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CIC Exam > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

which places have the highest TB incidence?

A

Africa and Asia

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2
Q

People are primarily infected with TB through what?

A

inhalation (airborne particles 1-5 microns in size generated by individuals with pulmonary and laryngeal TB)

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3
Q

which TB is the most infectious?

A

laryngeal

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4
Q

describe the pathophysioloygy of TB

A

the infectious droplet can go to the alveoli, be phagocyted by macrophages (where MTB survive), produce local infection, and in some cases disseminate. Bacteria first spread to regional lymph nodes and are then disseminated.

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5
Q

True or false. During the initial infection, the individual is not contagious unless active disease develops?

A

True

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6
Q

how long does it take for immunity to develop?

A

10-12 weeks and further spread is prevented. Within 2-12 weeks the PPD skin test becomes positive, but infection may remain latent or progress to active TB.

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7
Q

Within 2 years of initial infection ___ of persons develop active disease

A

5%

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8
Q

True or false. If no disease develops within 2 years, the annual risk of reactivation is low (5-10%)?

A

True

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9
Q

describe the primary TB infection

A

-asymptomatic with sometimes fevers, cough, or erythema nodosum (skin inflammation located in the fatty layer of skin. Reddish, painful lumps most commonly in front of the legs below the knees dime to quarter size).
-Gohn complex (infiltrate and lymphadenopathy on draining lymph nodes), miliary pattern in progressive cases
-disseminatoin can be controlled but multiple non pulmonary sites of controlled infection can be established and lead to extrapulmonary disease during postprimary TB reactivation

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10
Q

TB is an ____ pathogens

A

intracellular (lives inside macrophages)

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11
Q

what is caseous necrosis?

A

a form of cell death where the tissue maintains a cheese-like appearance. The host destroys its own tissue to control the uninhibited multiplication of bacilli that would otherwise be fatal. Integral part of host defenses. Majority of tubercle bacilli are killed, while some survive extracellularly in sold caseous material but can’t multiply because of anoxic conditions and presence of enzymes from dead cells.

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12
Q

How does post primary TB manifest?

A

productive cough, fever, night sweats.

Infiltrates on the upper lobes or superior segments of lower lobes. Cavitation on x-rays.

Cough is initially nonproductive but becomes sputum productive as tissue necrosis progresses.

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13
Q

what are some screening tools for TB?

A

country of origin, past exposure

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14
Q

pulmonary TB may be associated with what?

A

hemoptysis (small amounts of superficial erosion to airway or massive amounts if it is the result of rupture of a dilated vessel of the pulmonary cavity, known as Rasmussen aneurysm).

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15
Q

how does postprimary TB differ in HIV patients?

A

-higher CD4 T-cell counts, atypical with a miliary pattern, lower lobe infiltrates, or normal chest x-rays

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16
Q

MTB is a gram __ ____

A

positive bacillus; aerobic

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17
Q

what are some other organisms that can stain by acid-fast?

A

-leprosy
-nicardia
-rhodococcus
-legionella micdadei

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18
Q

which test is required for definitive TB diagnosis?

A

AFB culture (allows susceptibility to be done too)

19
Q

which tests can be used for rapid, but not definitive, TB diagnosis?

A

-two NAATs
-DNA probe and PCR tests

20
Q

True or false. The TST is used to detect people with latent TBI and cannot be used for ruling in or out active TB

A

True. This is because a positive TST merely indicates a history of LTBI at some point, it conveys no information regarding the persons current infection status (which may have been cured previously). Also, a TST may be negative even when a person has active disease.

21
Q

describe mantoux testing

A

-5 tuberculin units are injected intradermally on the volar (palmar) surface of the forearm; may be placed on the dorsal surface if necessary. Wheel at injection site.
-read 48-72 hours after placement. Positive test is determined by the number of millimeters in duration caused.

22
Q

When is a TB test considered positive?

A

increase induration of 10mm compared to be previous test

23
Q

In what groups of >5mm induration a positive test?

A

-HIV persons
-recent contacts of a TB case
-fibrotic changes on CXR consistent with old TB
-patients with organ transplants and immunosupressed (>15 mg/day prednisone for 1 month)

24
Q

when is >15mm a positive for TB?

A

persons with no TB risk factors

25
Q

when is 10mm induration a positive test?

A

-<5 years from a high prevalence country
-injection drug users
-residents and employees of high risk settings
-mycobacteriology lab personnel
-persons with high risk critical conditions (malnutrition, renal failure)
-medically underserved high risk minoroties
-children under 4 and those exposed to adults in high risk categories

26
Q

describe the IGRA

A

evaluate the release of interferon gamma from the host cell when exposed to TB proteins such as early secretory antigenic target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10)

27
Q

when are IGRAs preferred?

A

patients with a history of BCG therapy for bladder cancer or vaccination or those unlikely to return for TST reading

28
Q

true or false. Current recommendations are to interpret TST results without considering BCG vaccination status

A

True (a positive is more likely to represent latent TB than a BCG reaction)

29
Q

Is BCG recommended for HCP?

A

no because of unproven efficacy

30
Q

true or false. BCG vaccination may induce a TST reaction, the degree to which wanes with time

A

true

31
Q

What does the BCG vaccine consist of?

A

an attenutated strain of M. bovis that is given as a live bacterial vaccine to prevent from the develop of active TB. Range of effectiveness from 0-80%

32
Q

what are contraindications for BCG vaccination?

A

pregnancy and immunosuprised

33
Q

Who are persons at a high risk of Tb infection?

A

-those who have close contact with pulmonary or laryngeal TB cases (days or weeks), foreign born persons (within 5 years arrival, residents and employees of CLS, HCP, underserved/low income populations, children exposed to high risk adults

34
Q

Which source patients are at an increased risk of TB transmission?

A

those with cough, cavitations on CXR, positive smears, laryngeal or pulmonary TB involvement, failure to cover mouth when coughing, inappropraite use of TB meds, those that undergo AGMPs

35
Q

what are some environmental factors that may contribute to TB transmission?

A

TB exposures in closed spaces, iandequate ventilation, air recirculation, poor management of specimens, inadequate cleaning of reusable medical equipment,

36
Q

How is TB prevented?

A

-detection of cases
-airborne isolation in negative pressure rooms
-respiratory etiquette
-N95 use
-early treatment based on susceptibility testing

37
Q

what are some environmental controls to prevent TB transmission?

A

-develop and implement a respiratory protection program
-train HCP and patients on respiratory etiquette
-UV light in addition to ventilation
-negative pressure room

38
Q

what are some administrative controls for TB prevention?

A

-assign responsibility for TB infection control
-conducting TB risk assessment
-disseminate written TB infection control plan
-timely reporting
-train HCP on prevnetion, transmission, and symptoms
-cleaning and disinfection

39
Q

when is the optimal time to collect a sputum specimen for AFB?

A

first thing in the morning

40
Q

What is the protocol for ending TB isolation?

A

three consecutive negative sputum smears collected in 8-24 hour intervals (one should be an early morning specimen).

41
Q

to determine if an expectoriated specimen was sputum and not saliva, the gram stain should show what?

A

fewer than 10 epithelial cells per low power field

42
Q

what is the most common type of adverse reaction when undergoing treatment for TB?

A

hepatotoxicity

43
Q

what are some characteristics of TB surveillance?

A

-the method of specimen collection provides important information regarding the likelihood of results representing oropharnygeal flora versis the etiologic pathogen of lower respiratory tract infection
-sputum culture results commonly yield contaminant or colonizing organisms rather than etiologic agents
-gram stain rsults provide valuale information to distinguish between adequate and inadequate sputum samples by evaluating the presence of squamous epithelial cells and leukocytes

CIC Exam (9 decks)

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