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2016 PTB Flashcards

(49 cards)

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1
Q

Previously treated for TB, declared cured and is now diagnosed with TB

A

Relapse

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2
Q

Previously treated for TB and declared treatment failure at the end of most recent course of treatment

A

Treatment after failure

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3
Q

True or False: serum Uric acid should be taken before starting TB treatment

A

False. Serum Uric acid is not recommended before starting anti TB treatment. Asymptomatic hyperuricemia is not indication to hold pyrazinamide

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4
Q

What is the effective treatment regimen for new PTB cases?

A

2HRZE and 4HR (isoniazid + rifapicim)

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5
Q

Target: cell wall. Inhibits mycolic acid

A

Isonizid

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6
Q

Target: nucliec acid. Inhibits transcription by interfering the DNA dependent RNA polymerase

A

Rifampicin

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7
Q

Mechanism of resistance. Rifampicin

A

Mutation in rpoB gene

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8
Q

Target: intracellular. Targets essential membrane transport, in fatty acid synthesis

A

Pyrazinamide

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9
Q

Drug dose per Kg body weight HRZES.

A 
H 5
R 10
Z 25
E 15
S 15
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10
Q

Mechanism of resistance. Streptomycim

A

Mutation of ribosome target binding sites

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11
Q

Target: ribosome. Inhibits translation during protein synthesis

A

Streptomycin

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12
Q

Target: cell wall. Affects Lipid and cell wall metabolism. Inhibits RNA synthesis.

A

Ethambutol

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13
Q

Mechanism of resistance. Ethambutol

A

Mutation of embCAB gene

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14
Q

Mechanism of resistance. Pyrazinamide

A

Mutation in pncA gene

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15
Q

Gold standard of PTB diagnosis

A

TB culture

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16
Q

LED vs Zeihl Neelsen microscopy

A

LED is preferred. More sensitive and more specific

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17
Q

Indications for Drug sensitivity testing

A

ALL cases of re treatment, treatment failure, MDR suspects; Also for known contacts of MDR-TB, PLHIV

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18
Q

Additional work up for smear negative patients

A

CXR for all smear negative presumptive PTB. If available, Xpert MTB/Rif should be requested for CXR positive presumptive PTB

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19
Q

Pre-treatment tests prior to initiating TB treatment

A

SGPT, Creatinine, FBS

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20
Q

Indications for the use of corticosteroids as aadjuntive therapy

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A

TB meningitis and TB pericarditis

21
Q

Recommended regimen for corticosteroids for TB meningitis

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A

Dexamethansone 0.4 mg/kg/24 hours over 6-8 weeks

22
Q

Recommended regimen for corticosteroids for TB pericarditis

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A

Prednisone 60 mg for the first 4 weeks, 30 mg for weeks 5-8, 15 mg for weeks 9-10 and 5 mg for week 11

23
Q

Drug which can cause asymptomatic jaundice without evidence of hepatitis

24
Q

Management of interrupted cases. Less than 1 month

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A

Continue treatment and prolong to compensate

25
Management of interrupted cases. More than 1 month but less than 2 months
Positive DSSM and less than 5 months on treatment: continue treatment and prolong to compensate Positive DSSM and more than 5 months on treatment: Treatment failure
26
Management of interrupted cases. More than 2 months/
Classify as lost to follow up. Repeat DSSM
27
Monitoring PTB treatment response. New cases
At least 1 sputum smear microscopy after 2 months for new cases and end of 3 months for retreatment cases If at 2 months, speciment is smear -positive, repeat DSSM at end of 3rd month.
28
Monitoring PTB treatment response. If specimen obtained at end of 3rd month is still smear-positive
Do Xpert MTB/Rif, sputum culture and DST
29
Monitoring PTB treatment response. New smear posiitve TB patient
Sputum specimen at end of 5th or 6th month should be obtained for smear positive TB patients. If still positive, do culture and DST
30
When is a patient on TB treatment considered non infectious?
Bacteriologically confirmed: 14 daily doses, with sputum conversion and clinical improvement Clinically diagnosed: 5 daily doses with clinical improvement
31
Major adverse reactions and all drugs must be discontinued
Severe skin rash due to hypersensitivity Jaundice due to depatitis Impairment of visual acuity and color vision Hearing impairment, ringing of the ears, dizziness Oliguria or albuminuria Psychosis and convulsion Thrombocytopenia, anemia, shock
32
When to discontinue anti TB drugs?
SGPT 5x ULN or3x ULN and symptomatic
33
When to resume anti TB drugs if with elevated SGPT?
SGPT less than 2x ULN in stepwise reintroduction
34
Prevention of peripheral neuropathy in PTB
vitamin B6 at 50- 100 mg daily
35
Treatment of latent TBI
isoniazid 300 mg daily
36
Tuberculin reaction size. Who gets treated?
More than 5 mm: PLHIV, organ transplant recipients, recent contacts of a patient with TB, immunosuppresed, fibrotic lesion on CXR More than 10 mm: recent immigrants from high prevalence countries, injection drug users, children less than 5 years old
37
What is Sputum induction and when is it done?
Sputum induction (15-20 minutes of nebulization with 15mL 2.5-5% hypertonic saline) should be done for individuals who are unable to expectorate, provided it is done by trained staff in well-equipped facilities, with special caution for patients with history of asthma.
38
True or false. Tuberculin skin test (TST) be used in diagnosing active pulmonary tuberculosis (PTB)
False
39
Why is Rifampicin used to test for resistance?
Dictum: Rif resistant then it is also Isoniazid resistance.
40
What is the sensitivity of GeneXpert?
Sputum negative: specificity 99% sensitivity 67 | Spumum positive: specificity sensitivity
41
On Sputum microscopy, how do you interpret the result?
In Sputum result, number before the plus sign signifies more organism then that wiht plus sign followed by number (3+)>(+9)
42
What is the recommended treatment regimen for PTB among PLHIV?
Same as general population for PTB among PLHIV Co-trimoxazole prophylaxis at a total daily dose of 800 mg sulfamethoxazole + 160 mg trimethoprim should also be given to prevent Pneumocystis jirovecii pneumonia among PLHIV regardless of CD4 count.
43
What is the role of CXR?
``` Always ask for old chest xray films to compare CXR changes seen 4-6 months PTB scar: fibroliner densities PTB new: reticulu nodular Good screening for Presumptive PTB Good for years as long as it is not wet ```
44
How is tuberculin skin testing done? When is it positive?
Use 0.1 cc and inject intradermally Low sensitivity. Cannot differentiate from active vs latent TB Positive in general population: more than 10 mm
45
How is Presumptive PTB defined?
1. 2. 3. CXR showing PTB with or without symptoms
46
Why not more than 5 tablets HRZE in patient wiht more than 70 kg?
In the fixed dose combination drug, max of Rifampicin is achieved at 4 tablets already.
47
First line anti TB drug?
HRZE
48
How should MDR TB?
Referred to PMDT or satellite | VSMMC and Eversely
49
How to treat latent PTB?
Isoniazid 300 mg OD x 9 months | HR x 3-4 months

CPG (6 decks)

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