A

Agents with unclear efficacy
Clofazimine, linezolid, amoxicillin-clavulanic acid, thioacetazone, imipenem/cilastatin, clarithromycin, high-dose isoniazid (16-20 mkday)

68
Q

Mangement of pregnant mothers with latent TB infection

A

IPT x 9 months, at least 6 months with pyridoxine supplementation

69
Q

Women who become pregnant while on treatment for TB should continue therapy, except for which drugs?

A

streptomycin

fluoroquinolones

70
Q

Schedule of ALT monitoring for TB with liver disease

A

2x a week for the first 2 weeks, then weekly until the end of the second month, and monthly until the end of treatment

71
Q

Treatment of TB in children with liver disease

A 
2HRE/7HR
or 
2HRE+fluoroquinolone or aminoglycoside/4HR
In decompensated liver cirrhosis:
ES+fluoroquinolone x 18-24 months
72
Q

Hepatotoxicity may occur anytime during treatment but usually manifest in the first __of therapy

A

2-4 weeks

73
Q

Drug induced liver injury is defined as AST level __ in the presence of symptoms or __ in the absence of any symptoms

A

3 or more times than the upper limit of normal if symptomatic
5 times more than the upper limit if asymptomatic

74
Q

Dose adjustment of ethambutol and pyrazinamide in TB with renal impairment

A

three times a week

75
Q

Antituberculosis drugs that are significantly dependent on renal clearance

A 
ethambutol
levofloxacin
cycloserine
kanamycin
amikacin
capreomycin
streptomycin
76
Q

Which of the first line drugs is efficiently removed by hemodialysis? Which is not removed by hemodialysis?

A

Efficiently removed: pyrazinamide

Not removed: rifampicin

77
Q

Schedule of TST for children with HIV

A

annual

78
Q

Primary prophylaxis for TB in children with HIV (asymptomatic, no contact with TB case)

A

For children living with HIV who are more than 12 mo:

6 months of IPT at 10 mkday, range 7-15 mkday, max dose 300)

79
Q

T/F: BCG vaccine should not be given to children with HIV because of risk of disseminated BCG disease

A

T

80
Q

T/F: All children living with HIV who have successfully completed treatment for TB disease should receive isoniazid for an additional 6 months

A

T

81
Q

Indications of isoniazid prophylaxis for solid organ transplant recipients

A
  1. Tuberculin reactivity ≥5 mm before transplantation
  2. Patients with the ff characteristics regardless of reactivity
    - radiographic evidence of old TB and no prior prophylaxis
    - history of inadequately treated TB
    - close contact with an infectious patient
    - recipient of an allograft from a donor with a history of untreated TB or tuberculin reactivity without adequate prophylaxis
  3. Newly infected persons (recent conversion of tuberculin test to positive)
82
Q

Reintroduced first in rechallenge after skin reaction

A

Isoniazid

Then rifampicin after 3 days

83
Q

Which drug is introduced first or rechallenge after hepatitis?

A

Rifampicin

Then isoniazid if no increase in ALT after 1 week

84
Q

Which of the first line anti tb drugs is most likely to cause arthralgias

A

Pyrazinamide

85
Q

BCG Dose

A
  1. 05 mL for newborns to 1 mo

0. 1 mL thereafter

86
Q

Time course from vaccination to scar formation with BCG

A

12 weeks

87
Q

First line anti-TB drug most likely to cause influenza syndrome

A

Rifampin (esp in intermittent regimens)

88
Q

Timing of starting TB treatment in people living with HIV

A

TB treatment started first, followed by ART within 8 weeks, within 2 weeks for CD4 count below 50

89
Q

Temporary clinical deterioration that may occur within 3 months of starting ART and most commonly within the first month

A

Immune reaction inflammatory syndrome (IRIS)

90
Q

TB prophylaxis for patients receiving anti-TNFa therapy

A

6H

Or 3RH

91
Q

Dose of pyridoxine

A

10 mg per 100 mg isoniazid OD

PPS 2018 (17 decks)

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