TB

Question 1

a. Infectious disease caused by Mycobacterium tuberculosis

b. Lungs most commonly infected

Answer 1

TB

Question 2

Risk factors for TB

Answer 2

a. Poor, underserved, and minorities
b. Homeless
c. Residents of inner-city neighborhoods
d. Foreign-born persons
e. Living or working in institutions
f. IV injecting drug users
g. Overcrowded living conditions
h. Poverty, poor access to health care
i. Immunosuppression
j. Advanced age

Question 3

Resistance to 2 of the most potent first-line anti-TB drugs (isoniazid and rifampin)

Answer 3

Multidrug Resistant Tuberculosis (MDR-TB)

Question 4

resistant to any fluoroquinolone plus any injectable antibiotic

Answer 4

Extensively drug-resistant TB (XDR-TB)

Question 5

Several causes of drug resistance

Answer 5

i. Incorrect prescribing
ii. Lack of public health case management
iii. Nonadherence
iv. Lack of funding for education and prevention

Question 6

Etiology of TB

Answer 6

a. Spread via airborne droplets, 1 to 5 (micrometers)

i. Can be suspended in air for minutes to hours

Question 7

What influences transmission?

Answer 7

Number
Concentration
Length of time for exposure
Immunity

Question 8

Aerophilic (oxygen-loving)—has affinity for lungs

Can spread via lymphatics & grow in other organs

Answer 8

M. Tuberculosis

Question 9

Bacteria are inhaled, inflammatory response occurs; if adequate immune response (body is fighting it on its own) infection does not progress to disease

Answer 9

Primary TB Infection

Question 10

active disease within 2 years of infection

Answer 10

Primary TB

Question 11

Reactivation TB (post-primary) disease occurs

Answer 11

greater than 2 years after infection; infectious

Question 12

i. Infected (positive skin test) but not active disease
ii. Asymptomatic
iii. Noninfectious—can’t transmit

Answer 12

Latent TB infection

Question 13

Latent TB infection: may develop active TB later; what could cause it?

Answer 13

Immunosuppression, diabetes, aging, pregnancy, stress, chronic disease

Question 14

i. Takes 2 to 3 weeks to develop symptoms
ii. Characteristic initial:

Late:

Answer 14

Pulmonary TB
Dry cough that becomes productive

Dyspnea & hemoptysis

Question 15

Acute, sudden presentation of TB symptoms

Answer 15

i. High fever
ii. Chills, generalized flulike symptoms
iii. Pleuritic pain
iv. Productive cough
v. Crackles and/or adventitious breath sounds

Question 16

Mantoux test

Answer 16

Tuberculin Skin Test (TST)

Question 17

Greater than 10 mm induration (positive test)

Answer 17

high risk

Question 18

Greater than or equal to 15 mm induration (positive test)

Answer 18

low risk

Question 19

Greater than or equal to 5 mm (positive test)

Answer 19

immunocompromised

Question 20

Infectious for first 2 weeks after starting treatment if sputum +

Answer 20

Restrict visitors & limit public exposure

Hand & oral hygiene

Question 21

Two phases of treatment

Answer 21

1. Initial (8 weeks to 3 months): 4 drugs (below)

2. Continuation (18 weeks): 2 drugs (isoniazid and rifampin)

Question 22

b. Initial 4-drug regimen: REMEMBER “RIPE”

Answer 22

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

Question 23

All urine/blood/sweat will be what with treatment?

Answer 23

Orange

Question 24

major side effect for 3 of 4 first-line drugs

Answer 24

Non-viral hepatitis, liver function tests should be monitored

Question 25

MDR-TB (Multi-drug resistant TB) treatment

Answer 25

ii. Initial: Five drugs for at least 6 months

iii. Continuation: 4 drugs for 18 to 24 months

Question 26

i. Nonadherence is major factor in MDR-TB and treatment failures
ii. Provide drugs and watch patient swallow

Answer 26

Directly observed therapy (DOT)

Question 27

Physical symptoms

Answer 27

i. Productive cough (collect sputum for AFB in early morning), night sweats, fever, weight loss, pleuritic chest pain, abnormal breath sounds

Question 28

Acute care of TB

Answer 28

i. Airborne isolation
1. Single-occupancy room with 6 to 12 airflow exchanges/hour
2. Health care workers wear high-efficiency particulate air (HEPA) masks; fit tested
ii. Immediate medical workup: chest x-ray, sputum smear and culture
iii. Appropriate drug therapy

Question 29

Ambulatory care

Answer 29

ii. Monthly sputum cultures

1. Two consecutive negative cultures = noninfectious