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Clinical Medicine 1 > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q
  • In the 17th and 18th centuries, TB went rampant due to overcrowding and caused (…)% of deaths in Europe
  • In what year was Tubercle bacillus identified for being responsible for TB?
A
  • 25%
  • 1882
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2
Q

Pertaining to the history of TB:
- (…) out of (…) patients died within 5 years of diagnosis
- An estimated (…) people have died from TB over the last 200 years
- TB may be responsible for (…) in history than any other microbe

A
  • 2 out of 3
  • 1 billion
  • more deaths
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3
Q
  • In 1946, the use of (…) against TB began
  • In 1952, (…) treatment began against TB
  • In 1953, the incidence of TB declined by (…)%
  • In 1970, the combination with (…) proved even more efficacious
  • This resulted in (…) of TB surgeries to resent TB lung tissue
  • (…) disappeared completely
A
  • streptomycin
  • isoniazid
  • 75%
  • rifampin
  • reduced rates
  • sanatoriums
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4
Q
  • How many people worldwide are infected with TB currently?
  • Where are rates of TB highest?
  • Where are rates of TB lowest?
A
  • two billion people (1/4th of the worlds population)
  • sub-saharan Africa and parts of SE Asia
  • developed countries such as the US, Japan, and Western Europe
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5
Q
  • In 1985, causes of TB increased again due to (…) rates
  • (…) emerged during this time due to lack of adherence to antibiotic regimens
  • In 1992, rates began to decline again due to (…) and (…)
  • What is it called when a TB patient in person (sometimes daily) is observed taking medication?
A
  • HIV infection rates
  • TB resistance to multiple antibiotics
  • strict adherence policies and direct observed therapy (DOT)
  • direct observed therapy (DOT)
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6
Q

What are some risk factors for TB?

A
  • birth in a country where TB is endemic
  • poverty
  • HIV
  • immunocompromised individuals
  • children
  • belonging to a minority group
  • persons in close contact with an individual with TB
  • residence in close conditions or quarters
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7
Q
  • 95% of cases of TB occur in (…) countries
  • 1 of 14 new TB cases occur in an (…) person; their risk is 9-16x that of an (…) person
  • There is a 5-10x higher rate of TB cases in which minority groups?
  • People in close contact with individuals with TB include which individuals?
A
  • low-income countries
  • HIV+ person; HIV- person
  • hispanics, non-hispanic blacks, asians
  • family members, healthcare workers
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8
Q

Residence in close conditions that puts people at an increased risk of TB includes which spaces?

A
  • nursing homes
  • shelters
  • correctional facilities
  • military barracks
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9
Q
  • Which bacteria is an acid-fast bacilli (neutral gram staining) that grows slowly but is tough and resilient?
  • This is spread from person to person through (…)
  • How many bacilli are able to cause an infection?
  • Infection of the (…) can transmit organism through phonation
  • (…) and (…) routes of transmission are uncommon
A
  • mycobacterium tuberculosis
  • respiratory droplets when coughing
  • 1-5 bacilli
  • larynx
  • skin and placental routes
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10
Q

What are other mycobacterium that cause TB but are treated the same and present similarly?

A
  • mycobacterium africanum
  • mycobacterium bovis
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11
Q

Which TB causing bacteria is this describing:
- same clinical presentation as mycobacterium tuberculosis
- geographically present in West Africa, where it is responsible for up to 50% of TB cases

A

Mycobacterium africanum

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12
Q

Which TB causing bacteria is this describing:
- causes disease in humans, cattle, deer, and other animals
- can be transmitted through drinking unpasteurized milk
- now rare in US but can be common in other countries

A

mycobacterium bovis

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13
Q

How is TB transmitted?

A
  • coughing
  • talking, singing, sighing
  • intubation
  • bronchoscopy
  • aerosal treatments
  • irrigation of TB related abscess
  • autopsy

(anything that expels air)

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14
Q
  • Mycobacterium tuberculosis is killed by (…)
  • Most TB infections occur (…) as a result
  • TB is not infectious by (…)
  • In U.S. household infection rates are between (…)%; what does this depend on?
A
  • ultraviolet light
  • indoor
  • touching bed linens or dishes (fomites)
  • 27-80%; depnds of closeness of contact
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15
Q

Transmission of mycobacterium tuberculosis infection is usually spread from what?

(2 things)

A
  • long-term exposure
  • multiple inocula from infected person in close contact
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16
Q
  • In high-incidence areas and crowded conditions, 1 index case can lead to (…) infected individuals
  • Untreated TB leads to death within (…) in 1 in 3 patients
A
  • 20 infected individuals
  • 1 year
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17
Q

What do these do when it comes to TB transmission:
- prolonged exposure
- close quarters
- sputum positive individuals
- presence of cavitary lung disease
- laryngeal TB

A

increase transmission

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18
Q

What type of TB transmission is possible if a persons sputum smear is negative but cultures are positive?

A

possible transmission

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19
Q

What type of TB transmission is possible if a persons sputum is negative and culture is negative?

A

no transmission

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20
Q

What are the 4 scenarios that occur after an infection with TB?

A
  1. immediately clear the infection; never know and never have symptoms; never have a positive TB test
  2. patient (possibly immunocompromised or a child) is exposed to TB; immediately develop active TB disease
  3. have been exposed to TB, but may not know it; body sends its “attack” on TB and is able to wall it off, contain it, and is likely no symptoms; TB test is positive
  4. exposed to TB; body contained it initially but has now allowed it to reactivate at a later point; TB test remains positive
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21
Q

Exposure to mycobacterium tuberculosis has two outcomes, what are they?

A
  • individual completely eradicated organism, no infection occurs
  • primary TB infection occus with or without symptoms
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22
Q

What are the outcomes and percentages associated with a primary TB infection with or without symptoms?

A
  • 90%: infection is contained and becomes known as latent TB
  • 10%: patient develops progressive primary TB; more common in children and immunocompromised; often termed “pediatric TB”
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23
Q

With latent TB, what percentage of cases can lead to reactivation years later?

A

5-10%

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24
Q

What scenario is this describing:
- the person inhales the infectious tuberculosis bacilli
- the infectious bacilli travel to the lungs
- the tuberculosis bacillis undergoes phagocytosis by alveolar macrophages
- in some cases, where the human has a healthy immune system, there is a possibility that the macrophages can destroy the TB bacilli completely
- the organism is eradicated and no trace exists
- nearly impossible to determine how often this happens

A

scenario 1; the lucky one

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25
Q
  • Scenarios 2-4 are termed (…)
  • In this stage, an individual inhales TB droplets, and it travels to the (…)
  • Here, the macrophage (…) all the bacilli, especially if the person’s immune system is innately too impaired to do so
  • Within the macrophage, the bacilli continuously (…) until the macrophage lyses
  • Other macrophages “pick up” the released bacilli, where they may further (…)
A
  • macrophage fail
  • alveoli
  • cannot destroy
  • replicate
  • replicate
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26
Q

Pertaining to scenarios 2-4: macrophage fail:
- the presence of the infection recruits cells and substances to the region, such as (…) which turn into (…)
- the macrophages “band together” with other cells to form a multinucleated giant cell in order to (…) the bacilli
- the multinucleated giant cell forms a (…)
- Once this becomes visible to the eye, such as if a pathologist was looking at a slice of lung tissue, it is termed a (…)
- If the infection cannot be contained within the (…), it can spread to the lymphatics of the lung and possibly beyong to other organs
- The term for the presence of (…) + infection of regional lymphatics is (…)

A
  • monocyte; macrophage
  • surround
  • granuloma
  • ghon focus
  • ghon focus
  • ghon focus; ghon complex
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27
Q

If the TB infection spreads from the lymphatics to distant sites, TB has a preferential set of places it likes to travel to, what are these areas?

A
  • apical regions of the lungs (top of the lungs)
  • lymph nodes
  • kidneys
  • epiphyses of long bones
  • vertebral bodies
  • meninges
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28
Q
  • In 90% of TB cases, within 2-10 weeks, the body develops cell-mediated immunity and the infection is (…)
  • (…) cells activate “lazy” macrophages to kill the previosly phagocytosed bacilli
  • Some will have (…) and (…) as symptoms, but many are asymptomatic during this time
  • The center of the tubercle becomes (…) and the disease can no longer spread
  • It is now (…), ready to be activated at a later time when defenses are down
A
  • contained to only the tissues where it initially spread
  • CD4+ helper T cells
  • mild fever and malaise
  • caseous (like hardened cheese)
  • latent
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29
Q
  • In 10% of TB cases, patients go on to develop (…) TB
  • This is more common in which individuals?
  • This can become contagious to others as the disease spreads into the (…) by erosion
  • These patients will either (…) or (…)
A
  • active primary progressive TB
  • young children or immunocompromised patients
  • airways
  • recover (but not eradicate the disease) or will have active, chronic symptoms
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30
Q
  • What term refers to all individuals with new infections (TB naive person) who has recently been infected with TB?
  • 2/3 of pts are (…) at this time
  • 1/3 of pts have (…), which include what?
  • Conversion of these individuals TST test is (…), but it takes approximately (…) weeks for this result to occur
A
  • primary pulmonary TB
  • asymptomatic
  • symptoms; fever (lasts up to 3 weeks), dyspnea, cough, pleuritic chest pain
  • positive; 4-10 weeks
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31
Q
  • What percent of patients with a primary TB infection will have an infection that continues to progressive primary TB?
  • Those who develop this form are typically from what groups?
  • This progressive process occurs within (…) years after initial infection
A
  • 10%
  • children (under 5 are high risk), elderly, immunocompromised
  • 2 years
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32
Q

What percent of children under age 2 exposed to TB will develop TB within one year?

A

30-40%

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33
Q

What are the characteristics of progressive primary TB in the lungs?

A
  • progression and enlargement of lung infiltrates
  • seeding to pleura and resultant pleural effusion
  • site of primary infection enlarges, center becomes necrotic known as a cavitary lesion
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34
Q

If you see cavitary lesions on a CXR, what is this until proven otherwise?

A

TB

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35
Q
  • What percentage of patients with latent TB who are healthy and without any underlying co-morbidities will have reactivation of TB at a later time?
  • The cause of this is unclear but it is known that (…) patients have a higher rate of TB reactivation
  • Other populations known to have a higher rate of reactivation are who?
A
  • 5-10%
  • immunocompromised
  • HIV, lymphoma, smokers, diabetes, ESRD (end-stage renal disease)
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36
Q
  • Reactivation TB occurs at least (…) years after primary infection
  • Patients will present with (…) symptoms
A
  • 2 years
  • classic TB
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37
Q

What are some classic TB symptoms?

A
  • cough (worsens over time to produce green-sputum or hemoptysis)
  • night sweats
  • anorexia - “consumption”
  • weight loss
  • fever
  • bloody or purulent sputum
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38
Q

When should you think TB (what should you ask/look for in patients)?

A

Did/does patient do any of the following:
1. have a persistent and severe cough in the presence of risk factos for TB?
2. fail therapy with appropriate treatment for pneumonia (still sick/persistent infiltrates on CXR)
3. have hemoptysis or night sweats that have been relatively recent in onset?
4. have weight loss +/- risk factors for lung cancer (smoking)?

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39
Q

What are some physical examination findings of the lungs for TB?

A
  • may hear rales, AKA “crackles”
  • may hear dullness in the lungs
  • ## may hear distant hollow breath sounds if cavitation is present
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40
Q

What is caused by the alveoli opening under pressure from fluid or infection within the alveoli or around it?

A

Rales AKA “crackles”

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41
Q
  • What are some CBC abnormalities that may be seen in TB?
  • How will ESR/CRP be affected?
  • In endemic areas, seeing a patient with (…), (…), and an elevated (…) or (…) often spurs testing for TB due to it being very common
A
  • mild anemia, leukocytosis, thrombocytosis
  • increased ESR/CRP
  • anemia, thrombocytosis, and elevated ESR/CRP
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42
Q
  • Up to (…)% of TB patients will have mild anemia
  • This is possibly (…) that likely results from chronic inflammatory states and higher TB activity which is linked to worse (…)
A
  • 86%
  • anemia of chronic disease (normocytic, normochromic); anemia
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43
Q

Any organ can be affected by TB; what are the main sites of extrapulmonary TB?

A
  • lymph nodes “scrofula”
  • pleura
  • GU tract
  • bones and joints
  • meninges
  • peritoneum
  • pericardium
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44
Q

What is TB of the cervical lymph nodes?

A

scrofula

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45
Q
A
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46
Q

What is this describing:
- skeletal manifestation of TB
- more commonly affects the thoracic and upper lumbar spine, resulting in eventual vertebral collapse

A

Pott’s disease

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47
Q
  • Pott’s disease is more common in which patients (outside/inside endemic regions)
  • Usually it occurs within (…) of a primary lung infection from TB
A
  • young patients in endemic regions and young adults outside of endemic regions
  • within 1 year
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48
Q

What are some genitourinary symptoms of TB?

A
  • urinary frequency
  • nocturia
  • flank pain
  • urine testing shows pyuria and blood
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49
Q
  • Genitourinary TB can lead to destructive lesions of the (…)
  • It can affect female and male GU structures such as?
A
  • renal system
  • fallopain tubes in women, epididymis in men
50
Q
  • What describes the hematogenous spread of TB to pulmonary tissue?
  • This condition resembles millet seeds spead throughout the lung tissue.
  • What does this condition present with (symptoms)?
A
  • Miliary TB
  • night sweats, filminant respiratory symptoms
51
Q

What symptoms are associated with pleural TB?

A
  • fever
  • pleuritic CP
  • dyspnea
52
Q

What are symptoms of TB meningitis?

A
  • fever
  • stiff neck
  • headache
53
Q

What are symptoms of TB of the bones/joints?

A
  • synovitis of the joints
  • vertebral osteomyelitis
54
Q

What are peritoneal or gastrointestinal TB symptoms?

A
  • abdominal pain
  • fever
  • melena (dark stool)
55
Q

What tests can you use to diagnose TB?

A
  • TB (PPD) skin test (two step)
  • quantiferon
56
Q
  • What should you check on patients when testing them for TB due to it possibly causing a false positive on the skin test?
  • If there is a positive finding on the two-step TB or a positive quantiferon, what does a patient need to be evaluated for?
A
  • BCG vaccine status
  • need to be evaluated for active TB or latent TB (LTBI); appropriate treatment should be initiated
57
Q
  • A patient has a baseline TB skin test, what do the positive and negative results mean?
  • If negative, what do you do next?
  • What do these results mean if positive/negative?
A
  • positive: pt probably has TB infection; negative: retest 1-3 weeks later
  • retest 1-3 weeks later
  • positive: rxn is a boosted rxn d/t infection from a long time ago, pt has LTBI; negative: pt probably does not have TB infection
58
Q

What is the interpretation of a TB reaction size of < 5 mm?

A

negative in all pts

59
Q

What is the interpretation of a TB reaction size of ≥ 5 mm? (what pts this is positive in)

A
  • HIV infection
  • close contact with positive case
  • immunosuppressed
  • CXR findings of old TB
60
Q

What is the interpretation of a TB reaction size of ≥ 10 mm? (what pts is this positive in)?

A
  • children under 4
  • foreigners from high-risk countries
  • IV drug users
  • residents/employees in high-risk settings
  • economically disadvantaged
  • medical conditions associated with reactivated (cancer, diabetes, dialysis)
61
Q

What is the interpretation of a TB reaction size of ≥ 15 mm? (which individuals this is positive in)

A
  • positive in healthy, low-risk individuals over 4
62
Q

T or F:
all persons with symptoms of TB disease, or a positive TST or IGRA result indicating M. tuberculosis infection, should be medically evaluated to exclude TB disease

A

true

63
Q

In immunosuppressed and BCG-vaccinated individuals, which TB test is better to use?

A

quantiferon (IGRA)

64
Q
  • Once you have confirmed your pt indeed has a positive TST or IGRA, you must determine (…)
  • You will need to perform a history which includes what?
  • Note that (…) patients may be asymptomatic
  • You should also perform a physican examination which includes what?
  • What specific things should you look for?
  • You should also perform a (…)
A
  • if patient has latent or active TB
  • symptoms, recent travels, risk factors, close contacts or exposures
  • HIV positive
  • vital signs, full HEENT, pulmonary, cardiac exam
  • observe weight and vital signs for weight loss, auscultate lungs for changes in lung sounds
  • CXR
65
Q

You conduct a TST test and it comes back positive. You perform a chest XR next. What does it mean (how should you treat) if you get a normal vs abnormal CXR(or symptoms) result?

A
  • normal: treat for LTBI
  • abnormal: evaluate for active TB
66
Q
  • You conduct a TST and it comes back negative. What is not indicated to do if the person has no contact with a person who has active TB?
  • If the person did have contact with someone with active TB, what should be done?
A
  • treatment for LTBI is not indication
  • retest 12 weeks after contact has ended; if positive = get CXR and evaluate for active TB/LTBI
67
Q

Any person who has a positive TST or IGRA testing for TB plus clinical manifestations of TB (cough > 2 weeks, fever, night sweats, weight loss) or abnormal CXR findings should be sent where?

A

send them for evaluation for active disease: sputum testing in controlled circumstances

68
Q
  • If pt has positive TB skin or blood test, determine if this TB is (…) or (…)
  • What is the first step?
  • If this is normal and pt has zero symptoms, treat them for (…)
  • If this is abnormal OR they are symptomatic, they will need to have (…) testing performed
A
  • active or latent
  • latent TB
  • sputum cultures and other sputum testing
69
Q

Diagnosis of TB is made with consideration of which factors?

A
  • clinical suspicion based on symptoms of duration > 2-3 weeks (cough, fever, night sweats, weight loss)
  • positive TST or quantiferon test
  • risk factors such as travel to endemic area or recent/remote TB contact
  • CXR/radiologic findings
  • obtain sputum culture to confirm
70
Q

What are the cardinal 4 symptoms of TB?

A
  • cough
  • fever
  • night sweats
  • weight loss
71
Q
  • Where should TB sputum culture collections occur?
  • How many sputum specimens/cultures should you obtain and for what?
A
  • in airborne infection isolation rooms or outdoors
  • 3 sputum specimens for acid-bacilli smear
  • 1 sputum culture for M. tuberculosisi
  • 1 specimen for NAAT testing
  • can also test sensitivies vs antibiotics
72
Q

Specimens for TB diagnosis can also be obtained during what?

A
  • bronchoscopy, gastric aspiration
  • pleural fluid/biopsy
73
Q

What are these describing:
- inactive, contained tubercle bacilli in the body
- active, multiplying tubercle bacilli in the body

A
  • LTBI
  • TB disease (in the lungs)
74
Q

What is this describing:
- TST or blood test results usually positive

A
  • LTBI and TB disease
75
Q

What are these describing:
- CXR usually normal
- CXR usually abnormal

A
  • LTBI
  • TB disease in the lungs
76
Q

What are these describing:
- sputum smears and cultures negative
- sputum smears and cultures may be positive

A
  • LTBI
  • TB disease in the lungs
77
Q

What are these describing:
- no symptoms, not infectious
- symptoms such as cough, fever, weight loss; often infectious before treatment

A
  • LTBI
  • TB disease
78
Q

What are these describing:
- not a case of active TB
- a case of active TB

A
  • LTBI
  • TB disease
79
Q
  • Treating patients with LTBI reduces the chance of (…), although it does not reduce the risk to zero, and chances are variable in different regions
  • The CDC does not recommend annual CXRs on which individuals?
A
  • reactivation
  • patients with LTBI or active TB who have completed treatment
80
Q
  • What is an antimycobacterial medication that disrupts cell wall synthesis of M. tuberculosis and is used in treatment of LTBI and in active TB?
  • In treatment of LTBI, it is effective at reducing conversion to active TB by (…)%
  • This is (…) against rapidy dividing organisms (cavitary lesions)
  • This drug is (…) against slower dividing organisms (closed caseous lesions and macrophages)
  • This drug is also able to penetrate the (…) for treatment of (…) related to TB
A
  • Isoniazid (INH)
  • 60-90%
  • bactericidal
  • bacteriostatic
  • CSF; meningitis
81
Q
  • INH has multiple drug interactions, so what should you do when prescribing medications when a patient is on INH?
  • What are some side effects of INH?
  • What can occur in 10-20% of patients taking INH?
  • 1 out of 1000 patients taking INH will develop drug-induced (…); this is increased in which populations?
A
  • monitor all patients and evaluate all medications carefully when prescribing
  • GI distress, multiple dermatologic reactions
  • elevated liver enzymes
  • hepatitis; blacks, hispanics, and postpartum women
82
Q
  • Patients on INH should be monitored for signs of (…) at monthly visits and they should only be given (…) pills at a time with no refills
  • You should check (…) levels on these patients and if values are > (…) normal, stop the medication and attempt to give another regimen
  • (…) has occurred even months after finishing treatment
  • Patients cannot have (…) and should avoid (…) while on INH due to further liver damage
A
  • hepatitis; 30 pills
  • LFT levels; 5x
  • fatal hepatitis
  • alcohol; acetaminophen
83
Q
  • Patients should have what supplementation while on INH?
  • (…) can result if levels get too low from INH?
A
  • B6
  • peripheral neuropathy
84
Q

What are indications for rifampin use, which is a bactericide or bacteriostatic (inhibits RNA synthesis) agent? (what can it be used against)

A
  • tuberculosis
  • Hansen’s disease (leprosy)
  • legionnaire’s disease
  • staphylococcal infections (MRSA)
85
Q
  • Rifampin has similar efficacy to INH but the treatment regimen is only (…) long
  • Rifampin has a lower rate of (…) compared to INH and should use only when necessary in patients with (…) impairment
  • What are some side effects of rifampin?
A
  • 4 months long
  • hepatotoxicity; liver impairment
  • GI distress, renal dysfunction (increased BUN/Cr) leading to acute kidney injury
86
Q
  • There is a higher incidence of acute kidney injury when taking rifampin when taken more than (…) times per week
  • This drug has multiple (…) interactions and side effections
  • What does rifampin do to body fluids and contact lens?
A
  • 2 times per week
  • drug interactions
  • turns body fluids orange-red in color and ruins contact lens
87
Q
  • What is a derivative of rifampin and has a longer half-life than rifampin?
  • (…) is a combination regimen used for TB given with direct observed therapy (DOT) for 3 months to make sure patients are taking it every day and because side effects can be bad
  • What are the potential side effects of this combination therapy?
A
  • rifapentine
  • isoniazid + rifapentine
  • flu-like rxns, drug rxn or hypersensitivity (rash or angioedema), hypotension, syncope
88
Q

What is DOT good for?

A
  • monitoring for side effects
  • preventing lack of follow-up is side effects occur
89
Q

What are the different treatment regimens for latent TB?

A
  • INH for either 9 or 6 months
  • rifampin for 4 months
  • INH + rifapentine for 3 months
90
Q

Treatment of active TB is sometimes performed under DOTS program which includes what and what type of patients?

A
  • directly observe patients taking medication
  • patients who may be noncompliant
  • children and patients on regimens of 2,3, or 5 times per week dosing
  • non-compliant patients more likely to develop drug-resistant TB and more likely to die
91
Q

What are the different regimens and phases of active TB treatment?

A
  • phase 1: 4 medications for 8 weeks; includes INH + rifampin + pyrazinamide + ethambutol
  • phase 2: INH + rifampin for 18 weeks
92
Q
  • What should be performed monthly during active TB treatment?
  • Treatment for active TB may be extended if culture is persistently (…) and (…) is found on CXRs
A
  • sputum culture
  • positive; cavitation
93
Q
  • Pyrazinamide (PZA) is typically only used in the treatment of (…)
  • How does Pyrazinamide work?
  • This drug can be (…) and (…), depending on concentration
  • This drug is what category in pregnancy?
  • This is also only given in HIV + TB females after (…) in their pregnancy
A
  • TB
  • mechanism unclear but lowers the pH below acceptable for growth of M. tuberculosis
  • bactericidal and bacteriostatic
  • category C
  • first trimester
94
Q

What levels do you need to monitor when a patient is taking pyrazinamide for TB?

A
  • LFTs
  • Uric acid
95
Q
  • Pyrazinamide can cause (…) and is contraindicated in (…), (…), and (…)
  • The likelihood of (…) increases when patients are on multiple agents, which they are with TB treatment
  • PZA can also cause (…) which is why we monitor uric acid
A
  • fatal liver toxicity; alcoholism, hepatitis, and jaundice
  • hepatotoxicity
  • hyperuricemia (gout)
96
Q

What are some other side effects of pyrazinamide besides liver toxicity and hyperuricemia?

A
  • GI distress
  • myalgias and arthralgias
  • hematologic complications (thrombocytopenia, sideroblastic anemia)
97
Q
  • What TB drug is bacteriostatic/bactericidal at higher concentrations that works by inhibiting RNA synthesis that is used with caution and dose adjusted in renal impairment?
  • This drug can cause (…) if dose is over 15 mg/kg/day, so (…) is recommended in all patients and should be instructed to monitor for (…)
A
  • ethambutol
  • optic neuritis (inflammation of optic nerve); pretreatment eye exam; visual changes
98
Q
  • Ethambutol is not usually used in (…) because they may not be able to report visual changes which can lead to (…)
  • What levels should you monitor when a patient is taking ethambutol?
  • (…) is more likely to occur in combo with other agents, but ethambutol is less likely the cause than the other meds in this regimen
A
  • children; blindness
  • LFTs and uric acid levels
  • hepatotoxicity
99
Q

What are the side effects of ethambutol?

A
  • GI distress
  • arthralgias
  • peripheral neuropathy
  • hallucinations
  • erythema multiforme
100
Q

What is this describing:
- TB caused by an isolate of Mycobacterium tuberculosis that is resistant to at least one of the first-line drugs: isoniazid, rifampin, ethambutol, pyrazinamide, or streptomycin

A

drug-resistant TB

101
Q

What is this describing:
- resistance to 1 antituberculosis medication

A

monoresistance

102
Q

What is this describing:
- TB caused by an isolate of M tuberculosis that is resistant to the 2 most effective first-line drugs - isoniazid and rifampin - and possibly other antituberculosis drugs

A

multidrug-resistant TB (MDR)

103
Q

What is this describing:
- multidrug-resistant TB that is also resistant to the most effective second-line drugs, fluoroquinolones, and at least 1 of the 3 injectable second-line drugs used to treat TB (amikacin, kanamycin, or capreomycin) and, possibly, to other antituberculosis drugs

A

extensively drug-resistant TB (XDR)

104
Q
  • Treatment of MDR or XDR is complicated; a combo of medications is used for (…) months
  • It may be treated with up to (…) antibiotic combinations depending on sensitivities
  • If patients fail the regimen, you will need to add medications in factors of (…) at the minimum
  • Patients may also have (…) of affected tissue
  • Cure depends on several factors including what?
A
  • 18-24 months
  • 6+
  • 3
  • surgical resection (lobectomy or pneumonectomy)
  • extent of drug resistance, patient’s immune status, disease severity and patient adherence to medication regimen
105
Q
  • The prognosis of TB depends on many factors such as what?
  • Generally, there is a worse prognosis with what conditions?
A
  • extent of disease, drug resistance, immune system status
  • respiratory failure, meningitis, miliary TB, MDR or XDR TB
106
Q
  • What is the only vaccine currently given to prevent TB that is composed of a live strain of mycobacterium bovis?
  • This vaccine confers protection against TB of between (…)% which varies based on age; it may confer protection for (…) years
A
  • bacillus calmette-guerin (BCG) vaccine
  • 50-80%
  • 10-15 years
107
Q

Why is the BCG vaccine not recommended in the US?

A
  • low prevalence of TB in the US
  • causes false-positive TST
  • variable efficacy
108
Q
  • CXRs cannot tell you if a patient has (…) or (…)
  • In many cases, especially early TB, the patient may have a (…) CXR
  • Sometimes, a patient who has TB has a CXR that looks identical to (…) with only a few (…)
A
  • primary progressive TB or reactivation TB
  • normal CXR
    pneumonia; infiltrates
109
Q

What are the CXR findings you may see with a patient who has TB?

A
  • normal CXR
  • infiltrative processes
  • hilar edenopathy
  • pleural effusions
  • cavitary lesions in upper lobes; can be seen as thick-walled cavities
110
Q

Cavitary lesions (which can be seen as thick walled cavities) is more common in (…)

A

reactivation TB

111
Q

What is this showing?

A

ghon complex

112
Q

What is this showing?

A

cavitary lesion

113
Q

What is this showing?

A
  • infiltrate in right upper lobe
  • cavitations
114
Q

What is this showing?

A

lymphadenopathy

115
Q

What is this showing?

A
  • infiltrative process in the right upper lobe; usually seen in pneumonia but can be seen in TB
116
Q

What is this showing?

A

cavitary lesion in right upper lobe

117
Q

What is this showing?

A

possible cavitation in right upper lobe surrounded by infiltrate

118
Q

What is this showing?

A

bilateral cavity lesions with subtle infiltrative processes

119
Q

What is this showing? What is it caused by?

A

pleural effusion; seeding of TB to the pleura

120
Q

What is this showing?

A
  • infiltrative process in left upper lobe
  • cavitary lesion that is thick walled

Clinical Medicine 1 (4 decks)

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