TB

Question 1

What is BCG

Answer 1

Attenuated live vaccine from M. bovis

Question 2

functional of BCG

Answer 2

decrease disseminated TB but not decrease pulmonary TB in children

Question 3

effectiveness of BCG

Answer 3

decrease from 75% in old days, less effective when close to equator

Question 4

cause of TB

Answer 4

M. Tuberculosis

others: bovis, africannum, microti, Canetti

Question 5

non-tuberculosis mycobacteria

Answer 5

M avium complex

Question 6

TB transmission

Answer 6

droplet nuclei containing tubercle bacilli

Question 7

what is Ghon focus

Answer 7

calcified granuloma

Question 8

what is primary TB

Answer 8

may cause military spread in immunocompromised or extreme age( contained within 3 wk)

Question 9

what is post-primary TB

Answer 9

reaction with cavitation

Question 10

site of TB infection

Answer 10

brain, larynx, LN, pleura, bone, lung, kidney, spine

Question 11

finding on extra pulmonary tb

Answer 11

skipped lesion in potts disease

nodular appearance and military pattern

Question 12

transmission of TB depends on

Answer 12

1. infectiousness of person
2. environment of exposure
3. length of exposure
4. virulence of tubercle bacilli

Question 13

how to control transmission

Answer 13

isolation

effective treatment ASAP

Question 14

3 fates after Tb infection

Answer 14

1. spontaneous healing
2. acute infection
3. containment( 90%)

Question 15

pathology of TB

Answer 15

caseous necrosis and cell mediated immunity with granuloma in cavitation

Question 16

when will active TB develops?

Answer 16

when immune system unable to keep tubercle bacilli under control

Question 17

when will active tb develop

Answer 17

soon after infection or many years

usually within 3-5 year

Question 18

how many LTBI develop TB disease

Answer 18

10%

Question 19

which type of TB is infectious

Answer 19

pulmonary TB not extrapulmonary TB

Question 20

Risk factors to active TB

Answer 20

HIV, Steroid, TNF- inhibitor smoking, chemo, silicosis, organ transplantation, DM

Question 21

How to treat active TB

Answer 21

4 mon(rifampicin, isoniazid, ethambutol, pyrazinamide) for intensive phase, and 4 mo (rifampicin and isoniazid) for maintenance phase

Question 22

monoresistent TB

Answer 22

Resistant to any one TB treatment

Question 23

polyresistent TB

Answer 23

at least any 2 TB ( not both isoniazid and rifampicin)

Question 24

multidrug resistent TB

Answer 24

resistant to both isoniazid and rifampin

Question 25

extensive drug resistant TB

Answer 25

Resident to isoniazid and rifampin + fluoroquinolone+ injectable 2nd line( amikacin, kanamycin or capreomycin)

Question 26

what is LTBI

Answer 26

immune system able to control tubercle bacilli in the body

Question 27

how to detect LTBI

Answer 27

TST and IGRAs

Question 28

what inject in TST

Answer 28

PPD read after 2-3ds

Question 29

how to treat LTBI

Answer 29

isoniazid for 9 mo

Question 30

what test will have false positive result with previous BCG

Answer 30

TST not LGRAs

Question 31

what test will have false negative result with HIV

Answer 31

TST and lGRAS

Question 32

how to control HIV false negative IGRAs

Answer 32

use inbuilt mitogen controls if CD<50

Question 33

TST and IGRAs positive when?

Answer 33

LTBI and active TB

Question 34

when is chest x ray abnormal on TB

Answer 34

only active TB

Question 35

sputum smear and culture positive or negative on LTBI

Answer 35

negative ( but positive if active TB)

Question 36

how to dx TB

Answer 36

1. clinical suspicion
2. sputum smear with Ziehl-Nellson stain
3. sputum culture
   - Solid lowerstein-Jensen( LJ) slopes: 4wk
   - liquid mycobacteria growth indicator tube( MGIT) 2wk
4. PCR

Question 37

What test for TB can test for drug sensitivity?

Answer 37

MGIT and PCR

Question 38

M.Leprae cause?

Answer 38

leprosy ( loss of sweat, sharp touch) like cool skin area

Question 39

m. ulcerous causes

Answer 39

ulcer

Question 40

Non-TB mycoplasma: avium/ intracellular cause

Answer 40

causing cavity in lung and COPD