Lecture 11 Tb Flashcards

1
Q

Tb patients slowly waste away, hence the name ______

A

consumption

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2
Q

tb has a thick ____ covering that prevents staining by usual gram stains. some time it stains weakly gram ___

A

lipid;

positive

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3
Q

why is Tb more resistant to antibiotics?

A

divides very slowly, most Abs kill dividing bacteria

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4
Q

____ was the first Ab discovered to kill Tb because it affects ribosomes.

A

streptomycin

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5
Q

____ acts on the Tb cell wall and induces nitric oxide that kills bacteria

A

Isoniazid (INH)

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6
Q

____ lesions are more infectious than just smear positive infections

A

cavitary

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7
Q

infection is most likely to produce disease in _____ and the ____

A

infants, elderly

also 15-25 year olds

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8
Q

most common presentation of primary infection? What part of the lung is it seen in?

A

asymptomatic;

typically lower lung (ie lower part of the middle lobe)

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9
Q

what is usually the only evidence of a primary Tb infection?

A

positive PPD

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10
Q

bacteremic tb is called _____. do most patients after primary infection progress to more symptoms, or do most become asymptomatic?

A

milliary tb;

most become asymptomatic-latent Tb

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11
Q

In 5-10% of patients with latent Tb, it will become active again. this is called ____ tb.

A

reactivation

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12
Q

where does reactivation tb typically present in the lung? Why? what are the usual symptoms?

A

upper lobes, due to higher O2 tension;

fever, night sweats, hemoptysis, weight loss (classic Tb symptoms)

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13
Q

____ lesions on CXR are common in patients with reactivation Tb

A

cavitary

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14
Q

extra-pulmonary tb in the cervical lymph nodes is called _____. Tb in the spine is called ____.

A

scrofula; pott’s disease

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15
Q

The PPD is due to a _____ ____ immune response. It is measured based on ___ of the indurated skin

A

cell mediated;

diameter

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16
Q

false positive PPDs may be seen in patients with _____ or other mycobacterial infection. False negatives may occur in those with advanced ____, immunosuppresive therapy, or those with ____ ____

A

previous BCG vaccination;

HIV; active disease

17
Q

2 other tests for latent infection:

do those with previous BCG vaccination react ?

A

T-spot; Quantiferon TB (measures release of IFN gamma);

nope

18
Q

what is the gold standard for diagnosis of active disease?

A

culture; it takes 3-6 weeks

19
Q

how many sputum smears for Acid Fast Bacteria are needed to diagnose or rule out Tb?

A

3 smears, over 8 hours apart

20
Q

treatment of latent Tb:

A

Isoniazid (INH) for 9 months

21
Q

toxicity of INH?

what to include to prevent side effects?

A

neuropathy, hepatotoxicity;

include vitamin B6 to prevent neuropathy

22
Q

Standard care of treatment for active disease:

_____ for 2 months, check _____. then 4 months of _____

A

rifampin, isoniazid, pyrazinamide, ethambutol (RIPE);
sensitivity;
Rifampin, INH

23
Q

____ is also effective in treating Tb.

A

fluorquinolones