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Clinical Medicine: Infectious Disease (Part 2) > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What percentage of the world population is infected with Tuberculosis?

A

25%

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2
Q

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

A

Infection

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3
Q

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

A

Disease

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4
Q

What immune cells are the initial responders to Primary Tuberculosis?

A

Macrophages

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5
Q

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

A

Granuloma

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6
Q

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

A

Caseous Necrosis

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7
Q

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

A

Ghon Focus

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8
Q

What lymph nodes may Tuberculosis spread to resulting in lymphadenopathy?

A

Hilar Lymph Nodes

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9
Q

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

A

Ghon Complex

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10
Q

What is a Ghon Complex consistent with?

A

Primary TB

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11
Q

Is primary TB usually symptomatic or asymptomatic?

A

Asymptomatic

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12
Q

What percentage of Primary TB will enter the Latent Stage?

A

90%

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13
Q

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?

A

Ranke Complex

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14
Q

Is Latent TB contagious?

A

No

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15
Q

How long can Latent TB remain dormant for?

A

Years

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16
Q

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

A

Re-Activation

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17
Q

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

A

Apices of the Lungs

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18
Q

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

A

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

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19
Q

Reactivation of Tuberculosis is also referred to as what?

A

Secondary Tuberculosis

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20
Q

What are two characteristics of Secondary Tuberculosis?

A

Symptomatic
Contagious

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21
Q

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?

A

Primary Progressive TB

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22
Q

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

A

Malaise
Fever
Weight Loss
Night Sweats (severe)
Hemoptysis

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23
Q

What are some complications of Pulmonary TB?

A

Pneumothorax
Bronchopneumonia
Pleural Effusion
Hemoptysis

24
Q

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

A

Extra-pulmonary TB

25
Q

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.

A

Miliary TB

26
Q

Name for when Tuberculosis is in the central nervous system.

A

Tuberculosis Meningitis

27
Q

Name for when Tuberculosis is in the spine.

A

Pott’s Disease

28
Q

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

A

Addison’s Disease

29
Q

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

A

Scrofula

30
Q

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

A

PPD Test (purified protein derivative)
Mantoux Test

31
Q

Can the PPD test distinguish active TB from latent TB?

A

No

32
Q

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

A

Bacillus Calmette-Guerin (BCG)

33
Q

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

A

Greater than 15mm

34
Q

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

A

Greater than 10mm

35
Q

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

A

Greater than 5mm

36
Q

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

A

Interferon-Gamma Release Assay
- QuantiFERON-TB Gold

37
Q

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

A

Not Usually

38
Q

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

A

Chest X-Ray
Chest CT

39
Q

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

A

3

40
Q

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

A

Ziehl-Neelsan Stain
(Acid-Fast)

41
Q

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

A

Non-Tuberculosis Mycobacteria may be present

42
Q

What is the definitive diagnosis of TB?

A

Sputum Culture

43
Q

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

A

6 - 8 Weeks

44
Q

What is another definitive diagnosis of TB?

A

DNA/RNA Amplification
(takes 1 - 2 days)

45
Q

Active TB requires a medication regiment for how many months?

A

6 months

46
Q

What is the standard treatment for active TB?

A

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

47
Q

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

A

Isoniazid (9 months)
Rifampin (4 months)

48
Q

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

A

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

49
Q

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

A

Directly Observed Therapy

50
Q

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

A

Drug Resistant TB

51
Q

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

A

Multi-Drug Resistant TB

52
Q

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

A

Extremely Drug-Resistant TB

53
Q

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

A

Less than 1.3%

54
Q

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

A

2 - 3 weeks
- followed by community isolation

55
Q

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

A

Low Prevalence of TB
Interferes with ability to used PPD

Clinical Medicine: Infectious Disease (Part 2) (8 decks)

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