TB - Waldron

Question 1

what is an ancient human disease caused by mycobacterium tuberculosis

Answer 1

TB

Question 2

what is the most common presentation of TB

Answer 2

pulmonary disease - arguably most concerning

Question 3

what patients are particularly vulnerable to death due to TB

Answer 3

HIV patients

Question 4

what type of stain is used for m. tuberculosis

Answer 4

Ziehl-neelsen stain
“ghost cells” neither gram + nor gram -, very poor reaction wtih Gram Stain

Question 5

what makes m. tuberculosis able to survive under extreme conditions

Answer 5

hip lipid content of cell wall
makes it higher infectivity with resistance to several antibiotics

Question 6

what are major risk factors for TB

Answer 6

socio-economic factors
immunosuppression
occupational

Question 7

How is TB spread

Answer 7

inhalation of infected aerosolized droplets
only person with active TB can spread TB bacteria to others - usually spread from cough, speaking or singing

Question 8

What are the first line medicatiosn for TB

Answer 8

Rifampin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
Ethambutol (EMB)
Rifapentine (RPT)

Question 9

what are second line medications for TB

Answer 9

Kanamycin (d/c in US)
streptomycin
capreomycin
amikacin
levo/moxi/gaitifloxacin

Question 10

What are the MDR-TB medicatiosn

Answer 10

Bedaquiline
Linezolid
Delamanid
Pretomaanid

Question 11

If a patient is prescribed INH what else should they recieve

Answer 11

Pyroxidine (Vit B6) 25-50mg/day

Question 12

What are the SE of isoniazid

Answer 12

Asx AST/ALT elevations, clincial Hepatitis, pheripheral neurotoxicity, hypersensitivity

Question 13

what are the SE of Rifampin

Answer 13

orange discoloration of body fluids - especially urine.
pruritus, n/v, flu-like sxs, hepatotoxicity

Question 14

what are the SE of Rifapentine

Answer 14

orange discoloration of body fluids - especially urine.
pruritus, n/v, flu-like sxs, hepatotoxicity

Question 15

what are the SE of Pyrazinamide

Answer 15

polyarthralgias
acute gout
rash
photosensitive dermatitis
hepatotoxicity

Question 16

what are the SE of ethambutol

Answer 16

Retrobulbar neuritis

Question 17

what are the SE of fluoroquinolones

Answer 17

QT prolongation

Question 18

what causes drug resistance

Answer 18

failure to complete full course of TB treatment
meds not available or poor quality

Question 19

what are granulomas

Answer 19

aggregation of multi-nucleated giant cells surrounding mycobacterium particle
presentation on exams: caseous or cheese-like (due to mycolic acid concentration in cell walls); caseating necrosis

Question 20

what is the diagnostic histopathological hallmark of TB

Answer 20

granulomatous cavitation

Question 21

What is the presentation of LTBI

Answer 21

latent TB
no symptoms, do not feel sick and cannot spread to others
will have positive TST or IGRA
capable of developing active disease if host immunosuppression and/or not treated for latent TB

Question 22

what is it called when people develop TB after long period of latency

Answer 22

secondary tuberculosis

Question 23

what are the different types of drug resistant TB

Answer 23

multi-drug resistant TB (MDR TB)
Pre-Extensively Drug-Resistant TB (pre-XDR TB)
Extensively Drug-Resistant TB (XDR TB)

Question 24

what is Ghon focus

Answer 24

primary TB usually localized to middle portion of the lungs

Question 25

What is the presentation of TB disease

Answer 25

(active)
cough min 3 weeks duration, f/c, chest pain, hemoptysis, weakness/fatigue, no appetite, nocturnal sweating
may spread TB to others
usually has skin or blood test indicating Tb infection
may have abnormal CXR or positive sputum culture
needs treatment

Question 26

What is the presentation of latent TB

Answer 26

no symptoms, cannot spread TB
usually has skin or blood test indicating TB infection
normal CXR and negative sputum culture
needs treatment

Question 27

What is miliary TB

Answer 27

pulmonary or systemic dissemination of tubercles in active disease
CXR: millet shaped lesions, 1-3% all TB cases

Question 28

what is disseminated TB

Answer 28

may also be seen int he spine, the CNS or bowel

Question 29

who is at high risk of being infected and should get tested

Answer 29

exposure
immigrants from TB endemic countries
live or work in high-risk settings
infants, children and adolescents exposure to adults at increased risk
heathcare workers

Question 30

what is the skin test for TB

Answer 30

Mantoux tuberculin skin test (TST aka PPD)
preferred for children < 5 yo

Question 31

what is the blood test for TB

Answer 31

Interferon-gamma release assay (IGRA)
-QuantiFERON TB Gold Plus (PFT-Plus)
- T-SPOT TB test (T-SPOT)
preferred test

Question 32

if a patient tests positive for TB what should they have at minimum for follow up

Answer 32

CXR and consider ID consults

Question 33

What are the healthcare worker screenings for TB

Answer 33

TB risk assessment
TB symptom eval
TB test with additional testing as needed based on results

Question 34

what are the primary meds used to treat latent TB

Answer 34

Isoniazid (INH), Rifapentine (RPT), Rifampin (RIF)

Question 35

what are the most common possible regimens for latent TB

Answer 35

INH and RPT once weekly for three months (3HP)
INH and RIF once daily for 3 months (3HR)

Question 36

what is the treatment for active TB

Answer 36

4-month RPT-MOX regimen for drug susceptible TB
RIF + MOX _ Isoniazid + pyrazinamide
at least 5-7 weekly doses should be administered under direct observation
meds are administered once daily with food

Question 37

what is the RIPE TB for drug susceptible TB

Answer 37

6,9 months
Rifampin (RIF), Isoniazid (INH), Pyrazinamide (PZA), Ethambutol (EMB)

intensive 2 month phase then continuation phase for 4-7 months - good for everybody

Question 38

what TB treatment medicatiosn are contraindicated in pregnancy

Answer 38

streptomycin
kanamycin
amikacin
capreomycin
fluorquinoloens

Question 39

what is a category A for TB treatment during pregnancy

Answer 39

Isoniazid