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
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
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
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
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)
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
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
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
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
10
Q
What are other mycobacterium that cause TB but are treated the same and present similarly?
A
- mycobacterium africanum
- mycobacterium bovis
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
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
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)
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
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
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
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
18
Q
What type of TB transmission is possible if a persons sputum smear is negative but cultures are positive?
A
possible transmission
19
Q
What type of TB transmission is possible if a persons sputum is negative and culture is negative?
A
no transmission
20
Q
What are the 4 scenarios that occur after an infection with TB?
A
- immediately clear the infection; never know and never have symptoms; never have a positive TB test
- patient (possibly immunocompromised or a child) is exposed to TB; immediately develop active TB disease
- 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
- exposed to TB; body contained it initially but has now allowed it to reactivate at a later point; TB test remains positive
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
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”
23
Q
With latent TB, what percentage of cases can lead to reactivation years later?
A
5-10%
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
25
- 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 (...)
- macrophage fail
- alveoli
- cannot destroy
- replicate
- replicate
26
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 (...)
- monocyte; macrophage
- surround
- granuloma
- ghon focus
- ghon focus
- ghon focus; ghon complex
27
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?
- **apical regions of the lungs (top of the lungs)**
- lymph nodes
- kidneys
- epiphyses of long bones
- vertebral bodies
- meninges
28
- 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
- contained to only the tissues where it initially spread
- CD4+ helper T cells
- mild fever and malaise
- caseous (like hardened cheese)
- latent
29
- 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 (...)
- active primary progressive TB
- young children or immunocompromised patients
- airways
- recover (but not eradicate the disease) or will have active, chronic symptoms
30
- 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
- primary pulmonary TB
- asymptomatic
- symptoms; fever (lasts up to 3 weeks), dyspnea, cough, pleuritic chest pain
- positive; 4-10 weeks
31
- 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
- 10%
- children (under 5 are high risk), elderly, immunocompromised
- 2 years
32
What percent of children under age 2 exposed to TB will develop TB within one year?
30-40%
33
What are the characteristics of progressive primary TB in the lungs?
- 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**
34
If you see cavitary lesions on a CXR, what is this until proven otherwise?
TB
35
- 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?
- 5-10%
- immunocompromised
- HIV, lymphoma, smokers, diabetes, ESRD (end-stage renal disease)
36
- Reactivation TB occurs at least (...) years *after* primary infection
- Patients will present with (...) symptoms
- 2 years
- classic TB
37
What are some classic TB symptoms?
- cough (worsens over time to produce green-sputum or hemoptysis)
- night sweats
- anorexia - "consumption"
- weight loss
- fever
- bloody or purulent sputum
38
When should you think TB (what should you ask/look for in patients)?
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)?
39
What are some physical examination findings of the lungs for TB?
- may hear rales, AKA "crackles"
- may hear dullness in the lungs
- may hear distant hollow breath sounds if cavitation is present
-
40
What is caused by the alveoli opening under pressure from fluid or infection within the alveoli or around it?
Rales AKA "crackles"
41
- 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
- mild anemia, leukocytosis, thrombocytosis
- increased ESR/CRP
- anemia, thrombocytosis, and elevated ESR/CRP
42
- 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 (...)
- 86%
- anemia of chronic disease (normocytic, normochromic); anemia
43
Any organ can be affected by TB; what are the main sites of extrapulmonary TB?
- lymph nodes "scrofula"
- pleura
- GU tract
- bones and joints
- meninges
- peritoneum
- pericardium
44
What is TB of the cervical lymph nodes?
scrofula
45
46
What is this describing:
- skeletal manifestation of TB
- more commonly affects the thoracic and upper lumbar spine, resulting in eventual vertebral collapse
Pott's disease
47
- Pott's disease is more common in which patients (outside/inside endemic regions)
- Usually it occurs within (...) of a primary lung infection from TB
- young patients in endemic regions and young adults outside of endemic regions
- within 1 year
48
What are some genitourinary symptoms of TB?
- urinary frequency
- nocturia
- flank pain
- urine testing shows pyuria and blood
49
- Genitourinary TB can lead to destructive lesions of the (...)
- It can affect female and male GU structures such as?
- renal system
- fallopain tubes in women, epididymis in men
50
- 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)?
- Miliary TB
- night sweats, filminant respiratory symptoms
51
What symptoms are associated with pleural TB?
- fever
- pleuritic CP
- dyspnea
52
What are symptoms of TB meningitis?
- fever
- stiff neck
- headache
53
What are symptoms of TB of the bones/joints?
- synovitis of the joints
- vertebral osteomyelitis
54
What are peritoneal or gastrointestinal TB symptoms?
- abdominal pain
- fever
- melena (dark stool)
55
What tests can you use to diagnose TB?
- TB (PPD) skin test (two step)
- quantiferon
56
- 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?
- BCG vaccine status
- need to be evaluated for active TB or latent TB (LTBI); appropriate treatment should be initiated
57
- 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?
- 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
What is the interpretation of a TB reaction size of < 5 mm?
negative in all pts
59
What is the interpretation of a TB reaction size of ≥ 5 mm? (what pts this is positive in)
- HIV infection
- close contact with positive case
- immunosuppressed
- CXR findings of old TB
60
What is the interpretation of a TB reaction size of ≥ 10 mm? (what pts is this positive in)?
- 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
What is the interpretation of a TB reaction size of ≥ 15 mm? (which individuals this is positive in)
- positive in healthy, low-risk individuals over 4
62
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
true
63
In immunosuppressed and BCG-vaccinated individuals, which TB test is better to use?
quantiferon (IGRA)
64
- 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 (...)
- 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
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?
- normal: treat for LTBI
- abnormal: evaluate for active TB
66
- 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?
- treatment for LTBI is not indication
- retest 12 weeks after contact has ended; if positive = get CXR and evaluate for active TB/LTBI
67
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?
send them for evaluation for active disease: sputum testing in controlled circumstances
68
- 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
- active or latent
- latent TB
- sputum cultures and other sputum testing
69
Diagnosis of TB is made with consideration of which factors?
- 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
What are the cardinal 4 symptoms of TB?
- cough
- fever
- night sweats
- weight loss
71
- Where should TB sputum culture collections occur?
- How many sputum specimens/cultures should you obtain and for what?
- 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
Specimens for TB diagnosis can also be obtained during what?
- bronchoscopy, gastric aspiration
- pleural fluid/biopsy
73
What are these describing:
- inactive, contained tubercle bacilli in the body
- active, multiplying tubercle bacilli in the body
- LTBI
- TB disease (in the lungs)
74
What is this describing:
- TST or blood test results usually positive
- LTBI and TB disease
75
What are these describing:
- CXR usually normal
- CXR usually abnormal
- LTBI
- TB disease in the lungs
76
What are these describing:
- sputum smears and cultures negative
- sputum smears and cultures may be positive
- LTBI
- TB disease in the lungs
77
What are these describing:
- no symptoms, not infectious
- symptoms such as cough, fever, weight loss; often infectious before treatment
- LTBI
- TB disease
78
What are these describing:
- not a case of active TB
- a case of active TB
- LTBI
- TB disease
79
- 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?
- reactivation
- patients with LTBI or active TB who have completed treatment
80
- 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
- Isoniazid (INH)
- 60-90%
- bactericidal
- bacteriostatic
- CSF; meningitis
81
- 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?
- 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
- 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
- hepatitis; 30 pills
- LFT levels; 5x
- fatal hepatitis
- alcohol; acetaminophen
83
- Patients should have what supplementation while on INH?
- (...) can result if levels get too low from INH?
- B6
- peripheral neuropathy
84
What are indications for rifampin use, which is a bactericide or bacteriostatic (inhibits RNA synthesis) agent? (what can it be used against)
- tuberculosis
- Hansen's disease (leprosy)
- legionnaire's disease
- staphylococcal infections (MRSA)
85
- 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?
- 4 months long
- hepatotoxicity; liver impairment
- GI distress, renal dysfunction (increased BUN/Cr) leading to acute kidney injury
86
- 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?
- 2 times per week
- drug interactions
- turns body fluids orange-red in color and ruins contact lens
87
- 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?
- rifapentine
- isoniazid + rifapentine
- flu-like rxns, drug rxn or hypersensitivity (rash or angioedema), hypotension, syncope
88
What is DOT good for?
- monitoring for side effects
- preventing lack of follow-up is side effects occur
89
What are the different treatment regimens for latent TB?
- INH for either 9 or 6 months
- rifampin for 4 months
- INH + rifapentine for 3 months
90
Treatment of active TB is sometimes performed under DOTS program which includes what and what type of patients?
- 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
What are the different regimens and phases of active TB treatment?
- phase 1: 4 medications for 8 weeks; includes INH + rifampin + pyrazinamide + ethambutol
- phase 2: INH + rifampin for 18 weeks
92
- 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
- sputum culture
- positive; cavitation
93
- 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
- TB
- mechanism unclear but lowers the pH below acceptable for growth of M. tuberculosis
- bactericidal and bacteriostatic
- category C
- first trimester
94
What levels do you need to monitor when a patient is taking pyrazinamide for TB?
- LFTs
- Uric acid
95
- 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
- fatal liver toxicity; alcoholism, hepatitis, and jaundice
- hepatotoxicity
- hyperuricemia (gout)
96
What are some other side effects of pyrazinamide besides liver toxicity and hyperuricemia?
- GI distress
- myalgias and arthralgias
- hematologic complications (thrombocytopenia, sideroblastic anemia)
97
- 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 (...)
- ethambutol
- optic neuritis (inflammation of optic nerve); pretreatment eye exam; visual changes
98
- 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
- children; blindness
- LFTs and uric acid levels
- hepatotoxicity
99
What are the side effects of ethambutol?
- GI distress
- arthralgias
- peripheral neuropathy
- hallucinations
- erythema multiforme
100
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
drug-resistant TB
101
What is this describing:
- resistance to 1 antituberculosis medication
monoresistance
102
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
multidrug-resistant TB (MDR)
103
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
extensively drug-resistant TB (XDR)
104
- 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?
- 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
- The prognosis of TB depends on many factors such as what?
- Generally, there is a worse prognosis with what conditions?
- extent of disease, drug resistance, immune system status
- respiratory failure, meningitis, miliary TB, MDR or XDR TB
106
- 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
- bacillus calmette-guerin (BCG) vaccine
- 50-80%
- 10-15 years
107
Why is the BCG vaccine not recommended in the US?
- low prevalence of TB in the US
- causes false-positive TST
- variable efficacy
108
- 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 (...)
- primary progressive TB or reactivation TB
- normal CXR
pneumonia; infiltrates
109
What are the CXR findings you may see with a patient who has TB?
- normal CXR
- infiltrative processes
- hilar edenopathy
- pleural effusions
- cavitary lesions in upper lobes; can be seen as thick-walled cavities
110
Cavitary lesions (which can be seen as thick walled cavities) is more common in (...)
reactivation TB
111
What is this showing?
ghon complex
112
What is this showing?
cavitary lesion
113
What is this showing?
- infiltrate in right upper lobe
- cavitations
114
What is this showing?
lymphadenopathy
115
What is this showing?
- infiltrative process in the right upper lobe; usually seen in pneumonia but can be seen in TB
116
What is this showing?
cavitary lesion in right upper lobe
117
What is this showing?
possible cavitation in right upper lobe surrounded by infiltrate
118
What is this showing?
bilateral cavity lesions with subtle infiltrative processes
119
What is this showing? What is it caused by?
pleural effusion; seeding of TB to the pleura
120
What is this showing?
- infiltrative process in left upper lobe
- cavitary lesion that is thick walled
