Mycobacteria

Question 1

Transmission of M. tuberculosis only occurs from a person with infectious, active TB disease (T/F)

Answer 1

True

Question 2

Risk of developing TB disease increases by ____% each year in HIV infection individuals

Answer 2

5-10%

Question 3

Signs of pulmonary TB include a chronic, productive cough for _______

Answer 3

> 2 weeks

Question 4

Advanced stages of pulmonary TB can cause ____ sputum

Answer 4

blood-tinged

Question 5

Groups that are not high risk for TB should not be tested routinely (T/F)

Answer 5

True

Question 6

Persons at higher risk for exposure to or infection with TB include:

Answer 6

Close contacts of a person known or suspected to have TB
Foreign-born persons from areas where TB is common
Residents and employees of high-risk congregate settings (ex. prisons)
Health care workers who serve high-risk clients
Medically underserved, low-income populations
High-risk racial or ethnic minority populations
Children exposed to adults in high-risk categories
Persons who inject illicit drugs

Question 7

For patients who are HIV positive, recent contacts of TB cases, have fibrotic changes on chest x-ray, or organ transplant/other immunosuppressed patients, the classifying tuberculin reaction is ____ mm

Answer 7

≥5 mm

Question 8

For recent arrivals from high-prevalence countries, injection drug users, residents and employees of high-risk congregate settings, children <4 years, the classifying tuberculin reaction is ___ mm

Answer 8

≥10 mm

Question 9

For persons with no known risk factors for TB, the classifying tuberculin reaction is ___ mm

Answer 9

≥15 mm

Question 10

Nontuberculous mycobacteria and/or BCG vaccination may result in a false-___ TST

Answer 10

false-positive

Question 11

Very young age (<6months), live-virus vaccination, overwhelming TB disease, and immunosuppression may results in a false-____ TST

Answer 11

false-negative

Question 12

TST is contraindicated for BCG-vaccinated persons (T/F)

Answer 12

False

Question 13

Boosting occurs for patients who do not respond to the initial skin test. The initial skin test may stimulate the body’s ability to react to TB

Answer 13

True

Question 14

People with LTBI may have a positive TST when tested years after infection (T/F)

Answer 14

False, LTBI patients may show a NEGATIVE TST when tested years after infection, which is why they require boosting

Question 15

IGRA are not approved for use in children ___ years old

Answer 15

<5 years old

Question 16

IGRA are accurate in persons recently exposed or immunocompromised patients (T/F)

Answer 16

False

Question 17

IGRA can differentiate between latent and active infection (T/F)

Answer 17

False

Question 18

IGRAs are more expensive than TSTs (T/F)

Answer 18

True

Question 19

Chest radiographs can confirm TB diagnosis (T/F)

Answer 19

False, cultures are the gold standard for confirming TB diagnosis

Question 20

___ sputum specimens for smear examination and culture should be obtained

Answer 20

3

Question 21

TB uses the _____ bacilli smear

Answer 21

acid-fast bacilli

Question 22

All specimens should be cultures, even if smears are negative (T/F)

Answer 22

True

Question 23

The Nucleic Acid Amplification Test (NAAT) is more sensitive and specific than AFB smears (T/F)

Answer 23

True

Question 24

You do not have to run a NAAT test if you get a positive smear (T/F)

Answer 24

False, you should run a NAAT test on at least one sputum culture

Question 25

NAAT results are available after: A. within hours to days B. in 10-14 days

Answer 25

A. within hours to days

Question 26

The molecular Detection of Drug Resistance (MDDR) test can be used to detect mutations frequently associated with _____ and _____ drug resistance

Answer 26

rifampin and isoniazid - if positive, the test will also detect resistance

Question 27

For patients whose initial evaluation suggests a liver disorder, have HIV, are either pregnant or in the immediate postpartum period (≤ 3 months), have a history of regular alcohol use, injection drug user, medications with possible interactions, you should run baseline _____ measurements for LTBI treatment

Answer 27

hepatic

Question 28

Preferred LTBI treatment that has moderate evidence for HIV + and _ patients: _____ + ______

Answer 28

isoniazid + rifapentine once weekly for 3 months

Question 29

Preferred LTBI treatment for HIV - patients only: _____

Answer 29

rifampin daily for 4 months

Question 30

Preferred LTBI treatment that has low evidence for HIV + and HIV- patients: _____ + ______

Answer 30

isoniazid + rifampin daily for 3 months

Question 31

LTBI patients receiving treatment should be evaluated every _____

Answer 31

month

Question 32

For active TB, a single drug should be added to a failing regimen (T/F)

Answer 32

False, usually 2 or more drugs are added

Question 33

1st line active TB therapy includes RIPE - what are the medications?

Answer 33

Rifampin 10 mg/kg daily, Isoniazid 5 mg/kg once daily, Pyrazinamide 20-25 mg/kg daily, Ethambutol 15-20 mg/kg daily

Question 34

Things to look out for regarding rifampin include

Answer 34

DDIs - CYP3A4 inducer Discoloration of secretions Hepatotoxicity

Question 35

Things to look out for regarding isoniazid include

Answer 35

Peripheral neuropathy

Question 36

This drug for active TB treatment is the most hepatotoxic

Answer 36

Pyrazinamide

Question 37

Which 2 active TB drugs require renal adjustments and also use lean body weight measurements?

Answer 37

Pyrazinamide and Ethambutol

Question 38

This drug for active TB treatment is the least hepatotoxic

Answer 38

Ethambutol

Question 39

This active TB drug can cause ocular toxicity (green color and visual acuity issues)

Answer 39

Ethambutol

Question 40

What is usually prescribed with isoniazid at 25-50 mg/day to help in malnourished patients or those prone to neuropathy?

Answer 40

Vitamin B6

Question 41

RIPE meds should be given with food because food increases absorption (T/F)

Answer 41

False, empty stomach because food decreases absorption

Question 42

The regimen for TB therapy includes: | RIPE for ___ months (initial phase), then rifampin + isoniazid for ___ months (continuation phase)

Answer 42

2 months, then 4 months

Question 43

In HIV- persons, regimen should be adjusted once drug susceptibility results are known: If isoniazid + rifampin susceptible, ____ can be dropped during the initial phase but ____ should be kept on for a total of 8 weeks

Answer 43

can drop ethambutol but should keep pyrazinamide for a total of 8 weeks

Question 44

In HIV+ persons who are not taking any protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs), they should be on ___-based regimens

Answer 44

rifampin (RIPE)

Question 45

In HIV+ persons who are receiving protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs), they should be given initial RIPE therapy with rifampin substituted with _____

Answer 45

rifabutin

Question 46

For pregnant women with TB, what is their treatment and what should be avoided?

Answer 46

9-month regimen of isoniazid, rifampin, and ethambutol. AVOID pyrazinamide

Question 47

Children with TB should be in most cases treated with the same regimen used for adults (T/F)

Answer 47

True

Question 48

Children with bone and joint TB, miliary TB, or TB meningitis should be treated for a minimum of ___ months

Answer 48

12 months

Question 49

The two most common resistant TB drugs are

Answer 49

isoniazid and rifampin

Question 50

If isoniazid resistant, what should replace it in the therapy?

Answer 50

discontinue isoniazid and add LEVOFLOXACIN. Continue regimen for the entire 6 months

Question 51

What kind of therapy should be considered for all patients to help with treatment adherence issues?

Answer 51

DOT (Direct Observed Treatment)

Question 52

How often should patients be monitored bacteriologically?

Answer 52

Monthly until cultures convert to negative

Question 53

After ___ months of therapy, positive cultures should be re-evaluated for resistance and/or nonadherence

Answer 53

2 months

Question 54

Patients are no longer infectious with TB if these 3 criteria are met:

Answer 54

They are on adequate therapy, have had a significant clinical response to therapy, have had 3 consecutive negative sputum smear results

Question 55

Slow growing non-TB mycobacterium (NTM) is what duration? Rapidly growing NTM is what duration?

Answer 55

Slow: >1 week Rapid: within 1 week

Question 56

The most common clinical presentation of NTM is pulmonary disease (T/F)

Answer 56

True, and often occurs when there is underlying structural airway disease

Question 57

Diagnosis of NTM includes pulmonary or systemic symptoms, nodular or cavity opacities on a CT scan, and positive culture results from at least ____ separate sputum samples

Answer 57

TWO

Question 58

There is a possibility that you may not treat NTM at all and instead, use the watch and wait method (T/F)

Answer 58

True

Question 59

NTM requires a longer treatment duration (T/F)

Answer 59

True, around 12 months