173 - Tuberculosis Flashcards by Salman Majid

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

65
blacks
HIV
immigrants

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

air
pulmonary 
cough
talk
sneeze

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

duration
distance
ventilation

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

sputum smear
cavitary
larynx
most

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

cultures
sputum smear
HIV

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

pulmonary
cultures
contagious

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

primary
children
immunocompromised

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Primary TB tends to be more __ but less__

severe

infective

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

secondary/tertiary
severe
infective
cavitation

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

10
50
18

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

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

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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 ___.

1/3
50
60
infective

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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.

macrophage activating cell mediated inflammatory response

tissue damaging response

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TST=__

tuberculin skin test

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

CD4

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

quickly
asymptomatic
fever/pleuritic pain

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

lower

middle

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

Ghon focus
periphery
heal

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What will Ghon process include?

hilar/peritracheal lymphadenopathy
pleural effusion
pleural thickening

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

blockage
collapse
wheezing
inflation

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

pneumonia
necrosis
cavitation 
caseating 
bronchiectasis

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

erythema nodosum

Phlyctenular conjunctivitis

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

progressive primary TB
necrosis
cavitation

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Post primary disease=___

secondary/tertiary/reactivation

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

peaks

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

small infiltration large cavitation caseating

What are the clinical presentation of post primary TB? 5

``` B symptoms productive cough hemoptysis pleuritic pain dyspnea->ARDS ```

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

20-40 | 2/3

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

``` LN pleura upper airways GU skeletal CNS ```

Which LN are most commonly involved in TB?

posterior neck | supraclavicular

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

50 pulmonary FNA/surgical biopsy

Pleural TB will present with either __ or __

effusion | empyema

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

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

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

culture smear ADA IFN- gamma

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

biopsy granulomas tissue culture

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

well | steroids

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

rare cavitation culture smear

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

drainage

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

larynx/pharynx/epiglottitis | cavitary

Upper respiratory TB clinical symptoms include: 5

``` hoarseness dysphonia dysphagia productive cough ulcers ```

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

sputum smear | biopsy

Pott's disease/ tuberculous spondylitis=__

skeletal TB

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

thoracic thoracic lumber

What are the two manifestations of CNC TB?

meningitis | tuberculoma

Spread TB= __

Miliary tuberculosis

The origin of miliary TB is from __ spread.

hematogenic

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

B symptoms

Miliary tuberculosis physical examination may show: 5

hepatosplenomegaly lymphadenopathy choroidal tubercles (eye examination-pathognemonic) meningismus

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

smear BAL biopsy

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

aspergilloma aspergillus itraconazole

HIV accelerates the progression of an active __. When CD4

TB 200 primary

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

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

IRIS=__

immune reconstitution inflammatory syndrome

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

decline lymphadenopathy/fever respiratory empyema/infiltration

IRIS appears _-_ months after starting __ treatment.

1-3 | ART

What are the main microbiological lab diagnosis available?

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

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

Xpert MTB/RIF assay

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

PET-CT

What are the two examinations for latent TB?

TST | IGRA (IFN- Gamma Release Assays)

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

TST | IGRA

TB treatment first line: 4

isoniazid + rifampin + pyrazinamide + ethambutol

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

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

Second line drugs should be used only for __ TB

resistant

``` What are 2 line drugs for treating TB? A- ___ B- ___ C- ___ D- ___ ```

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

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

wedge resection/lobectomy

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

``` bacteriocidic decrease noninfective 2 4 ```

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

``` sterilized reinfection 4 isoniazid rifampin ```

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

``` hepatitis hypersensitivity hyperuricemia arthralgia gout thrombocytopenia optic neuritis ```

Which S/E will require stopping the treatment?

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

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

IRIS

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

rifabutin

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

7-10

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

streptomycin

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

isoniazid rifampin pyrazinamide aminoglycoside

In liver disease monitor- 2, and avoid __

lionized rifampin pyrazinamide

LTBI=__

latent TB

Who must be screened for LTBI? 5

``` HIV relatives of patients prior to transplantation silicosis dialysis/anti TNF ```

Who are recommended to be screened for LTBI? 5

``` inmates health workers immigrants homeless IVDU ```

173 - Tuberculosis Flashcards

(78 cards)