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IM RESPI & CARDIO (VHD) > TUBERCULOSIS > Flashcards

TUBERCULOSIS Flashcards

1
Q

• A DISEASE CAUSED BY AN AEROBIC BACTERIA CALLED
MYCOBACTERIUM TUBERCULOSIS
• DISCOVERED BY ROBERT KOCH IN MARCH 24,1882
• AFFECTS THE LUNGS MOST OFTEN(PULMONARY);
• MAY ALSO AFFECT OTHER PARTS OF THE BODY SUCH AS BONES, INTESTINES, KIDNEY, MENINGES OF THE BRAIN, LIVER, LYMPH NODES

A

TUBERCULOSIS

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2
Q
  • ROD-SHAPED, THIN, ACID-FAST, NON-SPORE-FORMING, STRICT AEROBE
  • CAN SURVIVE FOR SEVERAL HOURS IN RESPIRATORY DROPLETS
  • CAN BE DESTROYED IN 20 MINUTES AT 60 DEGRESS AND 5 MINUTES AT 70 DEGRESS CELSIUS
  • VERY SENSITIVE TO DIRECT SUNLIGHT ( CAN BE KILLED IN 5 MINUTES),MAY SURVIVE IN THE DARK FOR YEARS
A

MYCOBACTERIUM TUBERCULOSIS

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3
Q

TYPES OF TUBERCULOSIS

  • ACUTE CLINICAL ILLNESS DIRECTLY FOLLOWING INFECTION LATENT TB
  • EVIDENCE OF EXPOSURE WITHOUT ACTIVE DISEASE
  • POSSIBLE PERSISTENCE OF DORMANT BACILLI FOR YEARS
  • NONINFECTIOUS
A

PRIMARY TUBERCULOSIS (TB)

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4
Q

TYPES OF TUBERCULOSIS

  • REACTIVATION OF PREVIOUSLY ACQUIRED INFECTION CAUSED BY PREVIOUSLY DORMANT BACILLI (10% REACTIVATION RISK)
  • OFTEN INFECTIOUS
A

SECONDARY TB (AKA ADULT-TYPE TB OR REACTIVATION TB)

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5
Q

TYPES OF TUBERCULOSIS

POSITIVE SKIN TEST WITH NO EVIDENCE OF ACTIVE
INFECTION

A

LATENT TB

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6
Q

RISK FACTORS OF TB

A 
A. CLOSE CONTACT WITH INFECTED PERSON
• POVERTY
• HOMELESSNESS
• DRUG ABUSE
• INCARCERATION
• RESIDENCE IN NURSING HOME OR LONGTERMCARE FACILITY

B. LIVING / EXPOSURE TO ENDEMIC AREA (PHILIPPINES!)

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7
Q

TRANSMISSION OF TB

A

• THROUGH AIR
• TRANSMITTED BY AEROSOL/DROPLET, INHALATION THROUGH COUGHING/SNEEZING A PERSON WITH TB
(AEROSOLIZED RESPIRATORY DROPLETS)
• DROPLETS INHALED BY SUSCEPTIBLE PEOPLE

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8
Q

SIGNS AND SYMPTOMS OF PULMONARY TB

A

• COUGH, PRODUCTIVE OR NOT, OF TWO WEEKS OR MORE, WITH OR WITHOUT:

  • F EVER
  • E ASY FATIGABILITY
  • W EIGHT LOSS
  • B LOODY SPUTUM(HEMOPTYSIS)
  • A NOREXIA
  • N IGHT SWEATING
  • S HORTNESS OF BREATH
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9
Q

CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)

HAS BEEN TREATED BEFORE WITH ANTI-TB DRUGS FOR AT LEAST ONE MONTH.
- PREVIOUSLY TREATED FOR TB AND DECLARED CURED OR
TREATMENT COMPLETED, BUT IS PRESENTLY DIAGNOSED WITH ACTIVE TBDISEASE

A

RELAPSE

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10
Q

CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)

HAS NEVER HAD TREATMENT FOR TB OR HAS TAKEN
ANTI-TB DRUGS FOR LESS THAN ONE MONTH

A

NEW

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11
Q

CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)

HAS BEEN TREATED BEFORE WITH ANTI-TB DRUGS FOR AT LEAST ONE MONTH.
- PREVIOUSLY TREATED FOR TB BUT FAILED MOST
RECENT COURSE BASED ON A POSITIVE SMEAR AT FIVE MONTHS OR LATER,OR A CLINICALLY DIAGNOSED PATIENT W/O CLINICAL IMPROVEMENT ANYTIME

A

TREATMENT AFTER FAILURE

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12
Q

CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)

PREVIOUSLY TREATED FOR TB BUTDID NOT COMPLETE TREATMENT AND LOST TO FOLLOW-UP FOR AT LEAST TWO MONTHS IN THE MOST RECENT COURSE

A

RETREATMENT: TREATMENT AFTER LOST TO FOLLOW-UP

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13
Q

CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)

PREVIOUSLY TREATED FOR TB BUT WHOSE OUTCOME IN THE MOST RECENT COURSE IS UNKNOWN

A

RETREATMENT: PREVIOUS TREATMENT OUTCOME UNKNOWN

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14
Q

CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)

PATIENTS WHO DO NOT FIT ANY OF THE CATEGORIES LISTED ABOVE OR PREVIOUS TREATMENT HISTORY IS UNKNOWN

A

RETREATMENT: PATIENTS WITH UNKNOWN PREVIOUS TB TREATMENT HISTORY

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15
Q
  • REFERS TO DISEASE OUTSIDE THE LUNGS
  • IT IS SOMETIMES CONFUSED WITH NON-RESPIRATORY DISEASE
  • IS AN INFECTION CAUSED BY TUBERCULOSIS BACTERIA THAT HAVE SPREAD BEYOND THE LUNGS
A

EXTRA-PULMONARY TUBERCULOSIS

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16
Q

EXTRAPULMONARY SITES OF TB

A
  • LYMPH GLANDS AND ABSCESSES PARTICULARLY AROUND THE NECK (40%)
  • PLEURA (20%)
  • SKELETAL (POTTS) / ORTHOPAEDIC SITES SUCH AS BONES AND JOINTS (10%)
  • GU TRACT- DIFFERENT SITES AFFECTED
  • IN WOMEN: UTERUS
  • IN MEN: EPIDIDYMIS
  • RENAL DISEASE
  • BRAIN (TB MENINGITIS)
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17
Q

CLINICAL PRESENTATION:

EXTRA-PULMONARY TUBERCULOSIS

A

• LYMPH GLANDS (TUBERCULOUS LYMPHADENITIS; SCROFULA)
- DEVELOP SINGLY OR IN CHAINS
- BECOME SWOLLEN PAINFUL AND MAY HAVE A RUBBERY
TEXTURE

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18
Q

CLINICAL PRESENTATION:

PLEURAL TB

A
  • FEVER
  • PLEURITIC CHEST PAIN
  • DYSPNEA
  • DULLNESS TO PERCUSSION/ABSENCE OF BREATH SOUNDS
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19
Q

CLINICAL PRESENTATION:

TB OF UPPER AIRWAYS (LARYNX, PHARYNX, AND/OR EPIGLOTTIS)

A
  • HOARSENESS
  • DYSPHONIA
  • DYSPHAGIA
  • CHRONIC PRODUCTIVE COUGH
20
Q

CLINICAL PRESENTATION:

SKELETAL TB

A

WEIGHT-BEARING JOINTS ARE AFFECTED MOST COMMONLY.
> SPINE IN 40% OF CASES
> HIPS IN 13%
> KNEES IN 10%

21
Q 
CLINICAL PRESENTATION:
SPINAL TB (POTT'S DISEASE, TUBERCULOUS SPONDYLITIS)
A
  • OFTEN INVOLVES ≥ 2 ADJACENT VERTEBRAL BODIES
  • BACK PAIN
  • NEUROLOGIC SIGNS OF SPINAL CORD COMPRESSION, INCLUDING PARAPLEGIA
  • LOWER THORACIC AND UPPER LUMBAR VERTEBRAE USUALLY AFFECTED IN ADULTS
22
Q

CLINICAL PRESENTATION:

MILIARY TB

A
  • DUE TO HEMATOGENOUS SPREAD OF TUBERCLE BACILLI
  • LESIONS ARE USUALLY YELLOWISH
    GRANULOMAS 1–2 MM IN DIAMETER THAT RESEMBLE MILLETSEEDS
  • CHEST XRAY: MILIARY RETICULONODULAR PATTERN
23
Q

When can be done a Chest X-ray when sputum exam is negative

A

simultaenously or after

24
Q

DIAGNOSIS OF TB

  • Epidemiology
  • Radiograph
  • Tuberculin Skin Test
  • Sputum Smear
  • Adenosine Deaminase(ADA)
A
  • EPIDEMIOLOGY (HX OF CLOSE CONTACT)
  • ABNORMAL RADIOGRAPH (UPPER-LOBE INFILTRATES & CAVITIES)
  • POSITIVE TUBERCULIN SKIN TEST (TST) AMONG CHILDREN
  • POSITIVE SPUTUM SMEAR
  • DETERMINATION OF ADENOSINE DEAMINASE (ADA) FOR PLEURAL TB
25
Q

Gold standard in Diagnosing TB

A

MOLECULAR DIAGNOSTIC TEST

26
Q

TREATMENT GOALS OF TB:

A
  • TO INTERRUPT TRANSMISSION
  • INITIAL/BACTERICIDAL PHASE
  • TO CURE
  • CONTINUATION/STERILIZING PHASE
27
Q

TREATMENT PRINCIPLES OF TB:

A
  • MULTIPLE DRUGS: TO PREVENT EMERGENCE OF RESISTANCE

* LONG DURATION: TO PREVENT RECURRENCE

28
Q

DRUG REGIMEN OF TB

A
  • ISONIAZID(H), 5
  • RIFAMPICIN (R), 10
  • PYRAZINAMIDE (Z), 25
  • ETHAMBUTOL (E), 15
  • STREPTOMYCIN(S)
29
Q

Drug in TB that can cause Orange/red colored urine

A

Rifampicin

30
Q

Drug in TB that can cause optic neuritis

A

Ethambutol

31
Q

Drug in TB that can cause hearing impairment

A

Streptomycin

32
Q

TB Classification based on drug-susceptibility testing:

RESISTANCE TO ONE FIRST-LINE ANTI-TB DRUG (FLD) ONLY

A

MONORESISTANT TB

33
Q

TB Classification based on drug-susceptibility testing:

RESISTANCE TO MORE THAN ONE FIRST – LINE ANTI – TB DRUG (OTHER THAN BOTH ISONIAZID AND RIFAMPICIN)

A

POLYRESISTANT TB

34
Q

TB Classification based on drug-susceptibility testing:

RESISTANCE TO RIFAMPICIN DETECTED USING PHENOTYPIC OR GENOTYPIC METHODS, WITH OR WITHOUT RESISTANCE TO OTHER ANTI-TB DRUGS.

A

RIFAMPICIN RESISTANT TB (RR – TB)

35
Q

TB Classification based on drug-susceptibility testing:

RESISTANCE TO AT LEAST ISONIAZID AND RIFAMPICIN, WITH OR WITHOUT RESISTANCE TO OTHER ANTI-TB DRUGS.

A

MULTIDRUG – RESISTANT TB (MDR – TB)

36
Q

TB Classification based on drug-susceptibility testing:

MDR – TB WITH RESISTANCE TO ANY FLUOROQUINOLONE AND TO AT LEAST ONE OF THE THREE SECOND – LINE INJECTABLE DRUGS (CAPREOMYCIN, KANAMYCIN, AND AMIKACIN)

A

EXTENSIVELY DRUG – RESISTANT TB (XDR – TB)

37
Q

ART SHOULD BE STARTED WITHIN THE FIRST ___ OF TB TREATMENT FOR PROFOUNDLY IMMUNOSUPPRESSED PATIENTS WITH CD4+ T CELL COUNTS OF <50/UL

A

2 WEEKS

38
Q

ALL HIV-INFECTED TB PATIENTS, REGARDLESS OF CD4+ T CELL COUNT, ARE CANDIDATES FOR ART, WHICH OPTIMALLY IS INITIATED AS SOON AS POSSIBLE AFTER THE DIAGNOSIS OF TB AND WITHIN THE FIRST ___ OF ANTI-TB THERAPY

A

8 WEEKS

39
Q

IS MOST WIDELY USED IN SCREENING FOR LTBI

A

SKIN TEST WITH TUBERCULIN PPD (TST)

40
Q

COMMON IN IMMUNOSUPPRESSED PATIENTS AND IN THOSE WITH OVERWHELMING TB

A

vFALSE-NEGATIVE REACTIONS

41
Q

INFECTIONS WITH NONTUBERCULOUS MYCOBACTERIA AND BCG VACCINATION

A

FALSE-POSITIVE REACTIONS

42
Q

Tx for Latent TB infection

A

Isoniazid/ Rifampin

43
Q
  • WHO-APPROVED TREATMENT REGIMEN, AVAILABLE IN SE ASIA

* TB CAN BE CURED IF THE FULL COURSE OF THE PRESCRIBED DRUGS IS TAKEN REGULARLY, AND WITHOUT INTERRUPTION

A

DOTS (DIRECTLY-OBSERVED TREATMENT)

44
Q

PREVENT TB TRANSMISSION

A
  • ENSURING GOOD VENTILATION
  • MAINTAINING A CLEAN ENVIRONMENT
  • CONSULTING A PHYSICIAN REGULARLY
  • EATING HEALTHY FOOD
  • EXERCISING REGULARLY
  • PRACTICING THE RIGHT WAY TO COUGH
45
Q

Vaccine to prevent TB

A

BCG VACCINE AT BIRTH

IM RESPI & CARDIO (VHD) (11 decks)

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