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IM > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Caused by bacteria of the Mycobacterium tuberculosis complex

A

Tuberculosis

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2
Q

The most potent risk factor for TB among infected individuals

A

HIV co-infection

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3
Q

Most commonly involved in primary TB

A

MIDDLE AND LOWER LUNG ZONES

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4
Q

Lesion forming after initial infection; usually peripheral and accompanied by transient hilar or paratracheal lymphadenopathy

A

Ghon focus

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5
Q

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

A

Ghon complex

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6
Q

TB in young children - almost invariably accompanied by

A

HILAR OR PARATRACHEAL LYMPHADENOPATHY due to the spread of bacilli from the lung parenchyma through lymphatic vessels

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7
Q

Reactivation or secondary TB

A

Postprimary (Adult-Type) Disease

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8
Q

Postprimary (Adult-Type) Disease is usually localized to the

A

apical and posterior segments of the upper lobes

substantially higher mean oxygen tension (compared with that in the lower zones) favors mycobacterial growth

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9
Q

Produced d.t. massive involvement of pulmonary segments or lobes with coalescence of lesions

A

caseating pneumonia

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10
Q

HEMATOLOGIC FINDINGS: Postprimary (Adult-Type) Disease

A

mild anemia
leukocytosis
thrombocytosis with a slightly elevated erythrocyte
sedimentation rate and/or C-reactive protein level

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11
Q

MC presentation of extrapulmonary TB in both HIV-seronegative and HIV-infected patients

A

Lymph Node TB (Tuberculous Lymphadenitis)

presents as painless swelling of the lymph nodes

at posterior cervical and supraclavicular sites (scrofula –past name)

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12
Q

Reflects recent primary infection

A

pleural TB

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13
Q

Results from the hematogenous spread of primary or postprimary pulmonary TB or from the rupture of a subependymal tubercle into the SUBARACHNOID SPACE

A

tuberculous meningitis

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14
Q

Miliary or Disseminated TB

A

• due to hematogenous spread of tubercle bacilli
• CHILDREN: consequence of primary infection
• ADULT: recent infection or reactivation of old disseminated foci

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15
Q

Pathognomonic of miliary TB

A

choroidal tubercles (eye)

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16
Q

A presumptive TB case that is either bacteriologically confirmed or clinically diagnosed by the attending physician

A

Active TB

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17
Q

Refers to a case of tuberculosis involving the LUNG parenchyma.

A

Pulmonary TB

A patient with both pulmonary and extrapulmonary tuberculosis should be classified as a
case of pulmonary TB.

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18
Q

Refers to a case of tuberculosis involving organs other than the lungs (e.g. larynx, pleura, lymph nodes, abdomen, genito-urinary tract, skin, joints and
bones, meninges)

A

Extrapulmonary TB

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19
Q

Refers to a patient from whom a biological specimen,
either sputum or non-sputum sample, is positive for TB by smear microscopy, culture or rapid diagnostic tests (such as Xpert MTB/RIF, line probe assay for TB, TB LAMP).

A

Bacteriologically confirmed TB (BCTB)

20
Q

Refers to a patient for which the criterion for bacteriological confirmation is not fulfilled but diagnosis is made by the attending physicians on the basis of clinical findings, X-ray abnormalities, suggestive histology and/or other biochemistry or
imaging tests

A

Clinically diagnosed TB (CDTB)

21
Q

Refers to a patient who has never had treatment for TB or who has taken anti-TB drugs
for less than one month.

Preventive treatment is not considered as previous TB treatment

A

New Case

22
Q

Refers to a patient who had received one month or more of antiTB drugs in the past

Also referred to as Retreatment.

A

Previously Treated for TB

23
Q

Previously treated for TB, new TB cases that are contacts of confirmed DR-TB cases or non-converter among patients on DS-TB regimens

A

High risk for multidrug-resistant tuberculosis (MDR-TB)

24
Q

Resistance to rifampicin detected using phenotypic
or genotypic methods, with or without resistance to other anti-TB drugs

It includes any resistance to rifampicin, whether monoresistance, multidrug resistance, polydrug resistance or extensive drug resistance

A

Rifampicin-resistant TB (RR-TB)

25
Q

The time from collection of first sputum sample to initiation of treatment for TB

A

Turnaround time (TAT)

The desired turnaround time is five working days (also referred to as Program TAT).

26
Q

Previously treated for TB and declared cured or treatment completed, but is presently diagnosed with active TB disease

A

Relapse

27
Q

Previously treated for TB but failed most recent course
based on a positive SM follow-up at five months or later, or a clinically diagnosed TB patient who does not show clinical improvement anytime during treatment

A

Treatment after Failure

28
Q

Previously treated for TB but did not complete
treatment and lost to follow-up for at least two months in the most recent course

A

Treatment after lost to follow up

29
Q

Previously treated for TB but whose outcome in the most recent course is unknown

A

Previous treatment outcome unknown

30
Q

Patients who do not fit any of the categories listed above or previous treatment history is unknown (this
group will be considered as previously treated also)

A

Patients with unknown previous TB treatment history

31
Q

PTB or EPTB (except central nervous system [CNS], bones, joints) whether new or retreatment, with final Xpert result:

MTB, RIF sensitive
MTB, RIF indeterminate

New PTB or new EPTB (except CNS, bones, joints), with positive SM/TB LAMP or
clinically diagnosed, and:
Xpert not done*
Xpert result is MTB not detected

A

2HRZE/4HR

32
Q

EPTB of CNS, bones, joints whether new or retreatment, with final Xpert result:
MTB, RIF sensitive
MTB, RIF indeterminate

New EPTB of CNS, bones, joints, with positive SM/TB LAMP or clinically diagnosed, and:
Xpert not done*
Xpert result is MTB not detected

A

2HRZE/10HR

33
Q

Side effects of Isoniazid

A

Burning sensation in the feet due to PERIPHERAL NEUROPATHY
-Give PYRIDOXINE (Vit B6) 50–100 mg daily for
treatment; it can also be given 10 mg daily for prevention

Psychosis and convulsion

34
Q

Side effects of Isoniazid

A

MINOR

Burning sensation in the feet due to PERIPHERAL NEUROPATHY
-Give PYRIDOXINE (Vit B6) 50–100 mg daily for
treatment; it can also be given 10 mg daily for prevention
Gastrointestinal intolerance - give drugs at bedtime or with small meals

MAJOR
Jaundice due to hepatitis
Psychosis and convulsion

35
Q

Side effects of Rifampicin

A

MINOR

Gastrointestinal intolerance - give drugs at bedtime or with small meals
Orange-colored urine - reassure the patient
Flu-like symptoms (fever, muscle pains, inflammation of the respiratory tract) - pyretics

MAJOR

Oliguria or albuminuria due to renal disorder
Jaundice due to hepatitis
Thrombocytopenia, anemia, shock

36
Q

Side effects of Pyrazinamide

A

MINOR

Gastrointestinal intolerance - give drugs at bedtime or with small meals
Jaundice due to hepatitis
Arthralgia due to hyperuricemia

37
Q

Ethambutol

A

Impairment of visual acuity and color vision due to optic neuritis

38
Q

A patient with bacteriologically confirmed TB at the beginning of treatment and who was smear- or culture-negative in the last month of treatment and on at least one previous occasion in the continuation phase.

A

Cured

39
Q

A patient who completes treatment without evidence of failure but with no sputum smear negative results in the last month of treatment and on at least one previous occasion, either because tests were not done or because results are unavailable.

This group includes clinically diagnosed patients who completed treatment.

A

Treatment Completed

40
Q

A patient whose sputum smear or culture is positive at five months or later during
treatment.

Treatment terminated because of evidence of additional acquired resistance (e.g. RIF resistance on Xpert at 2nd month)

A patient for whom follow-up sputum examination was not done (e.g. child or EPTB) and who does not show clinical improvement anytime during treatment.

Severe uncontrolled adverse drug reaction

A

Treatment Failed

41
Q

A patient who dies for any reason during the course of treatment.

A

Died

42
Q

A patient whose treatment was interrupted for at least two consecutive months.

A patient diagnosed with active TB but was not started on treatment (i.e., initial LTFU).

A

Lost to follow-up (LTFU)

43
Q

A patient for whom no treatment outcome is assigned.

This includes patients transferred to another facility for continuation of treatment but the final outcome was not determined.

A

Not Evaluated

44
Q

Isoniazid

A

5 mg/kg, max 400 mg

(-) FAS and mycolic acid synthesis

excellent BACTERICIDAL
BACTERIOSTATIC against slowly dividing organisms

45
Q

Rifampicin

A

10 mg/kg, max 600 mg

binds to and (-) mycobacterial DNA dependent RNA polymerase –> blocking RNA synthesis

both intracellular and extracellular BACTERICIDAL
w/ STERILIZING activity

MOST ACTIVE antimycobacterial agent available

KEYSTONE of the 1st LINE TB TREATMENT

46
Q

Pyrazinamide 25 mg/kg, max 2 g

A

Fatty acid synthetase I

more active against SLOWLY replicating organisms

active only in ACIDIC environment

47
Q

Ethambutol 15 mg/kg

A

(-) arabinosyltransferases involved in cell wall synthesis

BACTERIOSTATIC

LEAST POTENT

IM (66 decks)

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