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clin med pulmonology > TB > Flashcards

TB Flashcards

1
Q

What is the most common presentation of TB

A

pulmonary disease (arguably most concerning)

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2
Q

Which patient population is particularly vulnerable to death from TB

A

HIV patients

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3
Q

Is TB gram negative or gram +

A

Neither… “ghost cell”
*weakly positive sometimes seen on gram stain

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4
Q

What allows for TB to have such high infectivity

A

High lipid content of cell wall allows it to survive under extreme conditions

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5
Q

What are major risk factors for TB

A

Socio-economic factors
Immunosuppression
Occupation (mining/ construction)

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6
Q

How is TB spread

A

inhalation of infected aerosolized droplets

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7
Q

Who can spread TB

A

Only those with active TB
-spread via cough, speaking, or singing

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8
Q

What determines whether a person who comes in contact with TB can fight it off

A

Persons immune status
Genetic factors
Primary vs. secondary exposure

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9
Q

What are first line TB medications

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol
rifapentine

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10
Q

What are second line TB medications

A

Streptomycin
Amikacin
Levofloxacin

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11
Q

What meds are used with MDR-TB

A

Linezolid
Pretomanid
Bedaquiline
Delamanid

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12
Q

What type of organism is TB

A

alcohol and acid-fast bacillus

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13
Q

If a patient is prescribed isoniazid, what also needs to be prescribed

A

pyridine (Vitamin b-6)

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14
Q

What are the side effects of rifampin

A

orang discoloration of body fluids

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15
Q

What are the side effects of isoniazid

A

AST/ALT elevations, clinical hepatitis, peripheral neurotoxicity

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16
Q

What are the side effects of Pyrazinamide

A

Hepatotoxicity
polyarthralgias
acute gout
rash
photosensitive dermatitis

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17
Q

What is a major cause of TB becoming drug resistant

A

failure to complete full course of treatment

18
Q

Where does primary TB usually settle in the lungs

A

middle portion (Ghon focus of primary TB)

19
Q

What is the only form of TB that is contagious

A

pulmonary

20
Q

What does Ghon focus TB do

A

enter latent phase

21
Q

If a patient develops the active disease after the first TB exposure, what kind of disease do they have

A

Primary progressive TB
Active TB

22
Q

What will be seen on CXR with primary TB

A

Middle lung zones but lacks marked tissue damage or cavitation

23
Q

What are cavitation lesions in the lungs

A

Granuloma: an aggregation of multinucleate giant cells surrounding mycobacterium particles

24
Q

What is the diagnostic histopathological hallmark of TB

A

Granulomatous

25
Q

What causes the granuloma to look cheese-like

A

mycotic acid concentration in the cell walls

26
Q

What is caveating necrosis

A

central area of eosinophilia

27
Q

Where does most of TB in the US come from

A

untreated latent TB infections

28
Q

What is secondary TB

A

People who develop TB after a long latency period

29
Q

What will a CXR look like on secondary TB

A

lesions in lung apices and cavitation

30
Q

What are symptoms of active TB

A

cough for a minimum of 3 weeks
pleuritic pain
hemoptysis
nocturnal sweating
no appetite

31
Q

What is military TB

A

Pulmonary or systemic dissemination of tubercles in active disease

CXR: millet shaped lesions

32
Q

What is disseminated TB

A

may also be seen in the spine, CNS or bowel

33
Q

When is IGRA TB test preferred

A

If BCG vaccine has been revieved
Unable to make second TST appt.

34
Q

What is high priority for TB treatment

A

Postive IGRA

positive TST >5mm & immunosuppressed, recent TB contact, fibrotic CXR changes

Positive TST >10mm & from endemic area, recent TB contact, kids<4y/o

35
Q

What is the preferred TB test for children <5

A

PPD

36
Q

What are the common latent TB treatment regimens

A

1) isoniazid + rifapentine 1/wk x3mo

2) Rifampin 1/day x4months

3)Isoniazid + rifampin 1/day x 3mo

37
Q

What TB treatment have lower risk for hepatotoxicity

A

Shorterrifampin treatment

38
Q

What are differentials. for TB

A

pneumonia
malignancy
non-TB mycobacterium
fungal infections
histoplasmosos
sarcoidosis

39
Q

Who should NOT have RPT-MOX treatment regimen for TB

A

<12 y/o
<40kg
pregnant or breast feeding
prolonged QT syndrome
known/suspected drug resistance

40
Q

What TB treatment is category A for pregnancy

A

isoniazid

clin med pulmonology (12 decks)

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