Pulmonary 1016 Tb

Front 1

What are the clinical symptoms of TB?

Back 1

productive cough, fever, night sweats, weight loss, hemoptysis

Front 2

Where does primary TB present in adults?

Back 2

lower lobe

Front 3

Where does reactivated TB present in adults?

Back 3

upper love, cavitary lesion

Front 4

What is the most likely form of TB in children?

Back 4

progressive primary disease

Front 5

What are the common features of TB in children?

Back 5

more likely to have progressive primary disease, can be culture negative, less likely to be transmitted to others

Front 6

What sputum samples do you get for TB?

Back 6

3 samples on 3 days, at least every 8 hours with one in the early am

Front 7

Why would you do a sputum induction?

Back 7

in perrsons from whom expectorated sputum cannot be obtained or is smear-negative
cost-effective

Front 8

What are the microscopy techniques for TB?

Back 8

acid fast, fluorochrome

Front 9

Which is the preferred microscopy technique for TB?

Back 9

fluorochrome

Front 10

What is the fastest way to culture TB?

Back 10

liquid media in 5-10 days

Front 11

What are the limitations of nucleic acid probes?

Back 11

still need a smear and culture, expensive, can't distinguish viable from non-viable

Front 12

What is Ethambutol's MOA?

Back 12

inhibits arabinosyl transferases in cell wall biosynthesis

Front 13

Does resistance to Ethambutol happen?

Back 13

in embA or embB

Front 14

What is the toxicity of Ethambutol?

Back 14

retrobulbar neuritis, peripheral neuropathy, rash

Front 15

What is the toxicity of PAS?

Back 15

GI upset

Front 16

What is the toxicity of Ethionamide?

Back 16

severe GI toxicity

Front 17

What is the toxicity of Cycloserine?

Back 17

CNS

Front 18

What are third line drugs for TB?

Back 18

linezolid, clarithromycin, clofazamine, amoxicillin-clavulanic acid

Front 19

Why would you give combination therapy?

Back 19

increased potency means shorter duration of therapy
prevents resistance
kills multiple populations of bacteria

Front 20

What is early bactericidal activity?

Back 20

decrease in colony counts in first two days of treatment, doesn't measure sterilizing activity

Front 21

What kind of sterilizing activity does Rifampin have?

Back 21

early and late

Front 22

What kind of sterilizing activity does Pyrazinamide have?

Back 22

early: first two months

Front 23

What best predicts TB relapse?

Back 23

2 months culture result

Front 24

What is the current TB treatment plan?

Back 24

2 days of INH, then INH/RIF/PZA /ethambutolfor two months, then INH/Rifampin for persistant bacteria

Front 25

How do you define XDR-TB?

Back 25

resistant to INH and Rif plus fluoroquinolones and 1 of 2nd line injectables (amikacin, kanamycin, capreomycin)

Front 26

How do you define MDR TB?

Back 26

resistant to INH and Rif

Front 27

How do you treat MDR TB?

Back 27

injectable agent + fluoroquinolone, treat for 18-24 months

Front 28

What do Fluoroquinolones do?

Back 28

inhibits DNA gyrase

Front 29

How do you get resistance to fluoroquinolones?

Back 29

mutation in DNA gyrase

Front 30

Which fluoroquinolones are better?

Back 30

later, like moxifloxacin and gatifloxacin

Front 31

What happens in a positive PPD test?

Back 31

T-cells sensitized by TB respond to antigens in PPD and release IFN-gamma

Front 32

For whom is the PPD test not as valid?

Back 32

immunocompromised people, HIV, corticosteroids, children, immunosuppressants

Front 33

What is the problem with the PPD?

Back 33

can't distinguish between TB and vaccination, can't distinguish latent infection/active, booster phenomenon with repeated testing

Front 34

Why would you use an IFN-gamma release assay?

Back 34

detects IFN-gamma after stimulation with TB, finds genes only in TB, not BCG or non-TB mycobacteria

Front 35

What does the QuantiFERON-TB gold test do?

Back 35

detects IFN-gamma by T cells after incubation wiht ESAT-6, CFP-10

Front 36

What is the most sensitive test for TB?

Back 36

T.SPOT/TB

Front 37

How do you rule out active TB?

Back 37

chest x-ray, symptoms of active disease

Front 38

For whom do you obtain a sputum?

Back 38

abnormal CXR, HIV+ and symptomatic

Front 39

What are the clinical manifestations of M avium complex disease with AIDS?

Back 39

fevers, night sweats, weight loss, abdominal pain, diarrhea, adenopathy, elevated alkaline phosphatase

Front 40

How do you treat M avium complex AIDS?

Back 40

clarithromycin, ethambutol, rifabutin

Front 41

How do you diagnose non-TB mycobacterial pulmonary disease?

Back 41

symptomatic patients, infiltrate, cavitary disease, bronchiectasis, positive cultures, biopsy with positive culture/histopath

Front 42

How do you treat M avium complex pulmonary disease?

Back 42

clarithromycin/axithromycin, rifampin/rifabutin, ethambutol
treat until negative for 12 months

Front 43

How does M kansasii manifest itself?

Back 43

pulmonary most common, HIV+ people

Front 44

How do you treat M kansasii?

Back 44

INH, rifampin, ethambutol for 18 months

Front 45

What are the rapid growers of mycobacteria?

Back 45

m fortuitum, abscessus, chelonae

Front 46

How do rapid mycobacteria growers show up?

Back 46

wound infections: augmentation mammoplasty, cardiac surgery

Front 47

What do you get from fish tanks?

Back 47

M marinum

Front 48

For whom does > 5mm mean + PPD?

Back 48

HIV+, close contact with infectious, fibrotic lesions on CXR, organ transplant or a lot of prednisone

Front 49

For whom does > 10 mm mean positive PPD?

Back 49

DM, renal failure, leukemia, lymphoma, silicosis, weight loss, jejunoileal bypass, gastrectomy, cancer of head/neck/lung, IDU
recent immigrant or living somewhere with lots of people
children, MTB lab workers

Front 50

For whom does > 15 mm mean positive PPD?

Back 50

no known risk factors