Tb

Question 1

most people effected by TB

Answer 1

number of immigrants
poor immune system
malnutrition
intitutional housing

Question 2

in US the Tb is becoming disease of

Answer 2

elderly
foreign- born from high prevalence
non-white minorities
person with immunodeficency

Question 3

description Mycobacterium tubercolisis

Answer 3

non-motile
rod -shaped baccilus 
about 2 microns long
slowing growing aerobe
multiplies faster in presence of oxygen 
likes to to grow in apices

Question 4

transmission

Answer 4

almost exclusively transmitted by very small, aerosolized droplets, usually less than 8 to 10 microns in diameter
other mean of contracting TB: ingestion of unpastreurized milk

Question 5

where does the TB settle

Answer 5

in distal parenchyma

Question 6

does the body stops TB

Answer 6

No the Tb still multiplies despite the defense mechanism

Question 7

how tb works

Answer 7

6 to 8 weeks after initial infection, host immune system causes localized inflammation and containment of infection by forming granulomas
intial lesion called Ghon nodule
the combination of initial lesion and the affect regional lymph node is known as Ghon complex
the bodes cell mediated immune response is usually effective in controlling the infection at this point

Question 8

Pocket of bacteria

Answer 8

it may lie dormant in either the primary Ghon nodule or matastatic sites, sometimes for many years until some event precipitates reactivation

Question 9

what happens between between primary and reinfection phase

Answer 9

is a dormant or healthy period known as tb with out disease

clinically there is not evidence of TB except positive skin test

Question 10

reactivation of TB

Answer 10

can take place 10% of infected individual and is most common in two years after initial infection
some factor that contribute to reactivation:aging, malnutrition, alcoholism, diabetes, immunocompromising diseases, silicosis, postpartum period, gastrectomy, chronic hemodialysis, other debilitating disorder.

Question 11

eventually fibrosis encases the ?

Answer 11

granulomatous lesion and resulting loss of lung

Question 12

continuous destruction of infected lung parenchyma leads to scarring and loss of lung volume along with destruction of blood vessels and may lead to …..

Answer 12

hypoxemia and hypercapnia and unsual findings

destruction of blood vessels may result in hemoptysis

Question 13

what to ask for medical history

Answer 13

careful history includes traces outside of US as well as other factors such as country of origin, immunosuppression, institutionalized care and previous or current treatment for TB

Question 14

TB is considered

Answer 14

a chronic disease with an insidious onset

Question 15

common complains

Answer 15

fatigue
low-grade fever
night sweats
 chronic cough
sputum production
hemoptysis
pleuritic chest pain
weight loss
symptoms may progress slowly over period of week as to be recognized on in retrospect

Question 16

physical examination

Answer 16

finding are not specified enough to make diagnosis

can help determine extent of progression and whether other areas of body outside the chest are involved

Question 17

pulmonary lesions may result in

Answer 17

impaired resonance to percussion
bronchial sounds
coarse crackles

Question 18

microbiology laboratory provides diagnoses base for TB

Answer 18

they are minimally helpful
WBC count is usually normal
a mild anemia may be present in chronic TB

Question 19

ABGs

Answer 19

rarely helpful

respiratory acidosis and hypoxemia with end state disease

Question 20

X-ray PA and lateral shows extent of pulmonary involvment

Answer 20

sputum, CXR are valuable test in diagnoses

the most common abnormality in the chest radiograph is hilar lymph node enlargement

Question 21

microbiology

Answer 21

a culture needed to confirm TB, can take up 6 weeks to complete the culture
early morning collection is needed or hypertonic solution can be used
also bronchoscopy can be employed if non-invasive procedure didn’t work.

Question 22

skin testing

Answer 22

an estimate 10-15 million persons in US have dormant M. Tuberculosis infection
mantoux skin test is a intracutaneous injection of a standardize dose of purified protein derivative
CDC classified positive skin testing based on the size of a visible or palpable induration(raised, hardened are)

Question 23

treatment regimen

Answer 23

organism must be susceptible to at least two of the drugs used
bacteriologic response should occur within the expected time
a single drug should never be added to a program that is failing
drug treatment must continue for a sufficient period of time
patient compliance must be monitor

Question 24

prophylactic therapy

Answer 24

the therapist observe patient taking the right dose of medication

patient without active disease but positive skin test can decrease the risk to develop the disease by going on isoniazid by taking 6 to 9 month

Question 25

Tb is transmitted by

Answer 25

very small aerosolized droplets

Question 26

the infection can

Answer 26

be primary or post primary/reactivation

Question 27

what provides bases for diagnoses?

Answer 27

the sputum culture provides the basis for diagnoses

Question 28

what is treatment requirements?

Answer 28

treatment is long-term and require strict compliance/adhere to drug regime