ALS Lecture 4 - Tuberculosis DONE

Question 1

factors that contribute to a person’s likelihood of contracting TB (4)

Answer 1

homelessness, IV drugs, AIDS, neglect of TB control programs

Question 2

look at figures from TB lecture

Answer 2

done

Question 3

TB is concentrated in certain medically underserved populations (6)

Answer 3

urban poor, alcoholics, IV drug users, homeless, prison inmates, people born abroad

Question 4

TB occurs in

Answer 4

contact-based micro-epidemics

Question 5

in first few weeks, host has almost no

Answer 5

immune defence against TB

Question 6

TB bacteria

Answer 6

Mycobacterium tuberculosis

Question 7

unrestrained bacterial multiplication proceeds for weeks, progressing as (3)

Answer 7

1. initial focus
2. lymphohaematogenous metastatic foci
3. tissue hypersensitivity, cellular immunity

Question 8

label the diagram of phagocytosis of mycobacterium tuberculosis by macrophages

Answer 8

done

Question 9

CD4+ cells have a T-cell receptor capable of recognising

Answer 9

TB antigens presented by macrophages1

Question 10

look at pictures of TB granulomas

Answer 10

done

Question 11

label the chest x-rays of primary (miliary) and post-primary TB

Answer 11

done

Question 12

in primary TB (2 steps)

Answer 12

1. rapid destruction of bacteria

2. infective process stopped

Question 13

after primary TB, what would be the only remaining evidence of infection?

Answer 13

positive skin test

Question 14

miliary TB

Answer 14

blood dissemination of TB

Question 15

post-primary TB infection usually presents in

Answer 15

immune deficiency, e.g. old age, alcohol

Question 16

TB becomes reactivated as (2 steps)

Answer 16

1. macrophage/granuloma break up

2. bronchial spread as necrosis occurs

Question 17

extra-pulmonary TB is when TB spreads metastatically to

Answer 17

any organ, e.g. abdomen, bone, brain, muscle

Question 18

approximately 30% of TB cases are exclusively

Answer 18

extrapulmonary

Question 19

spinal TB

Answer 19

may cause back pain

Question 20

kidney TB

Answer 20

blood in urine

Question 21

specimen collection in TB

Answer 21

3 sputum, smear and culture

Question 22

bronchoscopy can be done if there is suspicion of

Answer 22

TB, no sputum

Question 23

method to obtain specimens, especially used in children

Answer 23

gastric aspiration, get swallowed sputum

Question 24

CEPHAID test detects

Answer 24

TB specific DNA sequences

Question 25

CEPHAID test is a simple

Answer 25

nucleic acid amplification test

Question 26

CEPHAID test is easy and so good to do in

Answer 26

developing countries

Question 27

Heaf test results

Answer 27

bigger the skin reaction (induration), more likely you are to have been exposed to TB

Question 28

label the diagram of the CEPHAID test

Answer 28

done

Question 29

label the diagram of Heaf test grades

Answer 29

done

Question 30

IFN-g tests measure cell mediated immune response by measuring

Answer 30

IFN-g released by T cells in response to stimulation by Mycobacterium tuberculosis antigens

Question 31

look at the diagram of IFN-g test

Answer 31

done

Question 32

baseline diagnostic examinations for TB (3)

Answer 32

CXR, sputum specimens, drug susceptibility testing for INH, RIF and EMB

Question 33

other examinations to conduct when TB treatment is initiated (5)

Answer 33

HIV test, CD4+ test in HIV, HepB, liver tests, colour vision tests

Question 34

usually in TB, there will be a history of

Answer 34

TB exposure

Question 35

to find out whether someone has been exposed to TB we can contact the

Answer 35

local health department

Question 36

in TB, we must always consider

Answer 36

demographic factors

Question 37

symptoms of TB (4)

Answer 37

productive prolonged cough, chest pain, haemoptysis, systemic symptoms (fever, weight loss, night sweats)

Question 38

standard view used for the detection and description of chest abnormalities

Answer 38

posterior-anterior radiograph

Question 39

in pulmonary TB, radiographic abnormalities are often seen in

Answer 39

apical and posterior segments of upper lobe, superior segments of lower lobe (but may be anywhere)

Question 40

what kind of bacteria is TB?

Answer 40

obligate, intracellular (grows inside macrophages)

Question 41

how does TB bacteria grow?

Answer 41

slowly

Question 42

how does TB spread?

Answer 42

airborne droplets, gets to alveolus

Question 43

Mycobacterium tuberculosis is inhaled, then can be (3 options)

Answer 43

- cleared from body by macrophages, 90% - heal with scarring, Gohn focus lies dormant - primary progressive disease in immunocompromised

Question 44

primary TB reminds me of... because...

Answer 44

shingles, lies dormant and comes back when body is stressed

Question 45

the risk of TB reactivation is highest in the

Answer 45

first few years post infection

Question 46

prolonged exposure

Answer 46

increases risk and multiple aerosol inocula required

Question 47

brief contact with someone with TB carries

Answer 47

little risk

Question 48

infection is unlikely to occur outdoors as

Answer 48

aerosol disseminates

Question 49

fomites pose what level of risk?

Answer 49

not huge

Question 50

caseous necrosis is inherently unstable, especially in the lungs, where it tends to

Answer 50

liquify and discharge through bronchial tree, producing tuberculous cavity

Question 51

we should consider TB treatment initiation when we have a

Answer 51

positive AFB smear

Question 52

treatment should not be delayed because of ______ ___ _____ if there is high _____ ____

Answer 52

negative AFB smears, clinical suspicion

Question 53

high clinical suspicion includes (3)

Answer 53

history of cough/weight loss, CXR findings, emigration from high-incidence country

Question 54

label the 1st line TB drugs mechanism of action diagram

Answer 54

done

Question 55

first line drug treatments in TB are (6)

Answer 55

Isoniazid, Rifampin, Pyrazinamide, Ethambutol, Rifabutin, Rifapentine

Question 56

Isoniazid MOA

Answer 56

targets cell wall synthesis

Question 57

Rifampin MOA

Answer 57

inhibits RNA

Question 58

Ethambutol MOA

Answer 58

targets cell wall synthesis

Question 59

first 2 months of Tb treatment

Answer 59

rifamycin (or Rifampicin/Rifabutin) + isoniazid + pyrazinamide + ethambutol

Question 60

in the next 4-7 months after the first 2

Answer 60

rifamycin + iosoniazid

Question 61

in TB treatment we give a _____ supplement, e.g. ____

Answer 61

B6, pyridoxin

Question 62

rifampin turns bodily secretions _____, which is good for ______

Answer 62

orange, monitoring

Question 63

groups at increased risk for drug-resistance TB include (5)

Answer 63

- history of TB treatment - contact with person with drug-resistant TB - foreign-born persons from areas with drug-resistantTB - smears positive despite 2 months of drugs - inadequate treatment for >2weeks

Question 64

multi-drug resistant TB is defined as being resistant to (2)

Answer 64

isoniazid, rifampicin

Question 65

multi-drug resistant Tb can be due to (5)

Answer 65

poor compliance, single drug therapy, poor calculation, malabsorption, prescribing errors

Question 66

extensively drug resistant TB (XDR TB) is resistant to

Answer 66

any fluoroquinolone, at least one injectable second-line drug (capreomycin, kanamycin, amikacin), plus MDR-TB

Question 67

TB is the main opportunistic infection for

Answer 67

HIV positive patients

Question 68

look at the table and diagram of map TB

Answer 68

done