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IDS REVIEW > TUBERCULOSIS > Flashcards

TUBERCULOSIS Flashcards

1
Q

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

A

Children

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2
Q

Most commonly involved lung zone in primary TB?

A

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

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3
Q

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

A

Ghon focus

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4
Q

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

A

Ghon complex

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5
Q

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

A

TRUE

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6
Q

Lung zones involved in adult-type TB

A

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

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7
Q

The rupture of a dilated vessel in a cavity

A

Rasmussen’s aneurysm

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8
Q

Most common hematologic findings in adult type TB?

A

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

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9
Q

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

A

Lymph node TB (Tuberculous Lymphadenopathy)

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10
Q

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

A

TRUE

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11
Q

Areas where lymph node TB is commonly seen

A

Posterior cervical and supraclavicular sites

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12
Q

The diagnosis of lymph node TB is established by

A

fine-needle aspiration biopsy or surgical excision biopsy

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13
Q

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

A

TRUE

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14
Q

Pathogenesis of TB Meningitis or Tuberculoma?

A

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

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15
Q

Cornerstone of TB meningitis diagnosis?

A

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

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16
Q

Gold standard for the diagnosis of TB meningitis?

A

Culture of CSF

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17
Q

Preferred initial diagnostic test for CSF specimen in TB meningitis?

A

Xpert MTB/RIF assay

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

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18
Q

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

A

TRUE

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19
Q

The pathogenic mechanism of GI TB?

A

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

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20
Q

Sites most commonly involved in GI TB?

A

Terminal ileum and cecum

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21
Q

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

A

TRUE

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22
Q

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

A

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.
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23
Q

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

A

TRUE

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24
Q

Pathognomonic eye examination finding in miliary TB?

A

Choroidal tubercle

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25
Q

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

A

TRUE

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26
Q

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

A

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

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27
Q

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

A

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.
28
Q

Definitive diagnosis for TB?

A

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
29
Q

Causes of TST false negative results

A
  • In immunosuppressed patients
  • those with overwhelming TB
30
Q

Causes of TST false positive results

A
  • caused by infections with nontuberculous mycobacteria
  • BCG vaccination
31
Q

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

A

TRUE

32
Q

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

A

TRUE

33
Q

TB drugs with bactericidal activity?

A

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).

34
Q

Recommended dosage of anti-TB drugs in adults

A

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

35
Q

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

A

Pyridoxine 10-25mg/d

36
Q

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

A

Hepatitis

* symptoms of drug-induced hepatitis (e.g., dark urine, loss of appetite, nausea)
37
Q

Gene implicated for the Isoniazid resistance?

A

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

38
Q

Treatment for isoniazid-resistant TB

A

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

39
Q

Definition of MDR-TB

A

bacilli are resistant to (at least) isoniazid AND rifampin

40
Q

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

A

TRUE

41
Q

The regimen of choice for pregnant women with TB

A

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

42
Q

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

A

FALSE.
Treatment for TB is not a contraindication to breastfeeding

43
Q

Which of the following is TRUE about primary pulmonary tuberculosis?
A) It typically affects the apical segments of the lungs.
B) It occurs due to the reactivation of a latent infection.
C) It commonly affects children in areas with high TB transmission.
D) It is always symptomatic and severe.

A

Answer: C
Rationale: Primary pulmonary TB occurs soon after initial infection and is commonly seen in children in areas of high TB transmission. It usually affects the middle and lower lung zones, not the apical segments (A). Reactivation of latent infection occurs in post-primary TB (B). Many cases resolve spontaneously and may be asymptomatic (D).

44
Q

The hallmark radiographic finding of primary pulmonary TB is:
A) A Ghon focus with transient hilar lymphadenopathy
B) Cavitary lesions in the upper lobes
C) Miliary nodules spread throughout the lungs
D) Pleural effusion with no lymph node involvement

A

Answer: A
Rationale: The Ghon focus, often with transient hilar or paratracheal lymphadenopathy, is characteristic of primary TB. Cavitary lesions in the upper lobes (B) are seen in post-primary TB. Miliary nodules (C) indicate disseminated TB. Pleural effusion (D) is a feature of pleural TB.

45
Q

Which of the following is a common site of post-primary TB involvement?
A) Lower lung zones
B) Upper lobes (apical and posterior segments)
C) Anterior segments of the middle lobe
D) Pleural space only

A

Answer: B
Rationale: Post-primary (reactivation) TB is commonly localized to the apical and posterior segments of the upper lobes due to the higher mean oxygen tension. The lower lung zones (A) are more often involved in primary TB.

46
Q

Which extrapulmonary TB manifestation is the most common?
A) Tuberculous peritonitis
B) Tuberculous lymphadenopathy
C) Gastrointestinal TB
D) Tuberculous myocarditis

A

Answer: B
Rationale: Tuberculous lymphadenopathy is the most common form of extrapulmonary TB, particularly among HIV-infected individuals and children. Tuberculous peritonitis (A) and gastrointestinal TB (C) are less common. Tuberculous myocarditis (D) is extremely rare.

47
Q

Which of the following is TRUE regarding tuberculous meningitis?
A) It is caused by inhalation of TB bacteria directly into the meninges.
B) It usually presents with an acute onset of symptoms within hours.
C) Diagnosis is confirmed by lumbar puncture and CSF analysis.
D) Glucocorticoids are contraindicated in the treatment of CNS TB.

A

Answer: C
Rationale: Lumbar puncture is essential for diagnosing tuberculous meningitis, showing high protein levels, lymphocytic pleocytosis, and low glucose. TB meningitis results from hematogenous spread or rupture of a subependymal tubercle, not direct inhalation (A). Symptoms develop gradually, not acutely (B). Glucocorticoids are recommended to reduce mortality and disability (D).

48
Q

A patient presents with hemoptysis due to post-primary TB. Which of the following is a potential cause?
A) Erosion of a blood vessel in a cavity
B) Direct invasion of the pulmonary artery by TB bacilli
C) Isolated pleural effusion
D) Hematogenous dissemination without cavitary lesions

A

Answer: A
Rationale: Hemoptysis in post-primary TB is often due to the erosion of a blood vessel in the wall of a cavity. Rasmussen’s aneurysm (rupture of a dilated vessel in a cavity) and aspergilloma formation in an old cavity are also potential causes. Direct invasion of the pulmonary artery (B) is rare.

49
Q

Which diagnostic test is preferred for detecting TB in HIV-positive patients?
A) Tuberculin skin test
B) Sputum smear microscopy
C) Xpert MTB/RIF assay
D) Chest X-ray alone

A

Answer: C
Rationale: The Xpert MTB/RIF assay is the preferred initial diagnostic test in HIV-positive TB patients, as it provides rapid detection and assesses rifampin resistance. Sputum smear microscopy (B) is less sensitive in HIV patients. Chest X-ray alone (D) is insufficient for diagnosis.

50
Q

What is the most common route by which tuberculous meningitis develops?
A) Direct inhalation of Mycobacterium tuberculosis into the meninges
B) Hematogenous spread from primary or postprimary pulmonary TB
C) Direct extension from an adjacent brain abscess
D) Reactivation of latent TB in the meninges

A

Answer: B
Rationale: Tuberculous meningitis results from hematogenous spread of TB from either primary or postprimary infection or from the rupture of a subependymal tubercle into the subarachnoid space. Direct inhalation (A) is not a mechanism for CNS TB.

51
Q

Which of the following is a hallmark of tuberculous meningitis on cerebrospinal fluid (CSF) analysis?
A) Low protein, normal glucose, and no pleocytosis
B) High leukocyte count with lymphocytic predominance, high protein, and low glucose
C) Normal CSF findings with positive PCR for Mycobacterium tuberculosis
D) Elevated glucose with neutrophilic predominance

A

Answer: B
Rationale: CSF findings in tuberculous meningitis typically show a high leukocyte count (predominantly lymphocytes, though neutrophils may be present early), elevated protein, and low glucose concentration. A normal CSF profile (A, C) is unlikely, and glucose is usually low, not elevated (D).

52
Q

What is the gold standard for diagnosing tuberculous meningitis?
A) Lumbar puncture with CSF culture
B) Chest X-ray showing pulmonary TB
C) MRI of the brain alone
D) Tuberculin skin test

A

Answer: A
Rationale: Culture of CSF remains the gold standard for diagnosing tuberculous meningitis, though it takes time. Xpert MTB/RIF is the preferred rapid diagnostic tool but does not replace culture. Chest X-ray (B) may support a TB diagnosis but does not confirm CNS involvement.

53
Q

What imaging findings are commonly seen in tuberculous meningitis?
A) Isolated temporal lobe atrophy
B) Hydrocephalus and abnormal enhancement of basal cisterns
C) Normal brain MRI but positive CSF culture
D) Isolated cerebellar infarcts

A

Answer: B
Rationale: Imaging studies such as CT and MRI often show hydrocephalus and abnormal enhancement of the basal cisterns or ependyma due to meningeal inflammation and cerebrospinal fluid flow obstruction

54
Q

Which of the following is the preferred initial diagnostic test for tuberculous meningitis?
A) Xpert MTB/RIF assay on CSF
B) Sputum smear microscopy
C) Tuberculin skin test
D) Blood culture

A

Answer: A
Rationale: Xpert MTB/RIF assay on CSF is the preferred initial diagnostic test due to its rapid detection of M. tuberculosis and rifampin resistance. Sputum microscopy (B) is used for pulmonary TB but is not specific for CNS TB.

55
Q

According to WHO, what adjunctive therapy is recommended for tuberculous meningitis?
A) Antifungal therapy to prevent opportunistic infections
B) Long-term anticoagulation to prevent stroke
C) Adjuvant glucocorticoids (dexamethasone or prednisolone) tapered over 6–8 weeks
D) Immediate ART initiation in all HIV-positive patients

A

Answer: C
Rationale: WHO recommends adjuvant glucocorticoid therapy (dexamethasone or prednisolone) tapered over 6–8 weeks for CNS TB, as it helps reduce inflammation and improve outcomes. ART initiation (D) should be delayed in TB meningitis cases.

56
Q

What is the best method for definitively diagnosing tuberculous pericarditis?
A) Chest X-ray
B) Pericardiocentesis under echocardiographic guidance
C) Tuberculin skin test
D) Sputum culture

A

Answer: B
Rationale: Pericardiocentesis under echocardiographic guidance is the best method for obtaining pericardial fluid for biochemical, cytologic, and microbiologic analysis.

57
Q

Which of the following is a pathognomonic finding for miliary TB?
A) Pleural effusion on chest X-ray
B) Caseating granulomas in lung biopsy
C) Choroidal tubercles on eye examination
D) Miliary pattern on sputum smear

A

Answer: C
Rationale: Choroidal tubercles on eye examination are pathognomonic for miliary TB.

58
Q

What is the recommended timing of ART initiation in a patient with TB meningitis?
A) Within 1 week of starting TB treatment
B) Immediately after TB diagnosis
C) After 8 weeks of TB treatment
D) ART is contraindicated in TB meningitis

A

Answer: C
Rationale: ART should not be initiated during the first 8 weeks of TB treatment in TB meningitis, as early ART may worsen neurological inflammation.

59
Q

What is the recommended treatment for severe paradoxical IRIS?
A) Increase the dose of ART
B) Stop TB treatment and continue ART
C) Glucocorticoids (e.g., prednisolone)
D) Use second-line TB drugs

A

Answer: C
Rationale: Glucocorticoids (prednisolone) can be used for severe paradoxical IRIS to reduce excessive inflammation.

60
Q

Which gene is primarily associated with rifampin resistance in Mycobacterium tuberculosis?
A) katG
B) inhA
C) rpoB
D) embB

A

Answer: C
Rationale: Rifampin resistance is mainly due to mutations in the rpoB gene, which encodes the β-subunit of RNA polymerase.

61
Q

Molecular line probe assays (LPAs) detect drug resistance by identifying mutations in bacterial DNA. Which of the following genes is associated with isoniazid resistance?
A) rpoB
B) katG and inhA
C) embB
D) gyrA

A

Answer: B
Rationale: Isoniazid resistance is associated with mutations in katG and inhA genes.

62
Q

Which of the following is a limitation of both the Tuberculin Skin Test (TST) and the IFN gamma release assays (IGRAs)?
A) They are both able to distinguish between active TB and TB infection
B) They cannot differentiate between new infections and reinfections
C) They always provide positive results in individuals with active TB
D) They have no cross-reactivity with BCG vaccination

A

Answer: B
Rationale: Both TST and IGRAs cannot distinguish between new infections and reinfections, and they cannot differentiate between latent TB infection and active TB.

63
Q

Which of the following tests is preferred for TB infection testing in children aged less than 5 years?
A) QuantiFERON-TB Gold
B) T-SPOT.TB
C) Tuberculin Skin Test (TST)
D) Sputum smear microscopy

A

Answer: C
Rationale: TST is preferred for children under 5 years old, as IGRAs are not as widely validated for young children, especially those at a higher risk of developing TB.

64
Q

Which of the following can cause a false-negative result in the Tuberculin Skin Test (TST)?
A) Infection with nontuberculous mycobacteria
B) BCG vaccination
C) Immunosuppression or overwhelming TB
D) Proper administration of the test

A

Answer: C
Rationale: False-negative results in TST can occur in immunosuppressed patients or those with overwhelming TB, as their immune response may be insufficient to react to the test.

65
Q

Which of the following is a common cause of a false-positive result in the Tuberculin Skin Test (TST)?
A) Overwhelming active TB disease
B) Immunosuppression
C) BCG vaccination
D) Proper technique during the test administration

A

Answer: C
Rationale: A false-positive reaction in TST can be caused by a prior BCG vaccination or infections with nontuberculous mycobacteria, as these can stimulate the immune system in a similar way to the TB bacteria.

IDS REVIEW (21 decks)

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