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Clinical Medicine > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

how much of the world’s population is infected with TB?

A

1/4 of population (2 billion)
- latent TB –> can transition into active TB

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2
Q

Number of Active cases of TB?

A

7882

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3
Q

what are symptoms of TB?

A
  • loss of weight
  • tiring easily
  • a cough lasting longer than 3 weeks
  • fever
  • low BP
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4
Q

who does TB disproportionately affect?

A
  • Immunocompromised
  • Malnourished
  • Homeless
  • Overcrowded or poor living conditions
  • Advance, untreated HIV
  • healthcare workers
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5
Q

what is TB caused by?

A

mycobacterium tuberculosis (M. Tb)
- aerobic, rod shaped bacilli
-MC cause
-8 other bacteria can cause tb

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6
Q

How is mycobacterium tuberculosis transmitted?

A

droplet nuclei
- spreads easily
- transported to alveoli
- when patient coughs, sneezes, shouts, sings

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7
Q

Where does m.TB. Multiply in?

A

In the alveoli

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8
Q

what is a primary TB infection?

A

TB that occurs when bacteria are inhaled and the inflammatory response is activated

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9
Q

what is latent TB?

A

(90% of patients)
Bacterium are contained by granulomas
- no symptoms
- not infectious
- cannot spread disease

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10
Q

what is active TB?

A

(10% of patients)
- TB that progresses and is infectious
- mycobacterium tuberculosis spreads to other organs, infects more
- immune system cannot contain M.TB

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11
Q

latent TB can transition into?

A

active TB

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12
Q

What is the first step in M.TB transmission

A
  • droplet nuclei containing M. tb are inhaled and enter the lungs, travel to the alveoli
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13
Q

What is the second step of M.Tb transmission

A
  • droplet nuclei gets past pulmonary defenses
  • M. tb multiply in the alveoli
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14
Q

What creates Latent TB (90%)

A

macrophages ingest and surround the TB bacilli
*creates a barrier (granulomas) keeps bacilli contained
*need drug tx

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15
Q

What creates active TB or (reactivation of secondary TB)

A

Happens when the immune system cannot keep up with the TB bacilli and they escape macrophage activity (will multiply)
*extrapulmonary TB

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16
Q

Where does the M.TB bacilli spread during active TB

A

Blood stream and lymphatics

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17
Q

what type of room should a patient with TB be placed in?

A

negative pressure room

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18
Q

what determines the probability of transmission of TB?

A
  • immunocompetency of individual exposed
  • infectiousness of person disseminating TB (environmental factors, proximity, etc.)
    *number of TB bacilli the patient expels
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19
Q

T/F. patients with latent TB are infectious and can spread TB to others.

A

F

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20
Q

can you tell if a patient has latent or active TB when looking at a chest x-ray?

A

No

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21
Q

can M. tb be sampled in latent TB?

A

No

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22
Q

if a patient has latent TB and are not treated, what is the chance they will develop active TB?

A

5 to 6%

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23
Q

T/F. you cannot predict who will develop to active TB (Or re-activation)

A

T

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24
Q

what are risk factors for developing active TB?

A
  • untreated HIV infection
  • close contact with infectious TB case
  • renal failure
  • smoking
  • overweight
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25
Q

what happens to cause active TB?

A

granulomas break down and bacilli escape, multiply, spread

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26
Q

Are people with active TB infectious?

A

Yes can spread to others

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27
Q

which patients normally have a positive TB skin test?

A

latent TB, active TB, and those who have the TB vaccine

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28
Q

when are sputum smears and cultures positive for TB?

A

Active

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29
Q

when is TB notified to the public health department?

A

latent or active TB

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30
Q

what are increased risk patient populations for TB?

A
  • pediatric
  • foreign born patients
  • minorities
  • lower socioeconomic status
  • immunocompromised
    -health care workers
31
Q

if a child has TB, what does that mean?

A

there is an active spread somewhere

32
Q

if an immigrant has TB, what does that mean?

A

they probably got it from their home country

33
Q

what are the symptoms of active TB?

A
  • Constitutional symptoms
  • Malaise, Fatigue
  • Anorexia
  • Weight loss
  • Fever
  • Night sweats
  • Chronic cough** (dry and then productive, purulent to blood streaked later on)
  • Chest pain (pleuritic)
34
Q

what are the signs of active TB?

A
  • lymphadenopathy
  • possible abdominal, bone, or joint involvement
  • unremarkable pulmonary exam (may have rales)
35
Q

how is TB screened for?

A

TB skin test (PPD, Mantoux test)

36
Q

what does a positive skin or blood test show?

A

that a person has been infected with TB bacteria but DOES NOT differentiate whether the person has Latent or Active TB

37
Q

what is the Mantoux test?

A

intradermal injection of 0.1 mL PPD of volar surface of the arm

38
Q

when should the Mantoux test be delayed?

A

after live vaccines

39
Q

a patient with an induration of 5 mm may be?

A

immunocompromised
- HIV
- organ transplant
- recent contact with TB
-fibrotic changes on X-ray

40
Q

a patient with an induration of 10 mm may be?

A
  • IV drug users
  • healthcare employee
  • comorbid conditions
  • children«5
41
Q

a patient with an induration of 15 mm may be?

A

persons with no risk factors for TB

42
Q

what is a positive reaction of a Mantoux test?

A

a raise of skin (induration) 48-72 hours later
- DO NOT measure redness
- document in mm

43
Q

if there is a negative PPD, what can be done?

A

a two-step PPD
* - may take weeks for the person to develop a reaction

44
Q

what can cause a false negative of PPD?

A
  • Anergy (false immune response)
  • Viral, bacterial, fungal co-infection
    •Recent TB infection
    •Errors in skin test administration
45
Q

what can cause a false positive of a PPD?

A
  • Nontuberculous mycobacteria
  • BCG vaccination (for TB)
  • Errors in skin test administration
46
Q

what is the blood screening test for TB?

A

Interferon-gamma release assay
-Also called QuantiFERON or T-SPOT test

47
Q

what is an advantage of quanitferon test?

A

will not give a false positive in patients who have received a prior BCG vaccination

48
Q

can a quantiferon test determine if it is latent or active TB?

A

No

49
Q

what is the expected result of a chest x-ray for a patient with TB?

A

upper lobe/apical, cavitary disease (O2 level higher in upper lobes)

50
Q

how do chest x-rays appear in elderly patients with TB?

A

lower lobe infiltrates, +/- effusion

51
Q

who is a miliary pattern seen in?

A

immunocompromised patients
-diffuse small nodular densities (hematologic or lymphatic dissemination)

52
Q

a resolution of an active TB case can cause?

A
  • dense nodules calcification, upper lobe
  • Ghon complex: calcified primary focus
  • Ranke complex: calcified primary focus and calcified hilar lymph node
53
Q

what gives you an idea that a patient might have TB?

A

acid-fast microscopy
*does not confirm diagnosis
*shows presence of ATB

54
Q

what is needed to make a definitive diagnosis of TB? (Only active)

A

M tb culture or DNA/RNA amplification techniques
*NAAT-TB

55
Q

what is the mainstay of diagnosis for TB?

A

exam for acid-fast bacilli and TB culture
*TB culture done on all initial samples to confirm diagnosis
*Positive culture for M tb confirms diagnosis

56
Q

is a positive culture for TB always necessary to begin treatment for TB?

A

no, start treatment asap
- may take weeks to have a result

57
Q

what are complications of TB?

A
  • mortality
  • Musculoskeletal: vertebral (Pott’s disease), joint disease
  • Lymph nodes (scrofula)
  • Neurologic: meningitis
  • Cardiovascular: pericarditis
  • GI: peritonitis
  • GU: kidney, adrenal
  • Derm: cutaneous
58
Q

what is DOT?

A

directly observed therapy
- healthcare worker watches patient consume each dose
- preferred management strategy for patients who are on 2-3 times a week medication or it patient cannot stick to regimen on own

59
Q

what is the treatment for TB?

A
  • infectious disease consult/referral
  • drugs: Isoniazid, Rifampin, Pyrazinamide, Ethambutol, Maybe: Streptomycin
60
Q

what must not be consumed during TB treatment?

A

NO alcohol

61
Q

what must be monitored during treatment of TB? (General)

A
  • lab testing, CBC with platelets, serum bilirubin, hepatic enzymes, urea nitrogen, creatinine
62
Q

what must be monitored during treatment of TB? (Visual)

A

Ethambutol

63
Q

what must be monitored during treatment of TB? (Serum acid)

A

Pyrazinamide

64
Q

what must be monitored during treatment of TB? (Audiometry)

A

Streptomycin

65
Q

what are common adverse reactions with treatment of TB with INH?

A
  • peripheral neuropathy (give Vit B6)
  • fetal hepatitis
  • elevated liver enzymes (AST and ALT)
  • interacts with phenytoin, disulfiram
66
Q

what are common adverse reactions with treatment of TB with RIF?

A
  • hepatitis, fever, rash, flu-like illness, GI upset, bleeding issues, kidney dysfunction
  • orange body secretions/urine
67
Q

when is a patient considered no longer infectious with active TB?

A
  1. 3 consecutive negative sputum smears
  2. Symptoms have improved, and
  3. Patient is adherent to an adequate treatment regimen for at least 2 weeks
68
Q

if the treatment for TB is interrupted (common), what should you do?

A

restart or continue therapy

69
Q

what is the prognosis of TB?

A
  • immunocompetent often cured
70
Q

what is the TB vaccine?

A

Bacillus Calmette-Guérin (BCG)
-Mycobacterium bovis attenuated strain

71
Q

when is the TB vaccine CI?

A

pregnant women and immunocompromised patients

72
Q

what is a SE of the TB vaccine?

A

a bluish red pustule at site of injection, which in turn could progress to an ulceration
- Can last for up to three months

73
Q

Is nosocomial tb common in the us

A

No

Clinical Medicine (164 decks)

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