Tuberculosis

Question 1

What are the 4 recommended first-line anti-TB medications?

Answer 1

Isoniazid, Rifampin, Pyrazinamide, Ethambutol

Question 2

Why is a multi drug regimen approach used to treat TB?

Answer 2

to delay or prevent resistant strains

Question 3

True/False: Anti-TB meds can be discontinued as soon as symptoms subside

Answer 3

False. They are continued for at least 6 months to make sure all persistent organisms are eradicated.

Question 4

What is the most serious side effect of the anti-TB meds?

Answer 4

Liver dysfunction/hepatitis

Question 5

Because of their potential liver harming effects, which labs should be performed on patients on these meds?

Answer 5

ALT/ASTs for a baseline and then while taking as well

Question 6

What is the most serious side effect of Ethambutol? How do we monitor for it?

Answer 6

Loss of visual acuity as well as loss of ability to tell the difference between green and red. Need to perform vision tests monthly.

Question 7

What is the most common side effect of Isoniazid? How do we treat it?

Answer 7

Peripheral neuritis/neuropathy. Will feel paresthesias in their hands and feet. Can supplement with Vitamin B6.

Question 8

If a patient is on a Cytochrome P450 med (warfarin, oral contraceptives, prednisone, etc), would you need to adjust their dose if starting a anti-TB regimen?

Answer 8

Yes. Rifampin decreases the half-life of these meds and might need to increase dose.

Question 9

What other baseline labs should be performed on patient before starting a anti-TB drug regimen?

Answer 9

CBC (including platelets), creatinine, serum bilirubin, and urate level

Question 10

What is the preferred method of TB testing for patients who have received the BCG shot?

Answer 10

Interferon gold blood test

Question 11

After how many hours after placement does a skin PPD test need to be read?

Answer 11

48-72 hours.

Question 12

Can PPD skin testing be used to test for active TB in persons with symptoms?

Answer 12

Yes, but a positive test does not differentiate between active and latent infection

Question 13

True/False: If a patient has a negative Interferon gold (IGRA) negative blood test, active or latent TB is highly unlikely.

Answer 13

True

Question 14

True/False: A patient with a latent TB infection is symptomatic.

Answer 14

False

Question 15

What drug do you give for Latent TB infection prophylaxis?

Answer 15

Isoniazid

Question 16

How long is the prophylaxis for Latent TB infection?

Answer 16

at least 9 months

Question 17

Common SX of someone with active TB?

Answer 17

Chronic dry cough that progresses to productive then may have hemoptysis PLUS malaise, loss of some lbs, fever, night sweats (appears chronically ill and malnourished)

Question 18

What is a good lab test you could do to detect M. Tuberculosis?

Answer 18

Acid fast! But definitive diagnosis requires culture.

Question 19

How long is the typical tx for someone with active TB?

Answer 19

6-9 months of the 4 drug regimen

Question 20

In which populations is the highest incidence of TB recorded?

Answer 20

malnourished, homeless, living in overcrowded and substandard housing, and HIV-positive.

Question 21

What conditions can re-activate a latent TB infection?

Answer 21

gastrectomy, silicosis, DM, therapy with steroids, HIV infection

Question 22

What are risk factors for TB-drug resistance?

Answer 22

Immigration from countries with prevalence of drug-resistant TB, close and prolonged contact with individuals with drug-resistant TB, unsuccessful therapy, and non adherence to treatment

Question 23

What are diagnostic physical exam findings for TB?

Answer 23

none specific. Exam may be normal.

Question 24

How do you collect a culture on a patient that cannot produce enough sputum or acid-fast was negative?

Answer 24

Sputum induction with 3% hypertonic saline

Question 25

True/False. Current corticosteroid use can result in a false negative TB skin test

Answer 25

True.

Question 26

True/False. Patients with latent TB who test negative on a skin test, proves that the infection is gone.

Answer 26

False. May be negative many years after exposure but not gone.

Question 27

Can an interferon gamma test tell the difference between active and latent TB?

Answer 27

No, should not be used to exclude active TB

Question 28

Which TB test is preferred in patients < 5 years old?

Answer 28

TB skin test

Question 29

Is TB a reportable disease?

Answer 29

YES, ACTIVE ONLY

Question 30

What are ways to improve adherence with TB meds?

Answer 30

provide detailed patient education about TB, assign a case manager. Directly observed therapy (DOT) physically observes them taking meds.

Question 31

Who does the CDC recommend Direct observed therapy (DOT) for?

Answer 31

all patients with drug-resistant TB and for those receiving intermittent therapy.

Question 32

What is extra pulmonary TB?

Answer 32

TB spreads across body and can affect any organ system - bone, brain, liver, GI, GU, kidneys, etc

Question 33

How is treatment of extra pulmonary TB different to regular TB?

Answer 33

It’s not, in most cases the same regimens are effective. 9 months of therapy may be needed if bone, joint, or meningeal disease is present. May need early surgery and debridement of necrotic bone.

Question 34

Which TB med can precipitate a gout attack?

Answer 34

Ethambutol

Question 35

T/F: you have to report latent TB to health department

Answer 35

FALSE

Question 36

Which race has the highest incidence of TB?

Answer 36

Asian Americans