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PPS Diplomate Exam > TB in Infancy and Childhood > Flashcards

TB in Infancy and Childhood Flashcards

1
Q

_____ causes tuberculosis in humans.

A

Mycobacterium tuberculosis

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2
Q

_____ are obligately aerobic, non-motile, slightly curved or straight bacilli.

A

Mycobacteria

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3
Q

MTB retains _____ dye when decolorized with acid-ethanol by the _____ method (acid fastness).

A

carbofuchsin, Ziehl-Neelsen

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4
Q

MTB Survival Strategies

A
  1. prevention of acidification of phagosomes 2. neutralization of the effects of reactive oxygen intermediates by the mycobacterial cell wall 3. inhibition of plasma membrane repair 4. inhibition of phagosome-lysosomal fusion through secretion of SapM (acid phosphatase)
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5
Q

Key Risk Factors for TB

A

smear (+) household contact < 5 y.o. immunodeficiency

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6
Q

TB Transmission

A

inhalation of droplet nuclei (5-200 bacilli)

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7
Q

TB Incubation Period

A

3-12 weeks

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8
Q

_____ is the condition in which a child is in close contact with a contagious host but without any signs and symptoms, with (-) TST and (-) CXR and laboratory findings.

A

TB Exposure

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9
Q

_____ is the condition in which a child has no signs or symptoms, (-) CXR and laboratory findings but has (+) TST.

A

TB Infection Latent TB Infection (LTBI)

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10
Q

_____ is presumptive TB with (+) CXR and/or TST.

A

TB Disease

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11
Q

_____ TB has biological specimen which is positive by sear microscopy, culture or rapid diagnostic tests.

A

Bacteriologically Confirmed

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12
Q

_____ TB does not fulfill the criteria for bacteriological confirmation but has been diagnosed with active TB.

A

Clinically Diagnosed

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13
Q

_____ is a case of tuberculosis involving lung parenchyma and tracheobronchial tree ± other sites of the body.

A

Pulmonary TB (PTB)

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14
Q

_____ is a case of TB involving orgens outside the pulmonary system.

A

Extrapulmonary TB (EPTB)

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15
Q

Laryngeal TB is considered as _____.

A

EPTB

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16
Q

_____ is the initial stage in children who inhale MTB.

A

Primary Disease

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17
Q

Primary PTB Disease Components

A

Ghon focus lymphadenitis lymphangitis

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18
Q

95% of primary PTB disease heals by _____.

A

fibrosis and/or calcification

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19
Q

Primary TB in children is asymptomatic up to _____ of patients.

A

65%

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20
Q

Fever in primary Tb is usually _____ and lasts for _____.

A

low-grade 14-21 days

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21
Q

_____ is the condition which develops when initial TB infection fails to heal and continues to progress for months or years.

A

Progressive Primary TB

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22
Q

_____ is the condition which represents reactivation of an old, possibly subclinical TB infection.

A

Secondary (Reactivation) TB

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23
Q

Secondary TB occurs in _____ of the cases of primary infection.

A

< 10%

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24
Q

Secondary TB is more common on _____.

A

adolescents

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25
Q

Clinical Manifestations of Secondary TB

A

chronic or persistent cough prolonged fever chest pain hemoptysis supraclavicular adenitis

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26
Q

_____ is the clinical disease resulting from the hematogenous dissemination of MTB.

A

Miliary Tuberculosis

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27
Q

_____ is the most common clinically significant form of disseminated TB.

A

Miliary Tuberculosis

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28
Q

_____ is now used to denote all forms of progressive widely disseminated hematogenous TB.

A

Miliary Tuberculosis

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29
Q

The most common extrapulmonary sites of Miliary TB include the _____.

A

lymphatic system bones joints liver

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30
Q

_____ are more common in childhood TB than in adults.

A

peripheral lymphadenopathy hepatomegaly

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31
Q

Peritonitis is found in _____ of patients with advanced Miliary TB.

A

20-40%

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32
Q

_____ can be a complication of primary TB which results in enlargement of peribronchial lymph nodes with subsequent compression or nodal extension into the bronchus.

A

Endobronchial Tuberculosis

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33
Q

Compression from Endobronchial TB cam cause _____.

A

asphyxia obstructive emphysema atelectasis

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34
Q

The _____ is more vulnerable to Endobronchial TB due to its anatomy and drainage.

A

R middle lobe

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35
Q

Endobronchial TB can cause _____ which could be mistaken for pertussis or bronchial asthma.

A

crepitant rales wheezes

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36
Q

_____ is the most common form of extrapulmonary TB and probably the most common cause of chronic lymphadenitis in children.

A

Tuberculous Lymphadenitis (Scrofula)

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37
Q

TB Lymphadenitis occurs most frequently in the _____ age group.

A

10-18 y.o.

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38
Q

The most common location for TB Lymphadenitis is the _____, followed by the _____ areas.

A

anterior cervical space (49.4%) axillary and supraclaavicular areas

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39
Q

The most common presentation of TB Lymphadenitis is _____.

A

unilateral or multiple slow-growing nontender lymphadenopathies

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40
Q

The involved lymph node in TB Lymphadenitis is usually described as _____.

A

firm painless ruberry discrete matted fixed overlying skin induration

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41
Q

Fistula formation is seen in _____ of TB Lymphadenitis cases.

A

10%

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42
Q

The use of _____ can improve the diagnosis of TB Lymphadenitis.

A

FNAB with rapid molecular diagnostic tests

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43
Q

_____ is the most severe form of extrapulmonary TB.

A

Tuberculous Meningitis

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44
Q

TB Meningitis occurs most commonly in children _____ but uncommon in infants _____.

A

< 6 y.o., < 4 mos.

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45
Q

TB Meningitis usually appears within _____ after initial infection.

A

2-6 mos.

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46
Q

TB Meningitis usually accompanies Miliary TN in _____ of cases.

A

50%

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47
Q

TB Meningitis Stages: personality changes, irritability, anorexia, listlessness, fever

A

Stage 1

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48
Q

TB Meningitis Stages: increased ICP, cerebral damage, drowsiness, stiff neck, CN palsies, anisocoria, vomiting, tâche cérébrale, absence of abdominal reflexes, seizures

A

Stage 2

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49
Q

TB Meningitis Stages: coma, irregular HR and RR, rising fever

A

Stage 3

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50
Q

TB Meningitis CSF Findings

A

↑ WBC 50-500 WBC/mm3 PMNS - early Lymphocytes - late ↓ glucose ↑ protein

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51
Q

TB Meningitis Neuroimaging Triad

A

Hydrocephalus (80%) Basal Meningeal Enhancement (75%) Arteritis (cerebral infarcts)

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52
Q

_____ are enlarged granulomatous foci within the brain parenchyma.

A

Tuberculomas

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53
Q

Tuberculous brain abscesses lack _____ associated with tuberculomas.

A

giant cells granulomatous reaction

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54
Q

Tuberculomas occur most often in children _____.

A

< 10 y.o.

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55
Q

Tuberculomas are often located at the_____.

A

infratentorial area cerebellar area

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56
Q

The most common areas affected by TB spinal meningitis are _____.

A

dorsal cord (most common) lumbar region cervical region

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57
Q

TB osteomyelitis and arthritis account for _____ of EPTB and only _____ of all cases of TB.

A

10-15%, 2%

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58
Q

TB osteomyelitis and arthritis can be cause by _____ spread from an initial infection.

A

lymphohematogenous spread

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59
Q

Younger children are more vulnerable to TB osteomyelitis and arthritis due to the _____

A

increased blood flow to growing bones

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60
Q

TB osteomyelitis usually starts as an area of endarteritis in the _____ of long bone where blood supply is more abundant.

A

metaphysis

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61
Q

The most common skeletal sites affected by TB are _____.

A

spine (most common) hip knee

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62
Q

The most common sites affected by Pott’s Disease are _____.

A

upper lumbar lower thoracic lumbosacral

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63
Q

In Pott’s Disease, there is destruction of the intervertebral disk space and adjacent vertebral bodies, collapse of spinal elements and anterior wedging leading to _____.

A

angulation gibbus kyphosis

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64
Q

_____ is the most frequent symptom of Pott’s Disease.

A

back pain

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65
Q

Duration of Pott’s Disease ranges from _____.

A

4-11 mos.

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66
Q

TB arthritis is _____ in children and is usually _____.

A

rare, monoarticular

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67
Q

_____ is an aseptic reactive polyarthritis caused by TB..

A

Poncet’s Disease

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68
Q

_____ is second to PTB in frequency.

A

GITB

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69
Q

The most common forms of abdominal TB are _____.

A

nodal involvement peritonitis intestinal involvement liver (6.1%) ileum (1.5%) perineum (1..5%) spleen (1.5%)

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70
Q

Ingested of sputum infected with MTB is the most important suggested cause of _____.

A

TB Enteritis

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71
Q

TB Enteritis usually affects the _____.

A

ileocecal area mesenteric LN peritoneum

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72
Q

Enlarged caseous and calcified meseneric LNs also known as _____ are often seen as densities on abdominal x-ray.

A

tabes mesenterica

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73
Q

_____ is commonly due to rupture of a caseous abdominal LN and less frequently from a focus in the intestine or fallopian tube.

A

TB Peritonitis

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74
Q

_____ TB Peritonitis is less common and is characterized by tender abdominal masses and a doughy abdomen.

A

Plastic

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75
Q

_____ TB Peritonitis presents with ascitis and classic signs of peritonitis.

A

Serous

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76
Q

TB Peritonitis Peritoneal Fluid Analysis

A

exudative lymphocytic predominance serum ascitic fluid albumin gradient < 1.1 g/dl ↑ protein content (> 25 g/L)

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77
Q

_____ is referred to as primary miliary TB of the liver.

A

Hepatobiliary TB

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78
Q

Hepatobiliary TB Types

A

diffuse hepatic involvement with PTB or miliary TB diffuse hepatic involvement without PTB focal tuberculoma or abscess

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79
Q

The overall incidence of isolated liver TB is _____.

A

0.3%

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80
Q

Hepatic TB lesions that are larger than 2 mm are called _____.

A

macronodular TB pseudotumoral TB

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81
Q

Cutaneous TB Classification: tuberculous chancre

A

Primary

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82
Q

Cutaneous TB Classification: miliary tuberculosis

A

Primary

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83
Q

Cutaneous TB Classification: lupus vulgaris

A

Secondary

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84
Q

Cutaneous TB Classification: scrofuloderma

A

Secondary

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85
Q

Cutaneous TB Classification: tuberculous verrucosa cutis

A

Secondary

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86
Q

Cutaneous TB Classification: tuberculous gumma (metastatic abscess)

A

Secondary

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87
Q

Cutaneous TB Classification: orificial tuberculosis

A

Secondary

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88
Q

Cutaneous TB Classification: micropapular lichen

A

Tuberculid

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89
Q

Cutaneous TB Classification: scrofuloderma

A

Tuberculid

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90
Q

Cutaneous TB Classification: papular-papulonectrotic

A

Tuberculid

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91
Q

Cutaneous TB Classification: nodular (erythema induratum)

A

Tuberculid

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92
Q

Cutaneous TB Classification: Primary

A

tuberculous chancre miliary TB

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93
Q

Cutaneous TB Classification: Secondary

A

lupus vulgaris scrofuloderma tuberculous verrucosa cutis tuberculous gumma (metastatic abscess) orofocial TB

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94
Q

Cutaneous TB Classification: Tuberculids

A

micropapular lichen scrofuloderma papular-papulonecrotic nodular (erythema induratum)

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95
Q

_____ are hypersensitivity reactions to MTB.

A

Tuberculids

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96
Q

_____ is the most common form of childhood cutaneous TB.

A

Scrofuloderma

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97
Q

Cutaneous TB Manifestations

A

inoculation from an exogenous source or BCG hematogenous dissemination erythema nodosum

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98
Q

Ocular TB frequently involves the conjunctivae and the cornea in the form of _____.

A

phlyctenular keratoconjunctivitis

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99
Q

Phlyctenular Keratoconjunctivitis is considered a hypersensitivity reaction to _____.

A

tuberculin

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100
Q

Phlyctenular Keratoconjunctivitis presents as _____.

A

1-3 mm grey to yellow colored jelly-like nodules

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101
Q

Renal TB is an uncommon complication of primary TB which occurs _____ after primary infection.

A

15-20 years

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102
Q

Genitourinary TB is usually seen in children _____.

A

> 7 y.o.

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103
Q

_____ spread could cause tubercles in the glomeruli with caseating sloughing lesions.

A

Hematogenous

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104
Q

Children whose urine reveal presence of MTB are considered highly infectious and should be isolated until _____.

A

their urine is sterile

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105
Q

The most common sites for genital TB in females are _____.

A

fallopian tubes (90-100%) endometrium (50%) ovaries (20-30%) cervix (2-4%)

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106
Q

_____ should be highly suspected in the presence of painless otorrhea unresponsive to conventional treatment ina patient with TB.

A

TB Mastoiditis

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107
Q

Pathophysiology of Perinatal TB

A

hematogenous spread from umbilical vein → ingestion of infected amniotic fluid or postpartum inhalation

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108
Q

Criteria for Congenital TB

A
  1. 1st week of life 2. primary hepatic complex or caseating hepatic granuloma 3. TB infected placenta or endometrium
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109
Q

Effects of Maternal TB

A

infertility poor reproductive performance recurrent abortions stillbirth PROM preterm labor

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110
Q

Spectrum of TB: (+) exposure (-) signs and symptoms (-) TST (-) CXR (-) sputum smear (-) other diagnostics

A

TB Exposure

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111
Q

Spectrum of TB: (+) exposure (-) signs and symptoms (+) TST (-) CXR (-) sputum smear (±) other diagnostics

A

TB Infection

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112
Q

Spectrum of TB: (+) exposure (+) signs and symptoms (+) TST (±) CXR (±) sputum smear (±) other diagnostics

A

TB Disease

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113
Q

Classification of TB Disease is based on _____.

A

bacteriological status anatomical site history of previous treatment HIV status drug susceptibility

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114
Q

Those who can expectorate sputum may be classified into PTB, _____.

A

sputum smear positive or negative

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115
Q

TB Classification: a patient who has never had treatment for TB or who has taken anti-TB drugs for < 1 mo. Isoniazid Preventive Therapy (IPT) or other preventive regimens are not considered.

A

New Case

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116
Q

TB Classification: a patient who has been previously treated with anti-TB drugs for ≥ 1 mo.

A

Retreatment Case

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117
Q

TB Classification: a case of TB who has a (-) HIV result at the time of diagnosis

A

HIV (-) Patient

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118
Q

TB Classification: a case of TB who has a (+) HIV result at the time of diagnosis

A

HIV (+) Patient

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119
Q

TB Classification: resistant to 1 first-line anti-TB drug

A

Monoresistant TB

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120
Q

TB Classification: resistant to > 1 first-line anti-TB drug (other than Isoniazid or Rifampicin)

A

Polydrug-Resistant TB

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121
Q

TB Classification: resistance to at least both Isoniazid and Rifampicin

A

Multidrug-Resistant TB (MDR-TB)

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122
Q

TB Classification: resistance to any fluoroquinolone and to at least 1 of 3 second-line injectable drugs (capreomycin, kanamycin, amikacin)

A

Extensively Drug-Resistant TB (XDR-TB)

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123
Q

TB Classification: resistance to Rifampicin, detected using phenotypic or genotypic methods, ± resistance to other anti-TB drugs.

A

Rifampicin-Resistant TB (RR-TB)

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124
Q

A child is presumed to have active TB if ≥ 3 of the following criteria are met:

A

exposure to host with active TB (Epidemiologic) signs and symptoms (Clinical) (+) TST (Immunologic) (+) CXR findings (Radiologic) (+) laboratory findings (Laboratory)

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125
Q

_____ refers to any person with signs and/or symptoms suggestive of TB or those with CXR findings suggestive of TB.

A

Presumptive TB

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126
Q

Children who are ≥ 15 y.o. with cough of ≥ 2 weeks are presumed to have TB if they have any of the ff.:

A

weight loss fever hemoptysis chest or back pains easy fatigueability malaise night sweats shortness of breath difficulty of breathing

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127
Q

Children who are ≥ 15 y.o. with unexplained cough of any duration are presumed to have TB if they have _____.

A

close contact to host with active TB immunocompromised state

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128
Q

A child < 15 y.o. is presumed to have active TB if ≥ 3 of the following criteria are met:

A

coughing/wheezing x 2 weeks unexplained fever x 2 weeks weight loss failure to thrive loss of appetite failure to respond to 2 weeks of antibiotics failure to regain previous state of health 2 weeks after viral infection fatigue reduced playfulness lethargy

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129
Q

A child < 15 y.o. and has had _____ is presumed to have TB if at least 1 of the clinical criteria are met.

A

close contact to a known case of active TB

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130
Q

A child is presumed to have EPTB if the any of the ff. are present:

A

gibbus non-painful enlarged cervical lymphadenopathy with or without fistula nuchal rigidity pleural effusion pericardial effusion distended abdomen with ascites non-painful enlarged joint tuberculin hypersensitivity

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131
Q

Treatment for active TB should be done if the child has ≥ 3 of the ff.:

A

exposure (+) TST signs &amp;amp; symptoms (+) CXR (+) laboratory tests

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132
Q

_____ is the most important diagnostic tool in TB.

A

TST

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133
Q

Reaction to TST starts after _____ and reaches its peak at _____.

A

5-6 hours, 48-72 hours

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134
Q

The current standard for TST is the _____.

A

Mantoux Test

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135
Q

The Mantoux Test is done with _____ of solution containing _____ of purified protein derivative (PPD).

A

0.1 ml, 0.1 μg

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136
Q

PPD for Mantoux Test

A

5 tuberculin units of PPD-S 2 tuberculin units of PPD-RT 23 with Tween 80

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137
Q

Immunologic-based testing for TB is done with _____.

A

Interferon-Gamma Release Assay (IGRA)

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138
Q

The delayed hypersensitivity reaction is manifested as a _____ immune response mediated by _____ and is characterized by an indurated response to the intradermal injection from the cell wall of the MTB.

A

Type IV, sensiitized T-Lymphocytes

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139
Q

Administration of Mantoux Test

A

2 in. below elbow in the volar aspect of the forearm g.25-27 short bevel needle (1/4-1/2 in.) 0.1 ml of PPD intradermal - wheal of 6-10 mm

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140
Q

TST should be read within _____.

A

48-72 hours

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141
Q

(+) TST reactions can be read accurately for up to _____.

A

7 days

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142
Q

(-) TST reactions can be read accurately for up to _____.

A

72 hours

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143
Q

False (+) TST

A

infection with non-tuberculous mycobacteria previous BCG vaccination (≤ 5 years) incorrect TST administration incorrect measurement or interpretation incorrect strength of antigen

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144
Q

False (-) TST: Host Factors

A

infections live attenuated virus vaccinations (measles, mumps, polio, varicella) metabolic derangements nutritional factors lymphoid organ diseases coricosteroids immunosuppressive agents age (newborns, elderly) advanced TB infection stress complete anergy

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145
Q

False (-) TST: Tuberculin Factors

A

improper storage (light, heat) improper dilution chemical denaturation contamination adsorption into syringe (controlled with Tween 80)

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146
Q

False (-) TST: Administration Factors

A

too little antigen delayed administration after drawing into syringe too deep

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147
Q

False (-) TST: Reading and Recording Factors

A

inexperienced reader conscious or unconscious bias error in recording

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148
Q

The tuberculin solution must be stored at _____.

A

2-8°C

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149
Q

(+) TST: populations with no risk factors

A

≥ 15 mm

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150
Q

(+) TST: high risk populations

A

≥ 10 mm

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151
Q

(+) TST: ≥ 5 mm

A

HIV (+) close contact CXR with untreated TB organ transplant immunosuppression

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152
Q

_____ is the inability to react to a TST because of a weakened immune system.

A

Anergy

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153
Q

_____ is the change from a (-) to a (+) TST result.

A

Skin Test Conversion

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154
Q

_____ can distinguish latent TB from previous BCG vaccination.

A

IGRA

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155
Q

_____ is preferred for childern < 5 y.o.

A

TST

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156
Q

IGRA is preferred for children who _____.

A

have receivedd BCG are unlikely to return for reading

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157
Q

IGRA results are available within _____.

A

24 hours

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158
Q

IGRA blood samples should be processed within _____.

A

8-30 hours

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159
Q

_____ of blood is needed to perform IGRA.

A

1-2 ml

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160
Q

The only finding that may be highly suggestive of TB infants and children is the _____ found in miliary TB.

A

uniform stippling of both lungs

161
Q

Gastric AFB is only (+) in _____ of cases.

A

30-40%

162
Q

Primary Complex CXR Findings

A

parenchymal involvement (primary focus) lymphangitis localized pleural effusion regional lymphadenitis

163
Q

_____ is the most common CXR finding in children with TB.

A

Lymphadenopathy

164
Q

Proper Exposure for CXR

A

300-500 mA

165
Q

PTB CT Scan Findings

A

< 1 cm LN calcified nodes ring enhancement granuloma peribronchial, axillary, hilar, paricardiac nodes

166
Q

PTB CXR Findings

A

Ghon Complex (64%) parenchymal infiltrates (78%) air-space opacities (63%) atelectasis (22%) cavitary lesions (21%) bronchial and tracheal compression (12%) miliary pattern (10%)

167
Q

The parenchymal reaction to TB is typically _____.

A

acinar consolidation (homogenous with ill-defined borders)

168
Q

PTB predominantly affects the _____ with preferential location between _____.

A

upper lobes anterior-posterior segments right-left segments

169
Q

Atelectasis in TB usually affects the _____

A

R upper and middle lobes *bronchial compression by enlarged LN

170
Q

Progression from Ghon focus and lymohadenopathy occur in children _____.

A

< 5 y.o. > 10 y.o.

171
Q

Radiographic clearing of TB usually occurs within _____ after therapy.

A

6 mos. - 2 years

172
Q

Chronic PTB tends to localize in the _____.

A

apical and posterior segments of the upper lobes R > L

173
Q

Chronic PTB CXR Findings

A

Local Exudative TB Local Fibroproductive TB Cavitation Tuberculoma

174
Q

_____ is the radiolodic hallmark of reactivation TB.

A

Cavitation

175
Q

Tuberculomas are usually found in the _____.

A

upper lobe R > L

176
Q

In advanced Miliary TB, stippling in the lungs coalesce and produce a richly stippled patter called the _____.

A

snowstorm effect

177
Q

Radiographic Improvement of Miliary TB starts at _____ and complete clearing is seen in _____.

A

5 weeks 7-22 mos. (mean 16 weeks)

178
Q

Bronchiectasis from TB is 2x more frequent in patients with _____.

A

hemoptysis

179
Q

Pott’s Disease begins with deposition of MTD through end arterioles into the _____.

A

anterior part of the vertebral body adjacent to the end plate.

180
Q

_____ bone loss from TB is needed before changes are manifested on x-ray.

A

> 50%

181
Q

X-ray Triad of TB Arthritis

A

Phemister Triad juxtaarticular osteoporosis peripherally located osseous erosions narrowing of the interosseous space

182
Q

the Phemister Triad is characteristic of _____.

A

TB Arthritis

183
Q

The most specific CT Scan finding in TB Meningitis is _____.

A

basal cistern enhancement

184
Q

The majority of infarcts caused by TB Meningitis are located at the _____.

A

basal ganglia internal capsule

185
Q

The _____ are the most commonly affected regions of Tuberculoma.

A

frontal and parietal lobes

186
Q

If the caseous core of a tuberculoma liquefies, it results in a _____.

A

TB Abscess

187
Q

Tuberculomas are usually _____ while TB Abscesses are usually _____.

A

multiple (tuberculoma) solitary (abscess)

188
Q

Spinal TB MRI Findings

A

CSF loculation obliteration of he spinal subarachnoid space loss of outline of the spinal cord (cervicothoracic) matting of nerve roots (lumbar)

189
Q

Routes of Abdominal TB

A

ingestion of infected sputum hematogenous spread local spread

190
Q

_____ is the most common radiographic manifestation of abdominal TB.

A

Lymphadenopathy (55-66%) *mesenteric, omental, peripancreatic

191
Q

_____ is the most common clinical manifestation of abdominal TB.

A

Peritonitis (1/3)

192
Q

_____ involvement is seen in 80-90% of abdominal TB cases.

A

Ileocecal

193
Q

The wide gaping of the ileocecal valve with narrowing of he terminal ileum is called the _____.

A

Fleischner Sign

194
Q

The earliest radiographic abnormality seen in Renal TB is _____ due to erosion.

A

moth-eaten calyx

195
Q

Genital TB in males is usually confined to _____.

A

seminal vesicles prostate gland

196
Q

The primary sign of TB Pericarditis is pericardial thickening _____ on CT scan.

A

> 3 mm

197
Q

Most patients with TB Pericarditis have distention of the inferior vena cava to a diameter _____.

A

> 3 cm

198
Q

_____ microscopy is the easiest, least expensive and most rapid (1 hour) procedure in diagnosing TB.

A

AFB Smear

199
Q

Fluorescence Microscopy uses _____ which causes the acid-fast bacilli to fluoresce against a dark background.

A

auramine-based

200
Q

Traditional TB culture methods used solid culture media like _____.

A

egg-potato-based agar-based

201
Q

Solid TB culture requires _____ to isolate organisms and another _____ for sensitivity testing.

A

4-6 weeks, 2-4 weeks

202
Q

Mycobacterial culture with the use of _____ are more rapid and sensitive.

A

broth-based culture media

203
Q

Liquid TB culture provides results in ____.

A

7-14 days

204
Q

Specimen Collection: _____ is recommended for infants and children who are unable to produce sputum even with aerosol inhalation.

A

Gastric AFB

205
Q

Specimen Collection: _____ of gastric content should be aspirated for gastric AFB.

A

5-10 ml (max 15 ml)

206
Q

Specimen Collection: For gastric lavage, _____ of sterile distilled water is injected through a stomach tube.

A

25-50 ml

207
Q

Specimen Collection: Gastric AFB should be done once daily for _____.

A

3 consecutive days

208
Q

Specimen Collection: If transfer of gastric AFB is delayed for more than 1 hour, it must be neutralized with _____ and stored at _____>

A

sodium carbonate, room temperature

209
Q

Specimen Collection: For older children who can expectorate, a series of _____ should be collected in _____ before start of therapy.

A

2 sputum specimens 2 different days

210
Q

Specimen Collection: Sputum AFB

A
  1. clean and thorough rinse of mouth with water 2. breathe deeply 3 times 3. after 3rd breath, cough hard and bring sputum from deep in the lungs. 4. expectorate the sputum into a sterile container.
211
Q

Specimen Collection: _____ of sputum should be collected for AFB.

A

3 ml (1 tsp.)

212
Q

Specimen Collection: If a sputum AFB sample is delayed for more than 1 hour, it should be _____.

A

refrigerated

213
Q

Specimen Collection: The minimum amount for a respiratory aspirate AFB sample is _____.

A

3 ml

214
Q

Specimen Collection: If respiratory aspirate AFB sample is delayed for more than 1 hour, it should be _____.

A

refrigerated

215
Q

Specimen Collection: The minimum amount for a CSF AFB sample is _____.

A

1-2 ml

216
Q

Specimen Collection: If a CSF AFB sample is delayed for more than 1 hour, it should be _____.

A

kept at room temperature

217
Q

Specimen Collection: CSF AFB samples should be _____ if for PCR testing.

A

refrigerated or frozen

218
Q

Specimen Collection: Tissue AFB samples should have _____ added for transport.

A

2-3 ml sterile saline

219
Q

Specimen Collection: If a tissue AFB sample is delayed for more than 1 hour, it should be _____.

A

refrigerated

220
Q

Specimen Collection: If an exudate or abscess AFB sample is delayed for more than 1 hour, it should be _____.

A

refrigerated

221
Q

Specimen Collection: Exudate AFB swabs should have _____ added for transport.

A

2-3 ml sterile saline *ideally 7H9 broth

222
Q

Specimen Collection: _____ of blood should be taken for TB culture.

A

1-10 ml

223
Q

Specimen Collection: Blood for TB culture must be placed in a _____.

A

yellow top vial (sodium polyanetholsulfonate, SPS) green top vial (heparin)

224
Q

Specimen Collection: Blood for TB culture must be transported at _____.

A

room temperature

225
Q

Specimen Collection: BMA AFB specimen should be placed in a _____.

A

yellow top vial (sodium polyanetholsulfonate, SPS)

226
Q

Specimen Collection: _____ of first morning urine should be collected for _____ for urine AFB testing.

A

40 ml (min. 10-15 ml) 3 consecutive days q8-24 hours

227
Q

Specimen Collection: Stool AFB is not recommended except in patients with _____.

A

HIV

228
Q

When MTB antigen load is small and the degree of tissue sensitivity is high, granuloma formation results from _____.

A

organization of lymphocytes, macrophages, Langerhans giant cells and fibroblasts

229
Q

_____ utilize techniques to amplify nucleic acid regions specific to the MTB complex.

A

Nucleic Acid Amplification Tests (NAATs)

230
Q

The most common target of NAATs is the _____ followed by the _____.

A

IS6110, 65-kDa

231
Q

Line probe assays are recommended for _____ specimen only.

A

smear(+)

232
Q

The _____ is the first fully automated, cartridge-based NAAT for TB which simplifies molecular testing by integrating and automating sample preparation, amplification and detection.

A

Gene Xpert MTB/RIF Assay

233
Q

The _____ is a time-PCR-based molecular test that can simultaneously detect TB and Rifampicin resistance.

A

Gene Xpert MTB/RIF Assay

234
Q

The Gene Xpert MTB/RIF Assay will show results within _____.

A

2 hours

235
Q

The _____ is recommended by the WHO as a replacement for conventional microscopy, culture and drug susceptibility testing as the initial diagnostic test for TB.

A

Gene Xpert MTB/RIF Assay

236
Q

T-Lymphocytes from an infected host release _____ as a marker of infection or active TB.

A

Interferon Gamma (IFN-g)

237
Q

Drug Efficacy TB Groups

A
  1. actively growing MTB in open cavities (bactericidal drugs) 2. slowly multiplying MTB in caseous lesions (sterilizing drugs) 3. intracellular MTB in acidic compartments of macrophagesor acidic lung lesions (sterilizing drugs 4. TB persisters in hypoxic environments which are unresponsive to most anti-TB medication
238
Q

Children have fewer mycobacterial organisms and are thus less likely to develop _____.

A

secondary drug resistance

239
Q

EPTB is more common in _____.

A

children

240
Q

_____ involves direct observation of anti-TB medication intake.

A

Direct Observed Treatment Short Course (DOTS)

241
Q

3 Properties of Anti-TB Drugs

A

bactericidal activity sterilizing activity ability to prevent resistance

242
Q

Properties of Anti-TB Drugs: killing of bacteria in a log-phase growth

A

bactericidal activity

243
Q

Properties of Anti-TB Drugs: kill slowly growing or intermittently replicating bacilli

A

sterilizing activity

244
Q

_____ is the most potent sterilizing anti-TB drug.

A

Rifampicin

245
Q

_____ is only active in the acidic intracellular environment of macrophages and in areas of acute inflammation.

A

Pyrazinamide

246
Q

_____ is bactericidal against rapidly multiplying MTB in an environment with high oxygen tension and neutral pH.

A

Streptomycin

247
Q

_____ is used together with other drugs to prevent emergence of resistant bacilli.

A

Ethambutol

248
Q

First-Line Anti-TB Drugs

A

Isoniazid Rifampicin Pyrazinamide Ethambutol

249
Q

Second-Line Anti-TB Drugs: Injectables

A

Aminoglycosides (Streptomycin, Kanamycin, Amikacin) Polypeptides (Capreomycin)

250
Q

Second-Line Anti-TB Drugs: Fluoroquinlones

A

Levofloxacin Moxifloxacin Ofloxacin

251
Q

Second-Line Anti-TB Drugs: Rifampicin Analogs

A

Rifabutin Rifapentine

252
Q

Second-Line Anti-TB Drugs: Oral Bacteriostatic Agents

A

Para-Aminosalicylic Acid Cycloserine Terizidone Ethionamide Prothionamide

253
Q

_____, formerly a first-line anti-TB drug, is now classified as a second-line drug due to the increasing resistance and its IM route.

A

Streptomycin

254
Q

In cases of _____, Streptomycin may still be used as part of the initial treatment

A

meningitis liver disease

255
Q

_____ and _____ have recently been approved as anti-TB drugs as they have been proven to be effective in culture conversion.

A

Bedaquiline (hastens conversion) Delamanid (increasing conversion rates after 8 weeks of treatment)

256
Q

Children should be given the adult dose of anti-TB drugs once they reach _____.

A

25 kg

257
Q

Isoniazid: Dose

A

children - 10 (10-15 mkday) adults - 5 (4-6 mkday) *max. 300 mg/day

258
Q

Isoniazid: Mechanism of Action

A

bactericidal against actively growing MTB inhibits mycolic acid synthesis inhibits catalase-peroxidase enzyme

259
Q

Isoniazid: Adverse Reactions

A

hepatitis, peripheral neuropathy, allergic sken reactiong, possible hemolysis in G6PD, inhibits drug-metabolizing enzymes (DME) leading to increased risk of phenytoin, ethosuximide and carbamazepine toxicity

260
Q

First-Line Anti-TB Drugs: bactericidal against actively growing MTB inhibits mycolic acid synthesis inhibits catalase-peroxidase enzyme

A

Isoniazid

261
Q

First-Line Anti-TB Drugs: hepatitis, peripheral neuropathy, allergic sken reactiong, possible hemolysis in G6PD, inhibits drug-metabolizing enzymes (DME) leading to increased risk of phenytoin, ethosuximide and carbamazepine toxicity

A

Isoniazid

262
Q

Plasma half-life of Isoniazid varies from _____ to _____.

A

< 1 hour (fast acetylators) > 3 hours (slow acetylators)

263
Q

Discontinue Isoniazid, Rifampicin and Pyrazinamide if AST and/or ALT are _____.

A

> 3-5x normal values

264
Q

For Isoniazid and Rifampicin, there is _____ for renal dysfunction.

A

no dose adjustment

265
Q

Isoniazid and Rifampicin are best absorbed on an _____.

A

empty stomach

266
Q

When co-administering Isoniazid and Rifampicin, Isoniazid must not exceed _____.

A

10 mkday

267
Q

Rifampicin: Dose

A

children - 15 (10-20 mkday) adults - 10 (8-12 mkday) *max. 600 mg/day

268
Q

Rifampicin: Mechanism of Action

A

inhibits DNA-dependent RNA polymerase

269
Q

Rifampicin: Adverse Reactions

A

hepatitis, hypersensitivity reactions, flu-like symptoms, thrombocytopenia, orange discoloration of body fluids, induces drug-metabolizing enzymes (DME) resulting in decreased plasma levels of AEDs, antibiotics, hormonal therapy agents and corticosteroids

270
Q

First-Line Anti-TB Drugs: inhibits DNA-dependent RNA polymerase

A

Rifampicin

271
Q

First-Line Anti-TB Drugs: hepatitis, hypersensitivity reactions, flu-like symptoms, thrombocytopenia, orange discoloration of body fluids, induces drug-metabolizing enzymes (DME) resulting in decreased plasma levels of AEDs, antibiotics, hormonal therapy agents and corticosteroids

A

Rifampicin

272
Q

Pyrazinamide: Dose

A

children - 30 (20-40 mkday) adults - (20-30 mkday) *max. 2 g/day

273
Q

Pyrazinamide: Mechanism of Action

A

disruption of membrane energy metabolism

274
Q

Pyrazinamide: Adverse Reactions

A

nausea, vomiting, most common cause of hepatotoxicity, hypersensitivity reactions, polyarthralgia

275
Q

First-Line Anti-TB Drugs: disruption of membrane energy metabolism

A

Pyrazinamide

276
Q

First-Line Anti-TB Drugs: nausea, vomiting, most common cause of hepatotoxicity, hypersensitivity reactions, polyarthralgia

A

Pyrazinamide

277
Q

Pyrazinamide requires dose modification in _____.

A

renal failure

278
Q

Ethambutol: Dose

A

children - 20 (15-25 mkday) adults - 15 (15-20 mkday) *max. 1.2 g/day

279
Q

Ethambutol: Mechanism of Action

A

inhibits transferase enzymes involved in cell wall synthesis

280
Q

Ethambutol: Adverse Reactions

A

peripheral neuropathy, retrobulbar optic neuritis (impairment of visual acuity and red-green color vision)

281
Q

First-Line Anti-TB Drugs: inhibits transferase enzymes involved in cell wall synthesis

A

Ethambutol

282
Q

First-Line Anti-TB Drugs: peripheral neuropathy, retrobulbar optic neuritis (impairment of visual acuity and red-green color vision)

A

Ethambutol

283
Q

_____ was previously omitted from anti-TB regimens in children < 6 y.o. due to difficulty monitoring optic neuritis.

A

Ethambutol

284
Q

No anti-TB drug is effective against _____.

A

non-replicating or dormant MTB

285
Q

_____ has the best bactericidal activity against rapidly multiplying MTB.

A

Isoniazid

286
Q

Rifabutin’s advantages are _____.

A

reduced induction of hepatic metabolism used in patients also receiving antiretroviral therapt for HIV

287
Q

______ was developed for once-weekly anti-TB therapy because it was more potent and longer-acting.

A

Rifapentine

288
Q

Amikacin: Dose

A

children - 15-30 mkday IM/IV adults - 15 mkday IM/IV *max. 1 g/day

289
Q

Kanamycin: Dose

A

children - 15-30 mkday IM/IV adults - 15 mkday IM/IV *max. 1 g/day

290
Q

Streptomycin: Dose

A

children - 20-40 mkday IM adults - 15 mkday IM *max. 1 g/day

291
Q

Aminoglycosides: Mechanism of Action

A

bactericidal inhibits protein synthesis

292
Q

Aminoglycosides: Adverse Reactions

A

nephrotoxicity, electrolyte disorders, CN VIII damage (ototoxicity), neuromuscular blockade

293
Q

Second-Line Anti-TB Drugs: bactericidal inhibits protein synthesis

A

Aminoglycosides Polypeptides

294
Q

Second-Line Anti-TB Drugs: nephrotoxicity, electrolyte disorders, CN VIII damage (ototoxicity), neuromuscular blockade

A

Aminoglycosides

295
Q

Aminoglycosides are contraindicated in _____.

A

pregnancy

296
Q

Aminoglycosides need dose adjustment in _____.

A

renal insufficiency

297
Q

Capreomycin: Dose

A

children - 15-30 mkday IM adults - 15 mkday IM *max. 1g

298
Q

Capreomycin: Mechanism of Action

A

bactericidal inhibits protein synthesis

299
Q

Capreomycin: Adverse Reactions

A

personality changes, psychosis, depression, seizures

300
Q

Second-Line Anti-TB Drugs: personality changes, psychosis, depression, seizures

A

Capreomycin

301
Q

Ofloxacin: Dose

A

≤ 5 y.o. - 15-20 mkday PO BID > 5 y.o. - 10-15 mkday PO OD adults - 10-15 mkday PO OD

302
Q

Levofloxacin: Dose

A

children - 7.5-10 mkday PO adults - 10-15 mkday PO *max. 740 mg/day

303
Q

Moxifloxacin: Dose

A

children - 7.5-10 mkday PO adults - 10-15 mkday PO *max. 400 mg/day

304
Q

Fluoroquinolones: Mechanism of Action

A

bactericidal inhibits DNA gyrase

305
Q

Fluoroquinolones: Adverse Reactions

A

nausea, bloating, headache, dizziness, insomnia, tremulousness, tendon rupture, arthralgia, QTc prolongation, hypoglycemia

306
Q

Second-Line Anti-TB Drugs: bactericidal inhibits DNA gyrase

A

Fluoroquinolones

307
Q

Second-Line Anti-TB Drugs: nausea, bloating, headache, dizziness, insomnia, tremulousness, tendon rupture, arthralgia, QTc prolongation, hypoglycemia

A

Fluoroquinolones

308
Q

Fluoroquinolones are avoided during _____ due to concerns for arthropathy.

A

pregnancy < 18 y.o.

309
Q

Fluoroquinolones need dose adjustment in _____.

A

renal insufficiency

310
Q

Later-generation quinolones such as _____ are recommended instead of Ofloxacin since they are more potent.

A

Levofloxacin Moxifloxacin

311
Q

Children _____ metabolize Levofloxacin faster.

A

< 5 y.o.

312
Q

Prothionamide: Dose

A

children - 15-20 mkday BID or TID adults 15-20 mkday OD or BID (500 or 750 mg/day) *max. 1 g/day

313
Q

Prothionamide: Mechanism of Action

A

weakly bactericidal blocks mycolic acid synthesis

314
Q

Prothionamide: Adverse Reactions

A

GI upset, anorexia, metallic taste, hepatotoxicity, endocrine disorders, gynecomastia, hair loss, acne, impotence, menstrual irregularity, reversible hypothyroidism

315
Q

Second-Line Anti-TB Drugs: weakly bactericidal blocks mycolic acid synthesis

A

Prothionamide

316
Q

Second-Line Anti-TB Drugs: GI upset, anorexia, metallic taste, hepatotoxicity, endocrine disorders, gynecomastia, hair loss, acne, impotence, menstrual irregularity, reversible hypothyroidism

A

Prothionamide

317
Q

GI symptoms caused by Prothionamide can be minimized by _____.

A

food bedtime intake

318
Q

_____ is recommended while on Prothionamide.

A

Vit. B6

319
Q

Ethionamide: Dose

A

15-20 mkday PO *max. 750 mg/day

320
Q

Ethionamide: Mechanism of Action

A

bactericidal inhibits cell wall (mycolic acid) synthesis

321
Q

Ethionamide: Adverse Reactions

A

GI upset, hepatotoxicity, hypothyroidism

322
Q

Second-Line Anti-TB Drugs: bactericidal inhibits cell wall (mycolic acid) synthesis

A

Ethionamide

323
Q

Second-Line Anti-TB Drugs: GI upset, hepatotoxicity, hypothyroidism

A

Ethionamide

324
Q

Ethionamide should be given at a _____ initially and if there is no adverse GI events then it can be given OD.

A

split dose

325
Q

Ethionamide is contraindicated in pregnancy due to its _____.

A

teratogenicity

326
Q

Cycloserine: Dose

A

children - 10-20 mkday q12 adults - 10-15 mkday OD or BID (500 or 750 mg/day) *max. 1 g/day

327
Q

Cycloserine: Mechanism of Action

A

bacteriostatic inhibits cell wall synthesis

328
Q

Cycloserine: Adverse Reactions

A

CNS toxicity, inability to concentrate, lethargy, personality changes, peripheral neuropathy, skin problems, lichenoid eruptions, SJS

329
Q

Second-Line Anti-TB Drugs: bacteriostatic inhibits cell wall synthesis

A

Cycloserine

330
Q

Second-Line Anti-TB Drugs: CNS toxicity, inability to concentrate, lethargy, personality changes, peripheral neuropathy, skin problems, lichenoid eruptions, SJS

A

Cycloserine

331
Q

Cycloserine should be used with caution in patients with pre-existing _____.

A

mental health issues

332
Q

Cycloserine may be associated with severe _____ adverse reactions.

A

neuropsychiatric

333
Q

Cycloserine should be avoided in patients with a history of _____.

A

seizure disorder.

334
Q

_____ is recommended while on Cycloserine.

A

Vit. B6

335
Q

Para-Aminosalicylic Acid (PAS): Dose

A

150 mkday PO OD *max. 12 g/day

336
Q

Para-Aminosalicylic Acid (PAS): Mechanism of Action

A

bacteriostatic inhibits folic acid synthesis inhibits iron metabolism

337
Q

Para-Aminosalicylic Acid (PAS): Adverse Reactions

A

GI upset, hypothyroidism, hypersensitivity, crystallization in urine

338
Q

Second-Line Anti-TB Drugs: bacteriostatic inhibits folic acid synthesis inhibits iron metabolism

A

Para-Aminosalicylic Acid (PAS)

339
Q

Second-Line Anti-TB Drugs: GI upset, hypothyroidism, hypersensitivity, crystallization in urine

A

Para-Aminosalicylic Acid (PAS)

340
Q

Advantages of Fixed-Dose Combination (FDC) Tablets

A

prescription errors are less likely less tablets to ingest the patient cannot be selective about which drugs to take

341
Q

Fixed-Dose Combination (FDC) Tablets Preparations

A

H 50 mg + R 75 mg + Z 150 mg H 50 mg + R 75 mg

342
Q

Fixed-Dose Combination (FDC) Tablets: 4-7 kg, Intensive Phase (HRZ)

A

1

343
Q

Fixed-Dose Combination (FDC) Tablets: 8-11 kg, Intensive Phase (HRZ)

A

2

344
Q

Fixed-Dose Combination (FDC) Tablets: 12-15 kg, Intensive Phase (HRZ)

A

3

345
Q

Fixed-Dose Combination (FDC) Tablets: 16-24 kg, Intensive Phase (HRZ)

A

4

346
Q

Fixed-Dose Combination (FDC) Tablets: 25+ kg, Intensive Phase (HRZ)

A

adult dose

347
Q

Fixed-Dose Combination (FDC) Tablets: 4-7 kg, Continuation Phase (HR)

A

1

348
Q

Fixed-Dose Combination (FDC) Tablets: 8-11 kg, Continuation Phase (HR)

A

2

349
Q

Fixed-Dose Combination (FDC) Tablets: 12-15 kg, Continuation Phase (HR)

A

3

350
Q

Fixed-Dose Combination (FDC) Tablets: 16-24 kg, Continuation Phase (HR)

A

4

351
Q

Fixed-Dose Combination (FDC) Tablets: 25+ kg, Continuation Phase (HR)

A

adult dose

352
Q

_____ should be added in the intensive phase for children with extensive disease or living in settings where the prevalence of HIV or of Isoniazaid resistance is high.

A

Ethambutol

353
Q

TB Registration Groups: a patient who has never had treatment for TB or who has taken anti-TB drugs for <1 mo.

A

New

354
Q

TB Registration Groups: a patient previously treated for TB who has been declared cured or completed treatment in their most recent treatment episode, and is presently diagnosed with bacterioloically-confirmed or clinically diagnosed TB

A

Relapse (Retreatment)

355
Q

TB Registration Groups: a patient who has been previously treated for TB and whose treatment failed at the end of their most recent course

A

Treatment After Failure (Retreatment)

356
Q

TB Registration Groups: a patient whose sputum smear or culture is (+) at 5 mos. or later during treatment

A

Treatment After Failure (Retreatment)

357
Q

TB Registration Groups: a clinically diagnosed patient for whom sputum examination cannot be done and who does not show clinical improvement anytime during treatment

A

Treatment After Failure (Retreatment)

358
Q

TB Registration Groups: a patient who was previously treated for TB but was lost to follow-up for ≥ 2 mos. in their most recent course of treatment, and is currently diagnosed with either bacteriologically-confirmed or clinically-diagnosed TB

A

Treatment After Lost to Follow-up (TALF) (Retreatment)

359
Q

TB Registration Groups: a patient who has been previously treated for TB but whose outcome after their most recent course of treatment is unknown or undocumented

A

Previous Treatment Outcome Unknown (PTOU)

360
Q

TB Registration Groups: a patient who does not fit into any of the other groups

A

Others

361
Q

TB Categories: new PTB or EPTB (except CNS/bones/joints)

A

Category I

362
Q

TB Categories: new EPTB (CNS/bones/joints)

A

Category Ia

363
Q

TB Categories: previously treated drug-susceptible PTB or EPTB (except CNS/bones/joints)

A

Category II

364
Q

TB Categories: previously treated drug-susceptible EPTB (CNS/bones/joints)

A

Category IIa

365
Q

TB Treatment: Category I

A

2 HRZE / 4 HR

366
Q

TB Treatment: Category Ia

A

2 HRZE / 10 HR

367
Q

TB Treatment: Category II

A

2 HRZES / 1 HRZE / 5 HRE

368
Q

TB Treatment: Category IIa

A

2 HRZES / 1 HRZE / 9 HRE

369
Q

TB prophylaxis is recommended for _____.

A

children < 5 y.o. HIV (+) immunosuppressed individuals

370
Q

Isoniazid Preventive Therapy (IPT) Dose

A

10 mkday

371
Q

_____ is a case of TB, usually PTB, excreting bacilli which are resistant to one or more anti-TB drugs.

A

Drug-Resistant TB

372
Q

_____ is the bacterial resistance present in patients who have not received prior treatment with anti-TB drugs.

A

Primary Resistance

373
Q

_____ is the bacterial resistance in patients with some record of previous treatment.

A

Secondary Resistance

374
Q

_____ is defined as clinical evidence of TB together with the detection of MTB from a specimen collected from the subject with genotypic or phenotypic resistance to at least Rifampicin.

A

Confirmed MDR-TB

375
Q

_____ is defined as clinical evidence of TB and with positive clinical response to MDR-TB treatment or with immunological evidence of TB and documented exposure to a source case of MDR-TB.

A

Probable MDR-TB

376
Q

TB is said to be cured when _____.

A

treatment is completed as recommended by the national policy without evidence of failure and ≥ 3 consecutive cultures taken at least 30 days apart are (-) after the intensive phase

377
Q

The outcome when TB treatment is completed as recommended by the national policy without evidence of failure but no record that ≥ 3 consecutive cultures taken at least 30 days apart are (-) after the intensive phase is _____.

A

Treatment Completed

378
Q

Risk Factors for Drug Resistance

A

failure to adhere to the appropriate regimen previous inappropriate treatment contact with DRTB host immigration from an area withhigh incidence of DRTB HIV (+)

379
Q

Treatment Strategies for DRTB

A

Standardized Empirical Individualized

380
Q

Treatment Strategies for DRTB: drug resistance and susceptibility (DRS) data from representative patient populations are used to base regimen design in the absence of individual drug susceptibility testing, and all patients in a defined group or category receive the same regimen

A

Standardized

381
Q

Treatment Strategies for DRTB: each regimen is individually designed based in the patient’s previous history of anti-TB treatment and with consideration of drug resistance and susceptibility (DRS) data from the representative patient population

A

Empirical

382
Q

Treatment Strategies for DRTB: each regimen is individually designed based in the patient’s previous history of anti-TB treatment and individual drug susceptibility testing results

A

Individualized

383
Q

TB Treatment: focuses on sputum culture conversion

A

Intensive Phase

384
Q

TB Treatment: focuses on ensuring sterilization

A

Continuation Phase

385
Q

Anti-TB Drug Groups: Group 1

A

First-Line Oral Agents (HRZE)

386
Q

Anti-TB Drug Groups: Group 2

A

Injectable Agents (Kanamycin, Amikacin, Capreomycin, Streptomycin)

387
Q

Anti-TB Drug Groups: Group 3

A

Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin)

388
Q

Anti-TB Drug Groups: Group 4

A

Oral Bacteriostatic Second-Line Agents (Ethionamide, Prothionamide, Cycloserine, Terizidone, PAS)

389
Q

Anti-TB Drug Groups: Group 5

A

Agents with Unclear Efficacy (Clofazimine, Linezolid, Amoxicillin-Clavulanic Acid, Thioacetazone, Imipenem, Cilastatin, Clarithromycin, High Dose Isoniazid - 16-20 mkday)

390
Q

XDR-TB Treatment

A

use any Group 1 agents use an injectable agent to which the strain is susceptible and consider an extended duration of use if resistant to all injectable agents, use one which has not yet been given use later-generation fluoroquinolones use all Group 4 agents that have not been used extensively in a previous regimen use ≥ 2 agents from Group 5 consider low dose H treatment if with low-level resistance adjuvant surgery for local disease strong infection control measures treat HIV comprehensive monitoring and full adherence support

391
Q

BCG Vaccine Storage

A

lyophilized powder (heat and light sensitive) refrigerated (2-8°C)

392
Q

Once reconstituted, BCG must be refrigerated and used within _____.

A

2-3 hours

393
Q

Contraindications for BCG

A

HIV (+) Immunosuppression

394
Q

_____ are intended to be used on newborns and young infants to replace or amplify BCG early in life and on older children who have not yet been exposed or infected.

A

Pre-Exposure TB Vaccines

395
Q

_____ are given post-infancy and to older age groups to reduce progression of latent TB.

A

Post-Exposure TB Vaccines

396
Q

_____ are given to those with active TB in conjunction with anti-TB treatment to shorten the duration of drug therapy or reduce relapses after completion of treatment

A

Therapeutic Vaccines

397
Q

Algorithm for Preventive Therapy of Childhood Tuberculosis

A
398
Q

Diagnostic Algorithm for TB

A
399
Q

Screening of Pediatric Drug-Susceptible Household Contacts of TB

A

PPS Diplomate Exam (38 decks)

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