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Internal Medicine > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What are clinical manifestations of tuberculosis

A

Be micro-ambitious

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2
Q

DDx

A 
URTI, Pneumonia, COVID-19
Asthma, COPD
Heart failure
GERD
Lung cancer
Captopril
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3
Q

DDX FOR PEDIA

A 
Infection - URTI, Pneumonia, COVID-19, pertussis
Inflammatory - Asthma
Neoplastic - Mediastinal mass
Digestive - GERD
Iatrogenic - ACE inhibitors
Irritant - Smoke
Cardiac - Heart failure
Congenital / Hereditary -Cystic fibrosis, Structural abnormality
FBA
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4
Q

Primary history

A

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5
Q

ROS

A

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6
Q

Tertiary history

A

Be micro-ambitious

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7
Q

PE

A

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8
Q

Algorithm for tb mgt in pedia

A

Be passionately dedicated in the pursuit of short term goals

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9
Q

How to diagnose tuberculosis (pedia)

A

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10
Q

What to request?

A 
TST if pedia *what age?
CXR - Pneumonia? TB? Heart failure?
Sputum AFB
Nasopharyngeal swab - COVID 19
Gene xpert
Culture with DST if with treatment failure already

CBC - check WBC bac vs viral
creatinine - imp’t in drug dosage
Spirometry, if highly suspcious of asthma/COPD
CT, if suspicious of malignancy

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11
Q

How many are latent infected?

A

1.7 billion, 1/4 of human population

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12
Q

What is positive TST

A

Do your best

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13
Q

Drug dosages for TB

A 
ADULTS
Isoniazid 5mkd max 300mg
Rifampicin 10mkd max 600mg
Pyrazinamide 25mkd, max 2g
Ethambutol 15 mkd
PEDIATRICS
Isoniazid 10 (7-15) mkd, max 300mg
Rifampicin 15 (10-20) mkd, max 600mg
Pyrazinamide 35 (30-40) mkd
Ethambutol 20 (15-25) mkd
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14
Q

How to treat LTBI?

A
  1. ISONIAZID FOR 6-9MONTHS
    Adults 5mkd, max 300mg
    Children 10mkd
  2. RIFAMPIN for 3-4 months
    Adults 10mkd
    Children 10mkd (max: <45kg, 450mg; >45kg, 600mg)
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16
Q

MOA of Isoniazid

What’s the target mycobacterial population?

A

Inhibits synthesis of mycolic acid, which are essential components of mycobacterial cell walls

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17
Q

MOA of Rifampicin

What’s the target mycobacterial population?

A

binds to B subunit of bacterial DNA-dependend RNA polymerase, and thereby inhibits RNA synthesis

bactericidal
can kill organisms that are pooorly accessible to many other drugs, eg intracellular organisms and those sequestered in abscesses and lung cavities

  • *strongly induces most cytochrome p450 isoforms
  • -> increases elimination of other drugs, eg. anticoagulants, anticonvulsants, contraceptives
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18
Q

MOA of Pyrazinamidw

What’s the target mycobacterial population?

A

converted to pyrazinoic acid - the active form - by mycobacterial pyrazinamidase

pyrazinoic acid disrupts mycobacterial cell membrane metabolism and transport functions

used as “sterilizing” agent acctive against INTRACELLULAR organisms that may relapse

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19
Q

What are adverse reactions for Rifampicin

A 
orange urine
rashes
thrombocytopenia (major)
nephritis (major)
hepatitis
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20
Q

What are A/E of Isoniazid

A

Hepatitis - m/c major toxic effect
»> loss of appetite, N/V, jaundice, RUQ pain
»> may be fatal

Peripheral neuropathy (minor a/e)
>>>occurs in 10-20% of px given > 5mkd, but is infrequent in std 300-mg adult dose
>>>more likely to occur in px with malnutrition, alcoholism, DM , AIDS, and uremia
>>> d/t pyridoxine deficiency (isonizid promotes excretion of pyridoxine
>>> readily reversed by administration of pyridoxine in as low as 10mg/day

Other CNS toxicities: memory loss, psychosis (major), ataxia, seizures (major)

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21
Q

MOA of Ethambutol

What’s the target mycobacterial population?

A

inhibits mycobacterial arabinosyl transferases (involved in polymerization rxn of arabinoglycan, an essential component of mycobacterial cell wall)

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22
Q

What are A/E of Pyrazinamide

A

hepatotoxicity (1-5%)
photosensitivity
hyperuricemia
—not a reason to stop the drug if px is asymptomatic

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23
Q

What are A/E of Ethambutol

A

Retrobulbar neuritis

  • leads to loss of VA and red-green color blindness
  • less if 15mkd or less is used
  • do baseline and monthly VA and color discrimination testing, with particular attention to patients on higher doses or with impaired renal fxn
24
Q

What are minor adverse effects of TB drugs?

A 
GI intolerance
mild or localized skin reactions
orange/red urine
pain at the injuection site
burning sesatin in the feet due to peripheral neuropathy
arthralgia due to hyperuricemia
flu-like symptoms
25
Q

What are major adverse effects of TB drugs?

A

Severe skin rash due to hypersensitivity
Jaundice due to hepatitis
impairment of visual acuity and color vusion due to optic neuritis
Hearing impairment, ringing of ears, dizziness due to damage of 8th cranial nerve
oliguria or albuminuria due to renal disorder
psychosis and convulsion
thrombocytopenia, anemia, shock

26
Q

What to do if there’s adverse effects of TB drugs?

A

Be passionately dedicated in the pursuit of short-term goals!!!

27
Q

Prognosis

A

Be micro-ambitious

28
Q

Prevention

A 
Primary prevention
-cough etiquette
-use of n95
-stop smoking, reduce alcohol (<40g/day)
-eat well and enough (underweight is a RF)
-be loyal
-BCG vaccination of newborns
-

Secondary prevention

  • contact tracing
  • get screened if with exposure to tb patient (at least by CXR if adults, TST if child)

Tertiary prevention
-undergo treatment if with latent TB

29
Q

Definition of MDR-TB

A

Multidrug-resistant TB (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent TB drugs.

30
Q

Definition of XDR-TB

A

resistance to the two most powerful anti-TB drugs, isoniazid and rifampicin, also known as multidrug-resistance (MDR-TB), in addition to resistance to any of the fluoroquinolones (such as levofloxacin or moxifloxacin) and to at least one of the three injectable second-line drugs (amikacin, capreomycin or kanamycin).

31
Q

2013 WHO Case definitions for TB

A

Be passionately dedicated in the pursuit of short-term goals!!!

32
Q

What is a presumptive PTB (adults)

A

Be passionately dedicated in the pursuit of short-term goals!!!

33
Q

How should sputum specimens be collected in DSSM?

How to interpret?

A

Be passionately dedicated in the pursuit of short-term goals!!!

34
Q

TB culture facilities in the Philippines

A

Be passionately dedicated in the pursuit of short-term goals!!!

35
Q

When to request for sputum TB culture with DST?

A

Re-treatment cases
Treatment failure
Contacts of known DR-TB

*should NOT be routinely performed among new cases of PTB

36
Q

When to request Gene Xpert?

A

As initial diagnostic test for presumptive TB
As follow-on test to smear negative but with (+) CXR findings
As initial diagnostic test for presumptive DR-TB

37
Q

What’s the role of CXR in TB?

A

Be passionately dedicated in the pursuit of short-term goals!!!

38
Q

What’s the role of TST in suspected adult TB patients?

A

Be passionately dedicated in the pursuit of short-term goals!!!

39
Q

2013 WHO Case definitions (part 2)

A

New case
Retreatment case
-relapse
-treatment after failure
-treatment after lost to follow-up (TALF)
-Previous treatment outcome unknown (PTOU)

40
Q

Pre-treatment evaluation

A 
previous TB treatment
risk factors for hepatic, renal, ocular toxicity
Sexual history
personal/social history
occupation
41
Q

What baseline labs to request before starting TB meds?

A

baseline ALT, crea
HIV screening
DM screening

42
Q

Categories of TB treatment

A

Be passionately dedicated in the pursuit of short-term goals!!!

43
Q

How to monitor treatment response?

A

2nd month / 5th month

3rd month / 5th month

43
Q

What to do if there’s interruption in tb treatment?

A

Be passionately dedicated in the pursuit of short-term goals!!!

44
Q

How to classify outcomes?

A 
Cured
Treatment completed
Treatment failed
Died
Lost to follow up
Not evaluated
45
Q

When is DR-TB suspected?

A 
All re-treatment cases
New cases who are
-non-converter of category 1
-contacts of confirmed DR-TB cases
-PLHIV with signs and symptoms of TB
46
Q

How is DR-tb diagnosed?

A

Be passionately dedicated in the pursuit of short-term goals!!!

47
Q

How should DR-TB be managed

A

Be passionately dedicated in the pursuit of short-term goals!!!

48
Q

Discuss TB with HIV

A

Be passionately dedicated in the pursuit of short-term goals!!!

49
Q

Discuss tb in pregnant and lactating women

A

Be passionately dedicated in the pursuit of short-term goals!!!

50
Q

risk factors for contracting tb and progression of dse?

A

Smokers, alcholics (i.e. >40g/day)
underweight (BMI < 20)
recent tb infection (i.e. < 2 years), upper lobe fibro-nodular dse on CXR

51
Q

when to isolate?

A

Be passionately dedicated in the pursuit of short-term goals!!!

52
Q

What infection control measures must be observed in healthcare facitlities?

A

ADMINISTRATIVE - triage, separation of infectious cases, minimize exposure in health care facilities, cough etiquette

SURVEILLANCE of TB dse among HCW for TB transmission

ENVIRONMENTAL CONTROL - good ventilation

use of PPE for HCW at high risk

53
Q

How should job appplicants/students be managed if pre-emplyment screening suggest TB?

A

Workup for presumptive TB
For TB activity not entirely ruled out - periodic monitoring, rpt CXR 4-6 months
Policies of host countries prevail

54
Q

Discuss infectivity period of TB

A

Be passionately dedicated in the pursuit of short-term goals!!!

Internal Medicine (13 decks)

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