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SALMAN HARRISON'S > 173 - Tuberculosis > Flashcards

173 - Tuberculosis Flashcards

1
Q

Latent TB is more common in >_, __, __, and __

A

65
blacks
HIV
immigrants

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2
Q

TB transmission is via __ from a patient with a __ involvement (__,__,__).

A 
air
pulmonary 
cough
talk
sneeze
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3
Q

The risk to get infected depends on the __ of contact with the patient, __, __ etc.

A

duration
distance
ventilation

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4
Q

Patients with + __ and pulmonary __ disease, or involvement of the __ are the __ contagious.

A

sputum smear
cavitary
larynx
most

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5
Q

Patients with positive __ and negative __ or non cavitary __ patients are still contagious but less than the above.

A

cultures
sputum smear
HIV

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6
Q

Patients with a __ disease with negative __, or extra pulmonary disease are usually non ___

A

pulmonary
cultures
contagious

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7
Q

Clinical symptoms appearing shortly after being exposed to TB is considered __ TB. More common in __ and __

A

primary
children
immunocompromised

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8
Q

Primary TB tends to be more __ but less__

A

severe

infective

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9
Q

Reactivation of TB (__/__) will be less __ but more __ due to pulmonary __

A

secondary/tertiary
severe
infective
cavitation

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10
Q

__% of people with TB will eventually develop an active disease. __% of them will show symptoms within the first __ months post infection.

A

10
50
18

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11
Q

List 6 of the highest relative risk factors to suffer from active TB:

A 
post transplantation period
jejunoileal bypass
HIV infection
IVDU
chronic renal failure/hemodialysis 
silicosis
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12
Q

Without treatment, _ of patients will die within a year, and >_% within 5 years. From the survivors, _% will go through spontaneous remission while the rest become ___.

A

1/3
50
60
infective

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13
Q

What are the 2 reactions of the host’s to TB 2-4 weeks post infection?
Remember that the equilibrium between the two will determine if the TB will progress or be eradicated.

A

macrophage activating cell mediated inflammatory response

tissue damaging response

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14
Q

TST=__

A

tuberculin skin test

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15
Q

TST is based on attracting sensitized __ cells to the relevant site on the skin.

A

CD4

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16
Q

Primary TB appears __ post infection and can be __ or with __/__ pain

A

quickly
asymptomatic
fever/pleuritic pain

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17
Q

Primary TB involves mostly the __ and __ lubes since they are the most active in the breathing process.

A

lower

middle

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18
Q

What is the name of the primary TB pulmonary lesions? They usually found in the __ of the lung and tend to __.

A

Ghon focus
periphery
heal

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19
Q

What will Ghon process include?

A

hilar/peritracheal lymphadenopathy
pleural effusion
pleural thickening

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20
Q

Lymphadenopathy may lead to a __ of the pulmonary airways with distal __, giving rise to __ or ball in a socket which gives ends in hyper __

A

blockage
collapse
wheezing
inflation

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21
Q

Tear of the LN into the airway may cause __ with __ and __. With time __ pneumonia may lead to __.

A 
pneumonia
necrosis
cavitation 
caseating 
bronchiectasis
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22
Q

Some of the patients with primary TB may present __ and __ (conjunctiva nodules)

A

erythema nodosum

Phlyctenular conjunctivitis

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23
Q

Children/immunocompromised with primary TB may develop __- the primary lesion will grow and include central __ which will end up as __.

A

progressive primary TB
necrosis
cavitation

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24
Q

Post primary disease=___

A

secondary/tertiary/reactivation

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25
Q

Post primary disease lesions are found usually at the __ of the lung where the oxygen high pressure promotes growth.

A

peaks

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26
Q

Post primary expression could be anything between a __ to __. The latter, when combines with other lesions, ends up as __ pneumonia.

A

small infiltration
large cavitation
caseating

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27
Q

What are the clinical presentation of post primary TB? 5

A 
B symptoms
productive cough
hemoptysis
pleuritic pain 
dyspnea->ARDS
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28
Q

Extra pulmonary TB is present in -% of patient, while in the case of comorbidity with HIV- _ of patients.

A

20-40

2/3

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29
Q

What are the top 6 locations extra pulmonary TB spreads to?

A 
LN
pleura
upper airways
GU
skeletal
CNS
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30
Q

Which LN are most commonly involved in TB?

A

posterior neck

supraclavicular

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31
Q

_%< of patients with LN TB have __ TB. Diagnosis is made with __/__- extracting it completely.

A

50
pulmonary
FNA/surgical biopsy

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32
Q

Pleural TB will present with either __ or __

A

effusion

empyema

33
Q

Pleural effusion can be __ or __. When puncturing: 5

A 
light-severe
straw color
protein>50% of serum
glucose- low/normal
pH around 7.3
leukocytes (more neutrophils followed by more lymphocytes)
34
Q

Pleural effusion with TB usually produce negative __ and __, but high __ and __.

A

culture
smear
ADA
IFN- gamma

35
Q

It is recommended to perform __ in pleural effusion TB. We might find __ or manage to grow __.

A

biopsy
granulomas
tissue culture

36
Q

TB pleural effusion responds __ to treatment. __ does not __.

A

well

steroids

37
Q

TB pleural empyema is more __. It is the result of a __ tear. __ and __ will usually be positive.

A

rare
cavitation
culture
smear

38
Q

Treating pleural TB empyema involves surgical __ + normal medical treatment.

A

drainage

39
Q

Upper respiratory TB involves the __/__/__ and is the result of a severe __ disease.

A

larynx/pharynx/epiglottitis

cavitary

40
Q

Upper respiratory TB clinical symptoms include: 5

A 
hoarseness 
dysphonia
dysphagia
productive cough
ulcers
41
Q

Upper respiratory TB treatment is done with __ and sometimes even __.

A

sputum smear

biopsy

42
Q

Pott’s disease/ tuberculous spondylitis=__

A

skeletal TB

43
Q

Pott’s in children usually involves the 2 upper ___ vertebrae. In adults Pott’s involves the lower __ or upper __ vertebrae.

A

thoracic
thoracic
lumber

44
Q

What are the two manifestations of CNC TB?

A

meningitis

tuberculoma

45
Q

Spread TB= __

A

Miliary tuberculosis

46
Q

The origin of miliary TB is from __ spread.

A

hematogenic

47
Q

Miliary tuberculosis will involve __, and more specific-location related symptoms

A

B symptoms

48
Q

Miliary tuberculosis physical examination may show: 5

A

hepatosplenomegaly
lymphadenopathy
choroidal tubercles (eye examination-pathognemonic)
meningismus

49
Q

When trying to diagnose miliary TB, __ is usually negative. Instead we use __ or transbronchial __.

A

smear
BAL
biopsy

50
Q

TB complications leads to an increased risk for __ or chronic pulmonary __. The best treatment will be __ for >6 months, rather than surgical (very dangerous)

A

aspergilloma
aspergillus
itraconazole

51
Q

HIV accelerates the progression of an active __. When CD4

A

TB
200
primary

52
Q

Why is it more difficult to diagnose TB with HIV comorbidity? 5

A 
sputum smear are usually negative
atypical radiological findings
no granulomas
negative TST
similar HIV symptoms imitating TB
53
Q

IRIS=__

A

immune reconstitution inflammatory syndrome

54
Q

IRIS is a __ in general state (__ and __) or __ (__ and __) together with lab/radiological expressions.

A

decline
lymphadenopathy/fever
respiratory
empyema/infiltration

55
Q

IRIS appears - months after starting __ treatment.

A

1-3

ART

56
Q

What are the main microbiological lab diagnosis available?

A

nucleic acid amplification technology (Xpert MTB/RIF assay)
AFB microscopy
culture

57
Q

What is the best way to diagnose TB in HIV patients?

A

Xpert MTB/RIF assay

58
Q

__ is a good imaging test for subclinical disease in HIV patients

A

PET-CT

59
Q

What are the two examinations for latent TB?

A

TST

IGRA (IFN- Gamma Release Assays)

60
Q

Both __ and __ are less accurate in populations with high frequency of TB or HIV

A

TST

IGRA

61
Q

TB treatment first line: 4

A

isoniazid + rifampin + pyrazinamide + ethambutol

62
Q

Isoniazid may cause __, so supplement in risk patients (5) with __

A

neuropathy
alcohol abuse/malnutrition/pregnant/HIV/diabetic)
pyridoxin

63
Q

Second line drugs should be used only for __ TB

A

resistant

64
Q 
What are 2 line drugs for treating TB?
A- \_\_\_
B- \_\_\_
C- \_\_\_
D- \_\_\_
A

A- quinolones
B- aminoglycosides
C- PO drugs
D- add on

65
Q

In TB patients with localized disease + sufficient residual lung tissue __ or __ are also optional.

A

wedge resection/lobectomy

66
Q

The initial protocol is __, the symptoms __ and the patients become __. It lasts for _ months and include all _ drugs on a daily dose.

A 
bacteriocidic
decrease
noninfective
2
4
67
Q

The second phase of treatment is to __. The goal is to prevent __. It lasts for _ months and includes __ and __ on a daily dosage

A 
sterilized
reinfection 
4
isoniazid 
rifampin
68
Q

What are the common S/E for TB treatment? 5

A 
hepatitis
hypersensitivity
hyperuricemia
arthralgia
gout
thrombocytopenia
optic neuritis
69
Q

Which S/E will require stopping the treatment?

A

gout and thrombocytopenia in pyrazinamide
optic neuritis in ethambutol
hepatitis if 5-6 times the normal
hypersensitivity- stop all and resume each separately to find out which one is the problem and switch only that

70
Q

When receiving ART and anti TB in HIV patients, there is an increase in risk for __.

A

IRIS

71
Q

For HIV patients with TB, rifampin can be replaced with ___ if interaction exist.

A

rifabutin

72
Q

TB meningitis should be treated for - months in the second phase of the treatment protocol.

A

7-10

73
Q

Pregnant women should be treated with __. Breath feeding women are allowed.

A

streptomycin

74
Q

In CRF with severe failure which is not treated with dialysis- reduce 3, and avoid __

A

isoniazid
rifampin
pyrazinamide
aminoglycoside

75
Q

In liver disease monitor- 2, and avoid __

A

lionized
rifampin
pyrazinamide

76
Q

LTBI=__

A

latent TB

77
Q

Who must be screened for LTBI? 5

A 
HIV
relatives of patients
prior to transplantation
silicosis
dialysis/anti TNF
78
Q

Who are recommended to be screened for LTBI? 5

A 
inmates
health workers
immigrants 
homeless
IVDU

SALMAN HARRISON'S (163 decks)

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