Tuberculosis

Question 1

What percentage of the world population is infected with Tuberculosis?

Answer 1

25%

Question 2

What is the term used to describe Tuberculosis when it is non-active?

Answer 2

Infection

Question 3

What is the term used to describe Tuberculosis when it is active?

Answer 3

Disease

Question 4

What immune cells are the initial responders to Primary Tuberculosis?

Answer 4

Macrophages

Question 5

Macrophages and T-Cells surrounding Mycobacterium tuberculosis lead to the formation of what?

Answer 5

Granuloma

Question 6

A unique type of cell death that occurs inside of the granuloma and causes a “cheese-like” appearance.

Answer 6

Caseous Necrosis

Question 7

A localized area inside the lungs where a granuloma has formed and there is cell death inside causing Caseous Necrosis.

Answer 7

Ghon Focus

Question 8

What lymph nodes may Tuberculosis spread to resulting in lymphadenopathy?

Answer 8

Hilar Lymph Nodes

Question 9

When a Ghon Focus and Hilar lymphadenopathy are both present this is called?

Answer 9

Ghon Complex

Question 10

What is a Ghon Complex consistent with?

Answer 10

Primary TB

Question 11

Is primary TB usually symptomatic or asymptomatic?

Answer 11

Asymptomatic

Question 12

What percentage of Primary TB will enter the Latent Stage?

Answer 12

90%

Question 13

The Ghon Complex will develop fibrocalcifications around it in order to help keep the TB dormant and prevent it from spreading. This fibrocalcification is referred to as what?

Answer 13

Ranke Complex

Question 14

Is Latent TB contagious?

Answer 14

No

Question 15

How long can Latent TB remain dormant for?

Answer 15

Years

Question 16

If a patient with Latent TB became immunocompromised, what might occur?

Answer 16

Re-Activation

Question 17

When TB is re-activated where does it spread to first?

Answer 17

Apices of the Lungs

Question 18

When TB spreads to the apices of the lungs, what then develops?

Answer 18

Fibrocaseous Necrosis Lesions (Cavitary)
Necrosis of Lung Parenchyma
- site of Gas Exchange

Question 19

Reactivation of Tuberculosis is also referred to as what?

Answer 19

Secondary Tuberculosis

Question 20

What are two characteristics of Secondary Tuberculosis?

Answer 20

Symptomatic
Contagious

Question 21

Less than 10% of Primary Tuberculosis cases develop into a stage that has the same pathological process as reactivation TB. What is this stage called?

Answer 21

Primary Progressive TB

Question 22

What are some early symptoms that be associated with active TB?

Answer 22

Malaise
Fever
Weight Loss
Night Sweats (severe)
Hemoptysis

Question 23

What are some complications of Pulmonary TB?

Answer 23

Pneumothorax
Bronchopneumonia
Pleural Effusion
Hemoptysis

Question 24

If TB enters the blood stream it can spread to extra-pulmonary sites and then is referred to as what?

Answer 24

Extra-pulmonary TB

Question 25

Tuberculosis that has spread from the lungs and through the blood and is now affecting multiple organ systems. Formation of multiple millet-sized tuberculous foci may also develop in the lungs.

Answer 25

Miliary TB

Question 26

Name for when Tuberculosis is in the central nervous system.

Answer 26

Tuberculosis Meningitis

Question 27

Name for when Tuberculosis is in the spine.

Answer 27

Pott's Disease

Question 28

Tuberculosis in the adrenal glands can lead to the inability to produce cortisol and ultimately cause what disease?

Answer 28

Addison's Disease

Question 29

Name for when Tuberculosis infects the cervical lymph nodes of the neck.

Answer 29

Scrofula

Question 30

TB skin test that is read after 48-72 hours.

Answer 30

PPD Test (purified protein derivative) Mantoux Test

Question 31

Can the PPD test distinguish active TB from latent TB?

Answer 31

No

Question 32

What vaccine does not allow for the PPD skin test to be performed properly?

Answer 32

Bacillus Calmette-Guerin (BCG)

Question 33

What size of induration indicates a positive TB test in a person with no risk factors

Answer 33

Greater than 15mm

Question 34

What size of induration indicates a positive TB test in a person with medium risk factors?

Answer 34

Greater than 10mm

Question 35

What size of induration indicates a positive TB test in a person with high risk factors?

Answer 35

Greater than 5mm

Question 36

What serology test can be performed to diagnose TB and will have results within 24 hours?

Answer 36

Interferon-Gamma Release Assay - QuantiFERON-TB Gold

Question 37

Is the Interferon-Gamma Release Assay affected by the BCG vaccine?

Answer 37

Not Usually

Question 38

What imaging can be performed as an initial approach to a diagnostic evaluation of a patient with suspected TB?

Answer 38

Chest X-Ray Chest CT

Question 39

In the diagnosis of TB, how many consecutive morning sputum specimens are advised?

Answer 39

3

Question 40

What are TB sputum specimens treated with to test for TB?

Answer 40

Ziehl-Neelsan Stain (Acid-Fast)

Question 41

Sputum with acid-fast bacilli is indicative of TB, however it does not establish a definitive diagnosis. Why?

Answer 41

Non-Tuberculosis Mycobacteria may be present

Question 42

What is the definitive diagnosis of TB?

Answer 42

Sputum Culture

Question 43

How long does it take for a TB sputum culture to provide results?

Answer 43

6 - 8 Weeks

Question 44

What is another definitive diagnosis of TB?

Answer 44

DNA/RNA Amplification (takes 1 - 2 days)

Question 45

Active TB requires a medication regiment for how many months?

Answer 45

6 months

Question 46

What is the standard treatment for active TB?

Answer 46

Isoniazid Rifampin Pyrazinamide (2 months) Ethambutol (2 months)

Question 47

What drugs can be used as a monotherapy for Latent Tuberculosis?

Answer 47

Isoniazid (9 months) Rifampin (4 months)

Question 48

What two drug therapies can be used to treat Latent Tuberculosis?

Answer 48

Isoniazid + Rifapentine (weekly x3 months) Isoniazid + Rifampin (daily x3 months)

Question 49

Type of therapy which requires regular physician visits, who monitor medication intake and look for signs of medication side effects.

Answer 49

Directly Observed Therapy

Question 50

Type of TB resistant to one of the first line anti-tuberculosis drugs (Isoniazid or Rifampin)

Answer 50

Drug Resistant TB

Question 51

Type of TB that is resistant to both Isoniazid and Rifampin.

Answer 51

Multi-Drug Resistant TB

Question 52

Type of TB that is resistant to Isoniazid, Rifampin, fluoroquinolones, and aminoglycosides or capreomycin.

Answer 52

Extremely Drug-Resistant TB

Question 53

What is the rate of drug resistant TB in the US?

Answer 53

Less than 1.3%

Question 54

How long should TB patients be hospitalized for upon initial diagnosis and treatment?

Answer 54

2 - 3 weeks - followed by community isolation

Question 55

Why is the BCG vaccine not generally recommended in the United States?

Answer 55

Low Prevalence of TB Interferes with ability to used PPD