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PSBIM: Infectious Disease > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Rasmussen’s aneurysm

A

Complication of PTB - rupture of dilated vessel in a cavity leading to massive hemoptysis

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2
Q

Ghon lesion

A

Small calcified nodule in primary PTB

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3
Q

Most potent risk factor for PTB

A

HIV coinfection

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4
Q

MDR-TB

A

Resistance to isoniazid and rifampicin

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5
Q

XDR-TB

A

Resistance to:

  1. Isoniazid and Rifampicin
  2. Fluoroquinolones
  3. 1 Aminoglycoside (amikacin, capreomycin or kanamycin)
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6
Q

Highly infectious TB

A

Cavitary PTB and laryngeal TB

10^5 to 10^7 AFB/ml

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7
Q

Ranke complex

A

Healed lesions in lung parenchyma and hilar lymph nodes which may later undergo calcification

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8
Q

Most common extrapulmonary TB

A

TB Lymphadenitis

LN > pleural > genitourinary > bone and joints > meninges > peritoneum > pericardium

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9
Q

Diagnostics for TB lymphadenitis

A

FNAB or excision biopsy

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10
Q

Diagnostics for pleural TB

A

Thoracentesis
Adenosine deaminase
Pleural biopsy

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11
Q

Diagnostics for genitourinary TB

A

Urinary: Isolate in culture of 3 morning urine specimen
Genital: Biopsy or culture

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12
Q

Most commonly affected joints by TB

A

Spine

Weight-bearing joints: Spine > Hips > Knees

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13
Q

Most commonly affected part of the spine by TB in adults

A

Lower thoracic and upper lumbar

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14
Q

Most commonly affected part of the hip joint by TB

A

Head of femur

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15
Q

Diagnostics for bone and joint TB

A

Aspiration or biopsy

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16
Q

Most commonly affected cranial nerve in TB meningitis

A

Ocular nerves due to involvement of meninges at the base of the brain

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17
Q

Diagnostics for TB meningitis

A

Gold standard: CSF culture

Preferred initial test: Xpert MTB/RIF assay

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18
Q

Most commonly affected part of the GIT by TB

A

Terminal ileum and cecum

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19
Q

Diagnostics for GIT TB

A

Biopsy (including peritoneum)

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20
Q

Diagnostics for TB pericarditis

A

2D echo-guided pericardiocentesis

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21
Q

Type of TB where glucocorticoid administration is life-saving

A

TB meningitis and TB pericarditis

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22
Q

Pathognomonic of miliary TB

A

Choroidal tubercles

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23
Q

Diagnostics for miliary TB

A

Bronchoalveolar lavage and transbronchial biopsy, liver or bone-marrow granuloma biopsy

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24
Q

Acute septicemic form of miliary TB

A

Nonreactive miliary TB

25
Q

IRIS (immune reconstitution inflammatory syndrome) or TB-IRD (TB immune reconstitution disease)

A

Exacerbations in symptoms, signs and laboratory or radiographic manifestations of TB associated with administration of ART

Increased risk if earlier start of ART + lower baseline CD4

26
Q

Dyes in AFB microscopy

A

Traditional: Ziehl-Neelsen basic fuschin

Modern labs: Auramine-rhodamine

27
Q

Initial diagnostic test for new PTB case

A

AFB microscopy

28
Q

Initial diagnostic test for MDR-TB, HIV-associated TB, TB meningitis, retreatment cases, failure cases

A

Xpert MTB/RIF assay

29
Q

Definitive diagnostics for PTB

A

Isolation of M. tuberculosis from a specimen

30
Q

Resistance genes for each anti-TB drugs

A 
Rifampicin - rpoB
Isoniazid - katG, inhA
Pyrazinamide - pncA
Ethambutol - embB
Fluoroquinolones - gyrA-gyrB
Aminoglycosides - rrs
31
Q

Boosting phenomenon and True conversion for TST

A

Boosting phenomenon: Spurious TST conversion resulting from boosting of reactivity on subsequent TST 1-5 weeks after the initial test

True conversion: After BCG vaccination in a previously TST-negative person in close contact of an infectious patient

32
Q

Diagnostics for latent TB infection

A

Low- and middle-income: TST

Others: IGRA

33
Q

Definition and Treatment for TB Category I

A

All new cases of PTB, all extrapulmonary TB except meninges, bone and joint

2HRZE / 4HR

34
Q

Definition and Treatment for TB Category Ia

A

TB of the meninges, bone and joints

2HRZE / 9HR

35
Q

Definition and Treatment for TB Category II

A

Retreatment of Category I

2HRZES / 1HRZE / 5HR

36
Q

Definition and Treatment for TB Category IIa

A

Retreatment of Category Ia

2HRZES / 1HRZE / 9HR

37
Q

Primary drug resistance to TB

A

Resistant strains in a patient with no treatment more than a month

38
Q

Secondary drug resistance to TB

A

Resistant strains in a patient who has been taking or has taken anti-TB drugs for more than a month

39
Q

Daily dose and max dose for each anti-TB drugs

A 
Isoniazid: 5mkd, max 400mg
Rifampicin: 10mkd, max 600mg
Pyrazinamide: 25mkd, max 2000mg
Ethambutol: 15mkd, max 1000mg
Streptomycin: 15mkd, max 1200mg
40
Q

Extended TB therapy

A

Indicated for:

  1. cavitary PTB
  2. silicotuberculosis
  3. delayed sputum-culture conversion (culture-positive at 2 months)
  4. pyrazinamide not included in initial treatment regimen

Extend up to a total of 9 months

41
Q

Reduced TB therapy

A

May be done for sputum culture-negative PTB

Reduced to a total of 4 months

42
Q

Persons at high risk of vitamin B6 deficiency

A

Alcoholics, malnourished, pregnant, lactating, chronic renal failure, DM, HIV infection

43
Q

Monitoring schedule by AFB smear examination

A

New PTB cases: 2nd, 5th, 6th months
**if not converted by 2nd month, repeat AFB smear on the 3rd month instead
Retreatment cases: 3rd, 5th, 8th months

44
Q

TB cured

A

Completed treatment PLUS
2x AFB sputum smear-negative if new PTB case
3x AFB sputum smear-negative if MDR-TB

45
Q

TB treatment completed

A

Finished treatment but no confirmation bacteriologically

46
Q

TB treatment failed

A
  1. AFB sputum smear-positive on the 5th month

2. Became smear-positive on the 2nd month when previously smear-negative

47
Q

PTB treatment for patients with compensated liver cirrhosis

A
  1. 2HES / 10HE
  2. 2HRES / 6HR
  3. 9HRE
48
Q

PTB treatment for post-solid organ transplant patients

A

2HZE / 12-18HZE

49
Q

Most common significant adverse reaction to anti-TB drugs and what to do when it occurs

A

Hepatitis

Discontinue anti-TB drugs if AST/ALT

  1. 3x elevated plus symptomatic
  2. 5x elevated even if asymptomatic

Stop pyrazinamide permanently

50
Q

Contraindication for each anti-TB drugs

A

Rifampicin: autoimmune thrombocytopenia
Pyrazinamide: Gouty arthritis (but not for asymptomatic hyperuricemia), severe liver failure
Ethambutol: Optic neuritis
Streptomycin: Ototoxicity

51
Q

New TB case

A

Patients with less than 1 month TB treatment

52
Q

TB retreatment

A

Patients with more than or equal to 1 month TB treatment, excluding prophylaxis or LTBI

53
Q

Definition and treatment for TB relapse

A

Patients who had completed TB treatment previously and is with positive AFB sputum smears

All 1st line drugs + streptomycin pending drug susceptibility testing

54
Q

Lost to follow-up

A

Patients with more than or equal to 2 consecutive months interruption of treatment

55
Q

When are TB patient deemed non-infectious

A

Bacteriologically-confirmed: After more than or equal to 14 days treatment
Clinically-diagnosed: After more than or equal to 5 days treatment

56
Q

Treatment regimen if with INH resistance

A

6RZE

57
Q

Treatment regimen if with RIF resistance

A

2HES / 10HE

58
Q

Treatment for latent TB infection

A

6H

PSBIM: Infectious Disease (9 decks)

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