08.21 - TB (Cross) - Questions

Question 1

TB culture in liquid media will show results in

Answer 1

2 weeks

Question 1

How does IGRA work

Answer 1

Blood cells from patient are exposed to antigens from MTB and amount of IFN-gamma released from cells is measured

Question 2

Secondary infection usually involves

Answer 2

Apices of lungs (higher oxygen content)

Question 3

What protein is thought to play major role in inhibiting phagosome-lysosome function

Answer 3

PknG

Question 3

What stains tears

Answer 3

Rifampin and related

Question 3

What is positive PPD if no know risk factors?

Answer 3

>15 mm

Question 3

What is positive PPD if HIV, recent contact, immunosuppressed?

Answer 3

5-10mm

Question 4

Only evidence of primary infection in majority of patients is

Answer 4

Calcified lung nodule

Question 4

Possible NRAMP1 mutation –>

Answer 4

Unchecked bacillary proliferation –> Bacteremia, seeding of multiple sites

Question 5

How do TH1 cells activate macrophages

Answer 5

IFN-gamma

Question 5

Why not take rifampin and pyrazinamide together

Answer 5

Liver toxicity

Question 6

In XDR TB, resistance is to

Answer 6

INH, RIF, Fluoroquinolone, at least one other

Question 7

Adverse effects of Ethambutol

Answer 7

Optic Neuritis, Vision Discrimination, Hyperuricemia

Question 9

Function of Sulfatides (Surface Glycolipids)

Answer 9

Inhibit phagolysosome function

Question 10

Rifampin and other Rifamycins are __ inducers

Answer 10

CYP inducers

Question 11

Agar used for TB culture

Answer 11

Lowenstein-Jensen Agar

Question 12

Progressive primary TB initially looks like

Answer 12

Acute bacterial pneumonia: Lobar consolidation, Infiltrates, Adenopathy

Question 12

What is positive PPD if “at risk”: homeless, nursing home, immigrant, children

Answer 12

10-15 mm

Question 13

Can’t drink alcohol with

Answer 13

INH

Question 15

TB remains dormant until

Answer 15

Immune defense are lowered

Question 17

Spread of strep

Answer 17

Person-to-person (coughing)

Question 18

Virulent strains grow in characteristic ____ pattern, avirulent strains don’t

Answer 18

cord-like

Question 18

Most important virulence factor of MTB

Answer 18

Cell wall

Question 19

Common adverse effect of Ethambutol and Pyraziniamide

Answer 19

Hyperuricemia

Question 20

\_\_\_ following primary infection can result in miliary/disseminated TB

Answer 20

Lymphohematogenous Dissemination

Question 21

Importance of TNF-alpha

Answer 21

TNF-alpha inhibitor will allow granuloma to degrade, freeing and reactivating the TB

Question 21

Common toxicity of Rifampin and Pyrazinimide

Answer 21

Hepatotoxic

Question 23

RIPE =

Answer 23

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

Question 24

\_\_ is produced by TH-1 cells and enables macrophages to contain the infection

Answer 24

IFN-gamma

Question 25

Inhibits macrophage maturation and induces TNF-alpha release

Answer 25

Cord-Factor

Question 26

When can PPD be false positive

Answer 26

Immunization with BCG; Infection with nontuberculous MB

Question 28

What percent of patients who contract TB will contract from smear-negative patients

Answer 28

20%

Question 29

\_\_\_ response leads to granuloma formation and caseous necrosis

Answer 29

TH1 response

Question 29

Rifampin could cause drug-drug interactions in ___ patients

Answer 29

HIV

Question 30

\_\_ % of patients with primary TB will develop clinically significant disease

Answer 30

5%

Question 31

Which component of MTB retains AF stain?

Answer 31

Mycolic Acid

Question 32

Most important determinant of whether over disease occurs

Answer 32

Adequacy of host's cell-mediated immune response

Question 33

Anterior leg rash seen in TB

Answer 33

Erythema Nodosum

Question 34

Cavitation / Bronchial damage more severe in

Answer 34

Immunocompetent patients

Question 35

TB tx in HIV patients

Answer 35

RIPE for 9-12 months

Question 37

What cell mediates tuberculin positivity on skin test

Answer 37

TH1

Question 39

Vision discrimination probs

Answer 39

Ethambutol

Question 41

Function of Cord Factor

Answer 41

Inhibits macrophage maturation and induces TNF-alpha release

Question 42

When do we use 4 drug cocktail

Answer 42

Active disease, HIV

Question 44

Hyperuricemia

Answer 44

Pyrazinamide, Ethambutol

Question 45

With reduced immune response as in HIV, there are few ___ in sputum

Answer 45

AFB

Question 46

Hetpatoxic

Answer 46

Rifampin, Pyrazinimide

Question 47

PPD injection stimulates

Answer 47

Delayed type hypersenstivity by T lymphocytes

Question 48

In HIV patients with TB, there is incr freq of \_\_\_, and absence of ___ in tissues

Answer 48

Incr freq of false negative sputum smears; and absence of granulomas in tissues

Question 49

How does alveolar macrophage activate T Cell

Answer 49

Class 2 MHC + IL-12

Question 50

T/F: Mycolic acid cleaves antibiotics to render them ineffective

Answer 50

FALSE

Question 52

Optic neuritis

Answer 52

Ethambutol

Question 53

Initial test for TB:

Answer 53

Acid fast; but culture should be done at same time

Question 54

PPD and IGRA in HIV patients

Answer 54

False negatives in both can occur

Question 55

In MDR TB, most common resistance is to \_\_\_; in ___ patients

Answer 55

INH and RIF; AIDS patients