Tuberculosis

Question 0

Describe lesions in primary TB?

Answer 0

Lesions form in periphery with hilar and paratracheal lymphadenopathy

(Affects middle and lower lung zones)

Question 1

Suspect TB – Next step?

Answer 1

Serial sputum samples for culture

Question 2

Histology of lesions?

Answer 2

Caseating Granulomas (Liquefied center forms cavity)

Question 3

Healed TB lesions are called?

Answer 3

Gohn lesions

Question 4

Reactivation TB usually involves?

Answer 4

Apical and posterior segments of upper lobes (Or superior segments of lower lobes)

Question 5

Symptoms of TB?

Answer 5

Constitutional symptoms
Hemoptysis
Purulent sputum

Question 6

Rasmussen aneurysm

Answer 6

Rupture of dilated vessels in a TB cavity

Question 7

Physical findings in TB?

Answer 7

Fever
Wasting
Rales/rhonchi
Finger clubbing from Hypoxia

Question 8

Lab findings in TB?

Answer 8

Leukocytosis
Anemia
Hyponatremia from SIADH

Question 9

Sites of extrapulmonary TB?

Answer 9

1. Lymph nodes (Painless adenopathy)
2. Pleura
3. GU tract
4. Bones/joints
5. Meninges
6. Peritoneum

Question 10

Supplemental therapy in TB meningitis?

Answer 10

Glucocorticoids

Question 11

Signs of genitourinary TB?

Answer 11

Asymptomatic or

Dysuria, hematuria, urinary frequency

Question 12

Characteristic lab findings in genitourinary TB?

Answer 12

Leukocytes negative bacterial cultures (sterile pyuria)

Question 13

Milliary TB occurs by?

Answer 13

Hematogenous dissemination

Question 14

If pulmonary TB is suspected, next steps?

Answer 14

Three samples of early morning sputum

Place patient in isolation

Question 15

Treatment for TB?

Answer 15

Six-month course of RIPE
Rifampin
Isoniazid
Pyrazinamide
Ethambutol

Question 16

Positive PPD is defined by?

Answer 16

Induration after 48 to 72 hours and is 5 mm or greater in:

1. Patients with HIV
2. Close contacts of patients with TB
3. Patients with chest x-ray findings consistent with TP
4. Steroid users or transplant recipiants

10 mm or greater patients who are healthcare workers, prisoners, cancer, diabetes, alcoholics, recent immigrants

15 mm or greater than everyone else

Question 17

Treatment for latent TB?

Answer 17

Isoniazid for nine months

Question 18

Patient treated for tuberculosis should also receive?

Answer 18

Pyridoxine (vitamin B6), which is Deficient from isoniazid therapy

Question 19

Considerations to consider when treating women for TB?

Answer 19

Oral contraceptives may reduce Blood levels

Question 20

Patient is PPD positive but has had previous BCG vaccine. Management?

Answer 20

BCG vaccine does not change management (isoniazid)

Question 21

Patient with suspected TB;

1. Best initial test?
2. Most accurate test?

Answer 21

1. CXR

2. Pleural biopsy

Question 23

Active TB treatment?

Answer 23

RIPE
Rifampin (6 mo)
Isoniazid (6 mo)
Pyrazinamid (4 mo)
Ethambutol (4 mo)

Question 24

Side effects and management of:

1. Rifampin
2. Isoniazid?
3. Pyrazinaminde?
4. Ethambutol?

Answer 24

1. Red color (none)
2. Peripheral neuropathy (give B6)
3. Hyperuricemia (none, unless symptomatic)
4. Optic neuritis (Decrease dose)

Question 25

When to use steroids?

Answer 25

#Pericardial involvement (decrease restrictive pericarditis)
#TB meningitis (decrease neuro complications)

Question 26

Need longer (9 month) treatment in pts with?

Answer 26

#osteomyelitis
#miliary TB
#Meningitis
#Pregnancy