Tuberculosis

Question 1

Symptoms of TB

Answer 1

• cough that last 3 wk or more
• pain in chest
• coughing up blood or bloody sputum or rust colored sputum
• weakness/ fatigue
• weight loss
• no appetite
• chills
• fever
• night sweats

Question 2

Test for TB

Answer 2

1) mantoux or PPD skin test
2) quantiFERON - TB gold
3) sputum culture

Question 3

Mantoux or PPD skin test

Answer 3

• Test for presence of antibodies against mycobacterium tuberculosis

 - this indicates exposure to bacteria 
 - but it can’t confirm active disease 

• Positive test produces induration of greater or equal to 10 mm induration (size of dime) in patients who are not immunocompromised
• Positive test for for people who are immunocompromised (AIDS, organ transplants, immunosuppressant therapy) produce induration greater or equal to 5 mm

Question 4

The QuantiFERON-TB Gold test

Answer 4

Blood use to test for exposure to TB

Does not positively confirm TB

Question 5

Sputum culture for AFB ( acid fast bacillus)

Answer 5

Confirms active infection with mycobacterium

Question 6

When should airborne precautions be started with TB

Answer 6

1) Start for patients presenting with a cough and other symptoms of TB until proven otherwise
2) for patients diagnosed with active TB

Question 7

Airborne precautions (TB)

Answer 7

1) Keep door shut
2) use a negative pressure room- pulls bacteria back into room rather than allowing it to drift into hallways when door opens
3) all healthcare workers must wear N-95 respirator mask in room
4) patient must wear surgical mask when out of room

Question 8

When is stop airborne precautions for TB

Answer 8

Discontinued when a patient had a negative sputum test everyday for three consecutive days

The first morning sputum should be used for these cultures

Question 9

Treatment for TB

“RIPE”

Answer 9

1) Rifampin
2) isoniazid (INH)
3) Pyrazinamide (PZA)
4) Ethambutal
* these must be given in combination to prevent bacterial resistance and to provide optimal eradication of bacteria

Question 10

Therapy for TB

Answer 10

• Active disease: therapy last 6-12 months
• Exposed to TB but are not active: 9-12m
  This treatment normally only uses Isoniazide (INH) because it is the only drug that can prevent the development of TB after exposure

Question 11

Adverse reactions to Ethambutol

Answer 11

Eye damage- blurred/ change in vision, change in vision colors

Question 12

Adverse reaction to all 3…

Isoniazid
Pyrazinamide
Rifampin

Answer 12

Hepatitis with signs of:

• abdominal pain
• abnormal liver function
• dark urine
• fatigue
• fever for more than 3 or more days
• flu like symptoms
• lack of appetite
• nausea/ vomiting
• yellowish skin or eyes

*** must routinely check liver function panels

Question 13

Adverse reaction to Isoniazid

Answer 13

Nervous system damage characterized by:

• dizziness
• tingling
• numbness around mouth
• peripheral neuropathy-> give Niacin (VIT B6) to prevent

Question 14

Isoniazide

Answer 14

Used for post op exposure prophylaxis

Only drug that will slow/ stop development after exposure

Question 15

Adverse reaction to Pyrazinamide

Answer 15

1) stomach upset
- vomiting
- lack of appetite

2) increase uric acid
- abnormal uric acid level
- joint aches
- gout (rare)

Question 16

Adverse reactions to Rifampin

Answer 16

1) Bleeding problems
- easy bruising
- slow blood clotting

2) Drug interactions
- interferes w/ certain medications such as birth control pills or implants and methadone treatment

3) Sensitivity to the sun
- Frequent sunburn