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Pediatrics > TB + UTI > Flashcards

TB + UTI Flashcards

1
Q

How is TB transmitted

A

Infective droplet nuclei

“Small size will remain suspended in air”

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2
Q

What are the risk factors for progression of latent TB to TB disease

A
  • children <4y
  • adolescence
  • HIV
  • immunocompromised
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3
Q

What do you expect to find in patients who are asymptomatic for TB infection

A
  • positive Tuberculin skin test

- no clinical or radiographic mainfestations

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4
Q

How does primary pulmonary TB usually present?

A

Chronic cough & Hemoptysis

+ constitutional symptoms

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5
Q

What are the extra-pulmonary TB

A
  • TB meningitis
  • pleural effusion
  • pericardial effusion
  • ascites
  • jaundice
  • Tb adenitis (cervical)
  • sterile pyuria & hematuria
  • non-tender joint effusion
  • back pain
  • warty lesions - lupuus vulagris - erythema nodosum
  • iritis\optic neuritis -
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6
Q

What is pott’s disease

A

Tb spine

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7
Q

What is miliary TB?

A

Lympho-hematogenous dissemination leading to embolization in organs

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8
Q

What are the organs commonly affected by miliary TB?

A
  • liver
  • spleen
  • BM
  • lungs
  • meninges
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9
Q

What is the screening tests for TB?

A

Tuberculin skin test + IGRA (interferon gamma release assays)

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10
Q

What are the confirmatory tests for TB?

A
  • Lab: acid fast smear - culture - Xpert MTB\RIF

- imaging: chest radiograph\CT

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11
Q

A positive TST may indicate

A

Latent or active TB

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12
Q

Does negative TST rule out TB infection

A

No

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13
Q

What is the difference between interferon gamma release assays test and TST?

A

It’s more specific

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14
Q

In childrern who are not able to provide a sputum sample for TB, how to optain sample for culture and stain?

A

Gastric aspirate

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15
Q

How long does culture takes to be positive for TB?

A

14 days in liquid media and 32 in solid media

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16
Q

What is the name of stain used to diagnose TB?

A

ZN or flourescent

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17
Q

What is the role of CT chest in TB diagnosis

A

Done when radiographs are equivocal, they show better visualization of cavitation, bronchiactsis, endobrachial involvement

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18
Q

How to treat patients with TB?

A

Isoniazed, ethambutol, rifampicin, pyrazinmide, and streptomycin

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19
Q

How to provide treatment regimen for TB patients? “Durations”

A
  • in 1st 2 months: isoniazed, rifampicin, ethambutol, pyrazinimide
  • 6-9 or 7-10: INH, rifampicin
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20
Q

What is the major complication of isoniazid?

A

Peripheral neuropathy

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21
Q

What is the major complication of Rifampicin?

A

Orange color secertion

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22
Q

What is the major complication of pyrazinmide?

A

Arthralgia

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23
Q

What is the major complication of ethambutol?

A

Visual disturbance

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24
Q

How to treat latent Tb who are isoniazid sensitive:

A

Isoniazed for 9 months

25
Q

How to treat latent Tb who are isoniazid resistant:

A

Rifampicin 6 months

26
Q

What is the prognosis of pulmonary TB?

A

Good

27
Q

What is the prognosis of bone, joint, meningitis TB?

A

Depend on the time of adminstration of medications

28
Q

How to prevent TB infection

A
  • isolation of TB + in negative pressure room
  • airborne isolation
  • BCG vaccine
29
Q

how long does small and large droplets pass

A
  • 3 feet large

- 6 feet small

30
Q

Incidence of TB in KSA

A

Declined

31
Q

When to suspect UTI?

A

Temperature >38 and no other cause of infection is found

32
Q

What are the RF for UTI in children?

A
  • previous UTI
  • poor urine flow\constipation
  • spinal lesion
  • renal abnormality
  • abdominal mass
  • high BP
33
Q

What is the risk in females vs males for UTI?

A

If <1 year, boys more than girls
School age: 3x more in girls
Adolescence: far far more in girls

34
Q

If urine dipstick is

  • positive nitrate
  • positive leukocyte
A

UTI

35
Q

If urine dipstick is

  • positive nitrate
  • negative leukocyte
A

Start treatment if sample was fresh

36
Q

If urine dipstick is

  • negative nitrate
  • positive leukocyte
A

Treatment not started

“Unless there’s good evidence of UTI”

37
Q

If urine dipstick is

  • negative nitrate
  • negative leukocyte
A

Not UTI

38
Q

If urine dipstick is

  • positive pyuria
  • positive bacteriuria
A

Definite UTI

39
Q

If urine dipstick is

  • negative pyuria
  • positive bacteriuria
A

Regarded UTI

40
Q

If urine dipstick is

  • positive pyuria
  • negative bacteriuria
A

if clinically UTI: start Ab

41
Q

If urine dipstick is

  • negative pyuria
  • negatibe bacteriuria
A

No UTI

42
Q

What is pyuria

A

WBC > or = 5 “centerfuged”

WBC > or = 10 “uncenterfuged”

43
Q

What is the likelihood of having UTI infection if SPA showed gram negative bacili

A

Any number is UTI

44
Q

What’s the titer that indicate UTI in

  • clean catch
  • transuretheral asymp
  • transuretheral symp
  • gram positve cocci
A
  • 10^5
  • 50.000
  • 10^4
  • 10^3
45
Q

What are the indications for hospitilization of UTI patinets?

A
  • less than 3m
  • concern for bactermia\urosepsis
  • immunocompromised
  • can’t tolerate oral medics
  • renal insufficency
46
Q

when to refer children to secondary care

A
  • <3 month

- >3 month w\pyelonephritis - upper UTI

47
Q

What is the management of choice for infant <3month with possible UTI

A

Cefotaxim IV 7-10d

48
Q

What is the management of choice for infant >3month with possible pyelonephritis or upper UTI

A

Ceftriaxone for 7-10d

49
Q

What is the management of choice for infant >3month with possible UTI or cystitis

A

Trimethoprim - nitrofirtanotoin 5 days

50
Q

What is the risk associated with recurrent UTI?

A

Developing vesicoureteric reflux which can cause renal scarring

51
Q

What are the outcomes of renal scarring?

A
  • HTN
  • proteinuria
  • renal failure progression
52
Q

Most common type of tb

A

Pulmonary

53
Q

How can one be infected with TB

A

One needs from 5-200 inhaled bacili to get infection

“1 droplet:1-10 bacilli”

54
Q

What determines a person exposed to tb droplet to get the infection

A

Immmune system - age

55
Q

How many people from latent to active tb disease

A

Only 10%

56
Q

What is the most common extrapulmonary mainfestation of tb

A

Tb adenitis

57
Q

When you inject the TST test, what is the level of injection?

A

Intradermal

Do not reach subcutaneous part

58
Q

What are we measuring in tst

A

The raised reaction

59
Q

If you vaccinate the child for TB, what screening test will show false positive results

A

The tuberculin skin test

Pediatrics (41 decks)

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