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Tuberculosis Flashcards

1
Q

List 5 commonest symptoms of TB disease

A
  1. Cough
  2. Drenching night sweats
  3. Fever
  4. Weight loss
  5. Hemoptysis
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2
Q

Who should be checked for TB routinely even when there are no symptoms and when?

A
  1. The client had TB in the last 2 years: yearly and for 2 years after completing TB treatment
  2. The client is HIV positive: at diagnosis, yearly and at first antenatal visit if pregnant
  3. Excluding TB during TB preventive treatment work up
  4. Abnormal TB screening CXR even if no known TB exposure
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3
Q

List 6 features of TB you can possibly find on a chest X ray.

A
  1. Hemoptysis of fresh blood>=1 tablespoon
  2. Respiratory rate>=30
  3. Breathlessness at rest or while talking
  4. Accessory muscles usage
  5. Neck stiffness
  6. Confusion and drowsiness
  7. Persistent vomiting
  8. New weakness of arm/legs
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4
Q

What is the first initial test for diagnosing TB?

A

Sputum TB nucleic acid amplification test

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5
Q

How many sputum samples should be sent for TB work up?

A

2 taken 1 hour apart

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6
Q

Who should get a Urinary LAM done on if TB is being suspected?

A

HIV positive with CD4 count=<200 or WHO stage 3 or 4 disease

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7
Q

List investigations that should be done first in a patient suspected of having TB in order include tests requested in special cases

A
  1. Sputum for TB Nucleic acid amplification test
  2. HIV test
  3. Chest X ray

Special occasions
4. HIV positive with CD4 count=<200 or WHO stage 3/4: Rapid urinary lam
5. Had TB in last 2 years, Health care workers, prisoner and close contact R-R TB: Smear, TB culture and Line probe assays.

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8
Q

When suspecting TB, which group of patients should get a smear, TB culture and line probe assays done for them?[4]

A
  1. Health care workers
  2. Prisoners
  3. Close R-R TB contact
  4. Had TB in the last 2.years
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9
Q

Can you diagnose TB with only a urinary LAM?and say what to do if it is negative

A

Yes if it is positive Tb is diagnosed

But if it is negative it does not rule out TB, you have to use sputum results,. clinical and radiological findings to make a diagnosis

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10
Q

What should you do if a patient is unable to produce a sputum for Tb?

A

Arrange chest X ray.

They should return after 2 days for results

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11
Q

How long should a TB patient wait before their results come back?

A

They should return after 2 days

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12
Q

Is chest X ray the initial test for diagnosing TB?

A

Nope, TB NAAT is number 1 then if it is equivocal and the client has YB symptoms then CXR can be used to diagnose.

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13
Q

What should you do if TB NAAT is trace and the patient is asymptomatic?

A

Depends on whether they had TB in the last two years or not
Yes: Review Line probe assays and culture results and continue assessment for TB preventative therapy and do not start treatment
No: Arrange Chest X ray and doctor review

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14
Q

What is the next step if TB NAAT is negative in a patient who had no history of TB in the last 2 years?

A
  1. Check for rifampicin sensitivity:
    If sensitive: Diagnose Drug sensitive TB and start treatment immediately
    If resistant: Diagnose rifampicin resistant TB and start treatment immediately.
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15
Q

What should be done after TB NAAT is positive?

A

Sensitivity for rifampicin

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16
Q

What is your next step if a patient who had DS-TB in the last 2 years has TB NAAT that is positive and the smear is negative?

A

Symptomatic: Arrange CXR
Asymptomatic: Review culture and line probe assays and continue assessment for TPT and avoid treatment

Same thing for PRECIOUS RR-TB

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17
Q

If TB NAAT and smear are positive, what should be your next step?

A

Diagnose DS-TB and Start treatment sme day

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18
Q

What is your next step if a patient who had RR-TB in the last 2 years has a positive TB NAAT and smear?

A

Diagnose RR TB and start treatment

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19
Q

What is meant by a TB contact

A

Any person who shared an enclosed space for >=1 night or frequent/extended daytime periods with an adult/adolescent with pulmonary TB during the 3 months period before the adult/adolescent(index patient) started their treatment

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20
Q

What is the best time to obtain a sputum from a patient if they are unable to produce one?

A

Early morning

If not possible arrange for induced sputum

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21
Q

What will the lab people do if the patient who had rifampicin susceptible or unsuccessful Tb is the last 2 years has a TB NAAT that is positive?

A

Susceptible: Reflex smear on the second sputum
Unsuccessful: Reflex smear,.TB culture and LPA

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22
Q

What do the lab people do if the TB NAAT is trace?

A

Reflex culture and Line probe assays but not culture

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23
Q

What is your next step if TB NAAT is negative and the patient is HIV negative?

A

Symptoms: Arrange CXR
Asymptomatic: Continue assessment for TPT eligibility and advise to retun if TB symptoms develop.

24
Q

What is the next step if TB NAAT is negative and the patient is HIV positive?

A

Symptomatic: Arrange CXR
Asymptomatic: Continue assessment for TPT, review LPA and culture and avoid starting treatment

25
Q

List 6 features of TB you can possibly finon a chest X ray.

A
  1. Upper lobe cavitations
  2. Any opacification can be TB in HIV positive client
  3. Pleural effusion(Bilateral=refer)
  4. Intrathoracic lymphadenopathy
  5. Miliary TB
  6. Pericardial effusions (confirm on U/S)
26
Q

In a patient suspected of having TB and pleural effusion on CXR without a positive TB NAAT,what should be done next?

A

Aspirate the fluid and send 2 samples for
Clear: TB culture, LPA, ADA and cell count
Pus: TB NAAT, microscopy, TB culture and Drug sensitivity testing(refer same day)

27
Q

List tests that should be done on a clear pleural fluid if TB is suspected

A

Tb culture, LPA, ADA and cell count

28
Q

Lists 4 tests that should be requested for on a pus containing pleural fluid aspirate in a patient suspected of having TB.

A

TB NAAT, microscopy, TB culture and drug sensitivity testing

29
Q

Which patients deserve to get DS TB treatment even though the chest X ray findings were not suggestive of TB but they are symptomatic?

A
  1. TB NAAT negative in HIV positive patient
  2. TB NAAT trace positive and no TB in last 2 years
30
Q

List 5 commonest symptoms of TB disease

A
  1. Cough
  2. Weight loss
  3. Drenching night sweats
  4. Fever
  5. Hemoptysis
31
Q

List 12 tests that should be done at diagnosis of RR TB.

A

HIV test: If already positive check viral load
Pregnancy test
FBC and differential count
Creatinine and eGFR
ALT
Urea and electrolytes mainly potassium and magnesium
TSH
TB microscopy, culture, LPA and drug sensitivity testing from 1 sputum(automatically tested by the lab using the 2nd sputum)
EKG and chest X ray
Snellen chart for vision
Finger prick glucose

32
Q

Name two investigations that should be tested if someone if on linezolid and when it should be done.

A

FBC and differential count at 2 weeks and monthly
Vision with a Snellen chart monthly

33
Q

Why is the EKG done routinely in people with RR TB?

A

Bedaquiline, clofazimine, moxifloxacin or delamanid are cardiac toxic

34
Q

Name 4 investigations that should be done if someone is on amikacin.

A

Creatinine
Potassium
Magnesium
Audiometry

35
Q

Name two investigations that

36
Q

Name two drugs that when used for RR TB, TSH should be checked.

A

Ethionamide
Or PAS

Checked at 3 months

37
Q

Name two investigations that should be done at 6 months of RR TB.

A

Chest X-ray
If HIV: CD4 AND viral load

38
Q

If a patient with RR TB is unwell which tests should be done?

A

Chest X-ray, Creatinine, ALT, potassium and magnesium

39
Q

One bedaquiline is stopped, EKG should be done 3 monthly

40
Q

When should TB sputum testing done again after the diagnosis of RR TB?

A

At 1 months

41
Q

Name 4 RR TB drugs that prolong QT interval.

A

Bedaquiline
Clofazimine
Moxifloxacin
Delamanid

If QTcF>500 STOP THE DRUGS

42
Q

2 Adverse effect of amikacin

A

Hearing loss
Hypokalemia

Check with an audiometry

43
Q

When should all TB drugs be stopped based on the liver function test?

44
Q

When should MgCl be given?

45
Q

Name 2 combinations of TB and HIV drugs that should never be used together

A

Zidovudine and linezolid
Efavirenz and bedaquiline

46
Q

5 criteria that should be met to confirm that TB is cured.

A

TB culture converted
At least 3 consecutive negative cultures in the continuation phase
If on a shorter course: at least 9 months of treatment
If on a longer course: at least 12 months of treatment
Not clinically worsening

47
Q

5 criteria that should be met to confirm that RR TB treatment is completed.

A

Tb culture converted
If on a shorter course: at least 9 months of treatment
If on a longer course: at least 18 months of treatment
Not clinically worsening
<3 consecutive negative cultures in continuation phase

48
Q

4 criteria that should be met to confirm that RR TB treatment has failed.

A

Failure of month 4 TB to convert by month 6
At least 2 positive cultures in continuation phase and clinically worsening
Treatment stopped on clinical grounds or by instruction from PCAC
At least 2 new drugs added to the regimen due to poor clinical response

49
Q

4 clinical features that show slow clinical response to RE TB treatment

A

Poor weight gain
Ongoing TB symptoms
Poor improvement on chest X-ray
Delayed smear/culture conversion

50
Q

Outline the treatment of RR TB on a shorter course.

A

Intensive phase:
Linezolid 2 months
Bedaquiline for at least 6 months
Levofloxacin
Clofazimine
High dose isoniazid
Pyrazinamide
Ethambutol

Continuation phase

Bedaquiline
Levofloxacin
Clofazimine
Pyrazinamide
Ethambutol

51
Q

When do you typically use delamanid in treatment of tb.

A

If TB is fluoroquinolone resistant and there is CNS disease

52
Q

Name RR TB drugs that lead to psychosis and seizures

A

Terizidone
Levofloxacin
High dose isoniazid

53
Q

Adverse effect of rifabutin

A

Painful/red eyes with blurry vision and sensitive to light

54
Q

Name a TB durgbathat cause skin darkening and dry skin.

A

Clofazimine

55
Q

Name three RR TB drugs that lead to peripheral neuropathy

A

Isoniazid
Terizidone
Linezolid

56
Q

Name 4 RR TB drugs that lead to joint paint

A

Pyrazinamide
Levofloxacin
Delamanid
Bedaquiline

Ambulatory Care (10 decks)

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