TUBERCULOSIS

Question 1

Primary pulmonary TB occurs soon after the initial infection. In areas of high TB transmission, this disease is often seen in what age group?

Answer 1

Children

Question 2

Most commonly involved lung zone in primary TB?

Answer 2

Middle and lower lung zones are most commonly involved in primary TB.

Question 3

_____ is lesion forming after initial infection that is usually peripheral and accompanied by transient hilar or paratracheal lymphadenopathy

Answer 3

Ghon focus

Question 4

It is the term referred to a Ghon focus, with or without overlying pleural reaction, thickening, and regional lymphadenopathy

Answer 4

Ghon complex

Question 5

TRUE OR FALSE: Adult-type TB results from endogenous reactivation of distant or recent infection (primary infection or reinfection).

Answer 5

TRUE

Question 6

Lung zones involved in adult-type TB

Answer 6

Apical and posterior segments of the upper lobes.
Superior segments of the lower lobes are also frequently involved

Question 7

The rupture of a dilated vessel in a cavity

Answer 7

Rasmussen’s aneurysm

Question 8

Most common hematologic findings in adult type TB?

Answer 8

mild anemia, leukocytosis, and thrombocytosis with a slightly elevated erythrocyte sedimentation rate and/or C-reactive protein level.

Question 9

It is the most common presentation of extrapulmonary TB in both HIV-seronegative individuals and HIV-infected patients

Answer 9

Lymph node TB (Tuberculous Lymphadenopathy)

Question 10

TRUE OR FALSE: Lymph node TB presents as painless swelling of the lymph nodes

Answer 10

TRUE

Question 11

Areas where lymph node TB is commonly seen

Answer 11

Posterior cervical and supraclavicular sites

Question 12

The diagnosis of lymph node TB is established by

Answer 12

fine-needle aspiration biopsy or surgical excision biopsy

Question 13

TRUE OR FALSE: In pleural TB, the collection of fluid in the pleural space represents a hypersensitivity response to mycobacterial antigen

Answer 13

TRUE

Question 14

Pathogenesis of TB Meningitis or Tuberculoma?

Answer 14

Results from the hematogenous spread of primary or postprimary pulmonary TB or from the rupture of a subependymal tubercle into the subarachnoid space.

Question 15

Cornerstone of TB meningitis diagnosis?

Answer 15

Lumbar puncture.

*CSF reveals a high leukocyte count (up to 1000/μL), usually with a predominance of lymphocytes
CSF protein content of 1–8 g/L (100–800 mg/dL)
Low CSF glucose concentration

Question 16

Gold standard for the diagnosis of TB meningitis?

Answer 16

Culture of CSF

Question 17

Preferred initial diagnostic test for CSF specimen in TB meningitis?

Answer 17

Xpert MTB/RIF assay

*Treatment should be initiated immediately upon a positive Xpert MTB/RIF result.

Question 18

TRUE OR FALSE: WHO recommends that adjuvant glucocorticoid therapy with either dexamethasone or prednisolone, tapered over 6–8 weeks, should be used in CNS TB

Answer 18

TRUE

Question 19

The pathogenic mechanism of GI TB?

Answer 19

Swallowing of sputum with direct seeding
Hematogenous spread
Ingestion of milk from cows affected by bovine TB

Question 20

Sites most commonly involved in GI TB?

Answer 20

Terminal ileum and cecum

Question 21

In tuberculous peritonitis, peritoneal biopsy (with a specimen best obtained by laparoscopy) is often needed to establish the diagnosis

Answer 21

TRUE

Question 22

In pericardial TB, the definitive diagnosis can be obtained by _________

Answer 22

Pericardiocentesis under echocardiographic guidance

• exudative in nature with a high count of lymphocytes
  *Culture of pericardial fluid reveals M. tuberculosis
• pericardial biopsy has a higher yield
• High levels of adenosine deaminase, lysozyme, and IFN-γ may suggest a tuberculous etiology.

Question 23

TRUE OR FALSE: WHO currently recommends that in patients with tuberculous pericarditis, initial adjuvant glucocorticoid therapy may be used.

Answer 23

TRUE

Question 24

Pathognomonic eye examination finding in miliary TB?

Answer 24

Choroidal tubercle

Question 25

TRUE OR FALSE: Sputum smears are less frequently positive among TB patients with HIV infection

Answer 25

TRUE

Question 26

When should ART be initiated in HIV-positive patients recently diagnosed with TB meningitis?

Answer 26

ART should not be initiated during the first 8 weeks of TB treatment in patients with TB meningitis

Question 27

TRUE OR FALSE: Regarding NAAT, Xpert MTB/RIF can simultaneously detect TB and rifampin resistance in <2 h and has minimal biosafety and training requirements

Answer 27

TRUE

• The WHO recommends its use worldwide as the first-line diagnostic test in all adults and children with signs or symptoms of active TB.
• The WHO also recommends its use as the initial diagnostic test for people living with HIV in whom TB is suspected.

Question 28

Definitive diagnosis for TB?

Answer 28

Definitive diagnosis depends on the isolation and identification of M. tuberculosis

• Egg- or agar-based medium (e.g., Lowenstein-Jensen or Middlebrook 7H10 or 7H11) and incubated at 37C (under 5% CO2 for Middlebrook medium)
  
  • 4–8 weeks may be required before growth is detected

Question 29

Causes of TST false negative results

Answer 29

• In immunosuppressed patients
• those with overwhelming TB

Question 30

Causes of TST false positive results

Answer 30

• caused by infections with nontuberculous mycobacteria
• BCG vaccination

Question 31

TRUE OR FALSE: IGRA is preferred to the TST for most persons over the age of 5 years who are being screened for TB infection

Answer 31

TRUE

Question 32

TRUE OR FALSE: TST is preferred for TB infection testing of children aged <5 years

Answer 32

TRUE

Question 33

TB drugs with bactericidal activity?

Answer 33

Isoniazid and rifampin - recommended based on their bactericidal activity (i.e., their ability to rapidly reduce the number of viable organisms and render patients noninfectious).

Question 34

Recommended dosage of anti-TB drugs in adults

Answer 34

Isoniazid - 5mg/kg (max 300mg)
Rifampin - 10mg/kg (max 600mg)
Pyrazinamide - 25mg/kg (max 2g)
Ethambutol - 15mg/kg

Question 35

What is the dose of pyridoxine that should be added to the regimen given to persons at high risk of vitamin B6 deficiency?

Answer 35

Pyridoxine 10-25mg/d

Question 36

The most common adverse reaction of significance among people treated for drug-susceptible TB

Answer 36

Hepatitis

* symptoms of drug-induced hepatitis (e.g., dark urine, loss of appetite, nausea)

Question 37

Gene implicated for the Isoniazid resistance?

Answer 37

Rifampin - rpoB gene
Isoniazid - katG gene and inhA gene promoter region
Pyrazinamide - pncA gene
Ethambutol - embB gene
Fluoroquinolones - gyrA–gyrB genes
Aminoglycosides - rrs gene

Question 38

Treatment for isoniazid-resistant TB

Answer 38

Combination of Rifampin, Ethambutol, Pyrazinamide, and Levofloxacin for 6 months

Question 39

Definition of MDR-TB

Answer 39

bacilli are resistant to (at least) isoniazid AND rifampin

Question 40

TRUE OR FALSE: ART should be started within the first 2 weeks of TB treatment for profoundly immunosuppressed patients with CD4 of <50/μL

Answer 40

TRUE

Question 41

The regimen of choice for pregnant women with TB

Answer 41

9 months of treatment with isoniazid and rifampin supplemented by ethambutol for the first 2 months

Question 42

TRUE OR FALSE: Treatment for TB is a contraindication to breastfeeding

Answer 42

FALSE.
Treatment for TB is not a contraindication to breastfeeding