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Tuberculosis Flashcards

1
Q

pathognomonic of miliary TB

A

choroidal tubercles

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2
Q

most common site of GI TB

A

ileum and terminal cecum

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3
Q

gold std of TB meningitis

A

CSF culture (Positive in 80%)

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4
Q

CNS TB contrast enhanced ring lesions

A

tuberculoma

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5
Q

induced by ESAT-6

A

MMP9 (recruits naive macromphages)

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6
Q

most potent risk factor for TB among affected individuals

A

HIV co infection

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7
Q

host responses that develop 2-4 weeks after MTB infection

A

1) macrophage-activating response

2) tissue damaging response

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8
Q

antigens of MTB that play a protective role

A

20kDa or 85B

ESAT-6

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9
Q

size of MTB

A

0.5 x 3 um

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10
Q

exacerbation in s and s in lab and xray manifestations of TB in adminisration of ART

A

Immune reconstitution inflammatory syndrome (IRIS)

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11
Q

when does IRIS occur

A

1-3 mos after administration of ART

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12
Q

patho IRIS

A

immune response elicited by antigens as bacilli are killed (in an improving immune function)

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13
Q

First priority in face of IRIS

A

ensure that this is not a failure of TB treatment, or development of another infection

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14
Q

Recommended daily dose

Isoniazid

A

5 mg/kg

max 300 mg

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15
Q

Recommended daily dose

Rifampin

A

10 mg/kg

max 600 mg

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16
Q

Recommended daily dose

Pyrazinamide

A

25 mg/kg

max 2 g

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17
Q

Recommended daily dose

Ethambutol

A

15 mg/kg

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18
Q

Age: highest incidence of TB

A

late adolescence

early adulthood

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19
Q

Molecular mechanism by which M tuberculosis induces granuloma formation

A

Mycobacterial protein ESAT-6

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20
Q

Two types of cells essential in the CMI response to TB

A

1) macrophages

2) T cells

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21
Q

The Ghon focus

A

Lesion forming after initial TB infection which is peripheral and accompanied by transient hillier or paratracheal lymphadenopathy

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22
Q

Ghon complex

A

Ghon focus with or without overlying pleural reaction and thickening and regional lymphadenopathy

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23
Q

Location of Post primary (Adult type) Tb disease

A

Apical and posterior segments of the upper lobes

**Superior segments of the lower lobes

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24
Q

“consumption”/ “phthisis”

A

classic galloping consumption of the past in TB

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25
Most common presentation of extra pulmonary TB in both HIV seronegative and HIV patients
Tuberculous lymphadenitis
26
Most common location of Lymph node TB
posterior cervical and supraclavicular sites
27
% of Lymph node TB with concomitant pulmonary TB
50%
28
Culture positivity of Lymph node TB biopsy
70-80%
29
20% of extra pulmonary TB cases in US
pleural Tb
30
Most common complication of pulmonary TB
tuberculous empyema
31
Pleural fluid tests MTB
Adenosine deaminase | Interferon gamma
32
10-15% of extra pulmonary TB
geunitourinary TB
33
Frequency of abnormal urinalysis results in genitourinary TB
90% abnormal
34
10% of pulmonary TB
Pott'sdisease
35
Most common site of spinal TB in children
Thoracic
36
Most common site of spinal TB in adults
Lumbar
37
first affected in port's disease
anterior superior of inferior angle of the vertebral body
38
Catastrophic complication of Pott's disease
paraplegia
39
5% of extra pulmonary TB in the US
TB of the CNS
40
Uncommon extra pulmonary TB, only 3.5% of extra pulmonary cases
GI TB
41
Case fatality rate of pericardial TB
40%
42
This is pathognomonic of military TB in 30% of the cases
choroidal tubercles
43
Miliary TB rare presentation seen in elderly, chronic course with intermittent fever, anemia, meningeal involvement preceding death a) cryptic miliary TB b) nonreactive miliary TB
cryptic miliary TB
44
Acute septicaemic form of military TB due to massive hematogenous dissemination of the tubercle bacilli a) cryptic miliary TB b) nonreactive miliary TB
nonreactive miliary TB
45
less common extra pulmonary form of TB which is a soldering disease with nodules plaques and fissures
Lupus vulgaris
46
Where does tuberculous mastitis spread from?
retrograde lymphatic spread from the axillary lymphatics
47
Tb is responsible for ___% HIV related mortality
24%
48
Exacerbations in systemic or respiratory signs and symptoms signs and lab or radiographic manifestations of TB
IRIS or TB immune reconstitution disease
49
% HIV infected patients where IRIS occurs
10%
50
First drug for TB
streptomycin
51
Introduction of this drug shortened TB course to 12 months
Rifampicin
52
Discovery of this drug allowed the TB treatment course to be 6 months
Pyrazinamine
53
Rx hyperuricemia and arthralgia caused by pyrazinamide
ASA
54
Resistance due tours gene
aminoglycosides resistance
55
First line drug for ART for TB patients
2 NRTI | 1 NNRTI
56
TB regimen for pregnant women
``` 2 HRE (pyrazinamide contraindicated) 7 HR ```
57
why is streptomycin contraindicated in pregnancy
8th cranial nerve damage to the foetus
58
Units of PPD for TST
5 tuberculin units
59
Cut off PPD of low risk persons
>15 induration
60
Cut off PPD is >=5
``` HIV infected Recent contacts of patient with TB Organ transplant patient Persons with fibrotic lesions consistent with old TB Immunosuppressed HR medical conditions ```
61
Treatment of latent TB
9 months isoniazid
62
Treatment of TB intolerant to Z
2HRE 7 HR
63
Treatment of TB relapses and treatment default with pending susceptibility testing
3HRZES 5HRE
64
define treatment failure
when sputum is positive after 3 months treatment
65
Mechanism for congenital TB
1) transplacental | 2) drinking of amniotic fluid
66
2 extrapulmonary TB sites where adjunct steroids are given
Pericardial TB | TB meningitis
67
Gold standard for TB meningitis
CSF culture
68
Pathyphy of pleural TB
hypersensitivity response to MTB antigens
69
Acid fast Bacilli organisms other than mycobacteria
``` Isospora Crytosporidium Nocardia Rhodococcus Legionella ```

Infectious (11 decks)

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