Lec 16 Extrapulmonary Tuberculosis Flashcards by Ron Michael Castillo

The most common misconception about the etiology of TB

A. bacteria
B. fatigue
C. smoking
D. alcohol
E. genetic

smoking

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Enumerate the 5 pillars of DOTS (Directly Observed Treatment, Short-Course)

quality-assured smear microscopy
uninterrupted supply of anti-TB drugs
directly observed treatment (DOT)
program and patient monitoring
political will

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The name of the UP TB DOTS clinic is

UP PRIME TB DOTS Clinic

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What is the meaning of PRIME?

PGH Responsive Integrated Multidisciplinary Enhanced

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Who is the head of UP PRIME TB DOTS?

Dr. Camilo Roa

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TB is spread internally through what route?

hematogenous and lymphatic

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Early caseous necrosis is first seen in what clinical stage of TB?

A. 1
B. 2
C. 3
D. 4a
E. 5

Stage 1: onset
Stage 2: symbiosis
Stage 3: early caseous necrosis
Stage 4a & 4b: interplay of cell-mediated immunity and tissue-damaging delayed-type hypersensitivity
Stage 5: liquefaction and cavity formation

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When is coughed sputum best collected?

early morning

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How many samples of AFB (+) sputum are needed to confirm diagnosis?

2 samples

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T/F: AFB smears are highly sensitive.

F, only 30-40% sensitive

40-50% in PGH due to immunofluorescence

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T/F: (+) AFB is diagnostic for Mycobacterium tuberculosis.

F, all acid-fast bacilli look alike

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What is the gold standard for TB diagnosis?

culture and identification of isolate

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True of TB culture EXCEPT

A. usually takes 2-4 weeks
B. signed out as negative until 6 weeks
C. ID based on biochemical tests
D. cannot distinguish among MTB complex
E. NOTA

Do not sign out as negative until 8 weeks.

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True of tuberculin skin test

A. (+) is not diagnostic of PTB
B. (-) excludes TB as possible diagnosis
C. AOTA
D. NOTA

(+) only SUPPORTS but not diagnostic
(-) result DOES NOT exclude TB

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T/F: Interferon Gamma Release Assay (IGRA) is diagnostic of TB.

F, for screening only

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ID: Newest TB test endorsed by WHO due to near 100% TB sensitivity and ~92% rifampicin resistance sensitivity.

Gene Xpert

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ID: Findings in chest X-ray of TB patient.

infiltrates, nodular densities, cavities, with or without hilar lymphadenopathy

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T/F: TB patients co-infected with HIV has higher load of bacteria.

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T/F: TB patients co-infected with HIV has higher transmission risk and more infectious than TB patients w/o HIV.

F, HIV patients may have lesser cavitations in the lungs (due to poor immune response)

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The standard regimen for TB is

HREZ x 2 months then HR x 4 months

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Which first line TB drug is bacteriostatic?

A. isoniazid
B. rifampicin
C. ethambutol
D. pyrazinamide

C. ethambutol

All of the first line TB drugs are metabolized in the liver EXCEPT

A. isoniazid
B. rifampicin
C. ethambutol
D. pyrazinamide

C. ethambutol (renally excreted)

ID: Hearing loss is an adverse effect of what 2nd line TB drug?

streptomycin

T/F: There are fewer problems with anti-TB drug toxicity in children.

MDR TB is resistant to what drug/s? ``` A. isoniazid B. rifampicin C. ethambutol D. pyrazinamide E. AOTA ```

A & B

ID: XDR TB is resistant to what drug/s?

fluoroquinolones and any second line TB injectable drugs (amikacin, kanamycin, capreomycin)

What is the most important risk factor for MDR TB? A. known contact with person proven with MDR TB B. prior TB treatment C. treated in program outside DOTS D. sputum smear (+) at 2 months of treatment E. co-morbidities (e.g. HIV)

B. any prior TB treatment

T/F: EPTB is usually less infectious than PTB.

T/F: There are more percent EPTB cases in PGH.

The most common site of EPTB ``` A. pleural B. lymphatic C. musculoskeletal D. genitourinary E. miliary ```

B. lymphatic

ID: Most fatal EPTB.

meningeal TB

Dr. Berba: What is the clinical implication of EPTB? A. The Mycobacteria causing EPTB syndromes are usually resistant and more difficult to treat. B. The Mycobacteria causing EPTB are usually more virulent so mortality rates are higher. C. EPTB is less infectious and thus less a public health concern. D. All EPTB should be treated for at least 12 months.

C. less infectious

Dr. Berba: What is the best practice to establish diagnosis of EPTB? A. sputum AFB B. tissue/fluid AFB smear and TB culture C. tissue/fluid AFB, TB culture, and histopathology D. serological tests for TB

What is the best practice of treatment for newly-diagnosed pleural EPTB? A. 2HRZE/4HR B. 2HRZE/4HRE C. 2HRZ/4HRE D. 2HRZE/6HE

A. same with PTB

Which EPTB are treated for more than 6 months?

CNS and MSK TB

True of TB lymphadenitis EXCEPT A. peak age shifted from children to 20-40 y/o B. Asians are among high risk groups C. involves neck lymph nodes D. with numerous pulmonary calcifications

D. LITTLE / FEW pulmonary calcifications

ID: TB lymphadenitis in the neck is more commonly known as what?

scrofula

T/F: Surgical incision and drainage of scrofula is recommended.

F Did not say why.

Most common site of musculoskeletal TB ``` A. lumbar vertebrae B. thoracic vertebrae C. knee D. hip E. muscle ```

A. lumbar vertebrae prevalence in same order as choices

Tuberculous spondylitis is also known as

Pott's disease

True of TB osteomyelitis EXCEPT A. painful B. prefers diaphysis C. single in adults D. may extend to joint

B It prefers METAPHYSIS

Most common sign and symptom of genitourinary tuberculosis. ``` A. microscopic hematuria B. sterile pyuria C. suprapubic pain D. urine pus cells E. testicular swelling ```

B. sterile pyuria painless frequent micturition is also common

T/F: Steroids may be used in TB pericarditis.

T. to dampen the inflammatory process

Most common site of gastrointestinal TB A. spleen B. liver C. stomach D. small intestine

B. liver

Cutaneous TB resulting from an endogenous source A. tuberculous chancre B. prosector's wart C. scrofuloderma D. lupus vulgaris

C. scrofuloderma A & B are exogenous D is hematogenous

ID: Predilection (location) of tuberculous meningitis.

base of the brain (high oxygen)

True of CSF analysis in CNS TB EXCEPT. A. elevated protein B. elevated glucose C. clear or slightly opalescent D. may be (+) AFB

B. There is LOW glucose.

T/F: Steroids may be used in TB meningitis.

T also true for TB pericarditis

A previously treated drug-susceptible TB with CNS involvement (TB meningitis) is classified as ``` A. Category I B. Category Ia C. Category II D. Category IIa E. Category III ```

D. IIa walang A = walang CNS or MSK involvement cat II = previously treated cat III = wala neto

MDR-TB is treated for at least how many months?

18 months