Tuberculosis

Question 1

Risk factors for TB?

Answer 1

Poverty, HIV, MRD strains, Immunocomprime, Substance abuse, malnutrition, underlying chronic disease, young>older, male>women, living in close quarters with TB + , minority, crowded living facilities

Question 2

Primary organism that causes TB?

Answer 2

Mycobacterium tuberculosis, acid-fast bacilli

Question 3

Other organisms that cause TB?

Answer 3

Mycobacterium africanum and Mycobacterium bovis

Question 4

Modes of transmission of TB?

Answer 4

Through respiratory droplets. Coughing, talking, singing, intubation, bronchoscopy, aerosol treatments, autopsy

Question 5

How long can TB remain infectious in the air?

Answer 5

30 mins

Question 6

4 outcomes when exposed to TB?

Answer 6

Clear the infectious organism resulting in no disease, primary disease, latent infection, reactivation of TB

Question 7

Pathophysiology of infection?

Answer 7

Bacteria carried to lungs where it proliferates in macrophage. Macrophage produces cytokines and chemokines, which attract other macrophages and neutrophils, and monocytes. Tubercle is formed enclosing these cells.

Question 8

When the tubercle expands and causes a lesion into the lung it is called?

Answer 8

Ghon

Question 9

These individuals who have latent TB are at a high rate for reactivation.

Answer 9

Immunosuppressed patients (HIV, Lymphoma, smokers, DM, ESRD)

Question 10

Primary tuberculosis refers to a _______ blank infection.

Answer 10

recent

Question 11

What are CXR characteristics in people with TB?

Answer 11

Unilateral hilar adenopathy, lower and upper infiltrates, upper lobe abnormalities more common

Question 12

Which lung is more commonly infected?

Answer 12

right lung

Question 13

Patients with primary TB can develop these additional disease?

Answer 13

Meningitis, pericarditis, further lung cavitation of lung tissue

Question 14

Patients with reactivation present ____ years after initial infection with these symptoms and signs?

Answer 14

2 years, cough (worsens to produce green-sputum or hemoptysis), night sweats, anorexia, weight loss, fever

Question 15

Abnormal lung findings with reactivation TB?

Answer 15

Rales, whispered pectoriloquy, dullness, distant hollow breath sounds in cavitation

Question 16

This extrapulmonary manifestation presents with hematogenous spread of tuberculosis to pulmonary tissue?

Answer 16

Miliary tuberculosis

Question 17

Extrapulmonary tuberculosis examples?

Answer 17

Meningitis, miliary TB, scofula (of neck), TB pleurisy, Potts disease, urogenital TB

Question 18

Does treatment of latent TB mean that the patient is cured?

Answer 18

No it just reduces the risk of reactivation but does not reduce risk to zero

Question 19

Medications and duration of treatment for TB

Answer 19

Isoniazid (INH) 9-6 months, Rifampin 4 months

Question 20

Side effects of isoniazid (INH)

Answer 20

Elevated live enzymes, peripheral neuropathy (2%), 1:1000 drug induced hepatitis, NO ALC on medication

Question 21

Side effect of rifampin?

Answer 21

Small chance of hepatotoxictiy, multiple drug interactions, turns body fluids orange

Question 22

Drug combination therapy for latent TB which requires DOT?

Answer 22

Isoniazide + Rifapentine for 3 months via DOT

Question 23

Side effects of isoniazide + rifapentine?

Answer 23

Flu like reaction, drug reaction, hypotension, syncope

Question 24

Individuals with these diseases have a worse prognosis with TB?

Answer 24

Respiratory failure, meningitis, miliary tuberculosis, MDR/XDR TB