TB and non-TB mycobaterium Oct18 M1

Question 1

TB examples of symptoms

Answer 1

fever, cough, minimal sputum

Question 2

TB CXR finding

Answer 2

• opaque -abnormality
• blunting of costophrenic angle
• straight line at bottom of lung (air-fluid interface)

Question 3

what can counfound TB with

Answer 3

lung abcess

Question 4

easy test for TB detection + gold standard

Answer 4

sputum analysis for acid-fast smear microscopy and culture

Question 5

strongly positive smear for TB: what’s the diagnosis

Answer 5

active contagious pulmonary TB

Question 6

TB level of contagion

Answer 6

highly contagious

Question 7

2 evolving challenges with TB today

Answer 7

Global phenomenon (migration)
Increasing antibiotic resistance

Question 8

mycobacterium TB description

Answer 8

Aerobic slightly curved rod

Question 9

mycobacterium TB: mechanism to survive certain conditions

Answer 9

survives in dormant state if adverse conditions (low oxygen, dry)

Question 10

best conditions for TB growth and what it explains

Answer 10

high oxygen tension. explains why lung apices affected

Question 11

TB physical protection it has

Answer 11

thick waxy outer layer (cell wall): protects from light, heat, dryning. + gives acid fast property

Question 12

TB hosts known

Answer 12

humans only

Question 13

TB transmission routes

Answer 13

airborne only

Question 14

how to evaluate prob of inhaling TB

Answer 14

proportional to its conc. in air (essentially prob of inhaling a viable bacterium)

Question 15

how to evaluate conc. of TB in air (2)

Answer 15

1) volume of air it’s diluted in (inside vs outisde, room size)
2) production vs elimination (ventilation. sunlight and drying kills it)

Question 16

contagious TB CXR findings and smear findings

Answer 16

Cavities

AFB smear positivity

Question 17

why TB prevalent in Inuit communities and northern Qc communities

Answer 17

Lot of people live in same house, no ventilation, isolation. higher TB conc. in air

Question 18

primary infection def

Answer 18

when exposure to TB results in new infection

Question 19

how good body responds to primary infection

Answer 19

initial immune response is highly ineffective

Question 20

what determines if exposure results in new infection or no infection

Answer 20

innate immunity

Question 21

1st phase of progression of TB and length

Answer 21

local alveolus (1-2 weeks)

Question 22

2nd phase of progression of TB and length

Answer 22

TB drains/spreads to regional lymph nodes (2-4 weeks)

Question 23

3rd phase of progression of TB and length

Answer 23

Hematogeneous dissemination (4+ weeks)

Question 24

what kind of immunity against TB

Answer 24

cell mediated (not humoral) (T cells)

Question 25

result of immune reaction to TB (on microscopy what we see)

Answer 25

hard shells called granulomas

Question 26

what determines if disease will develop or become dormant after primary infection

Answer 26

the development of effective cell mediated immunity

Question 27

who is most likely to get developing TB after primary infection

Answer 27

Young people, immunosuppressed, comorbidities, HIV

Question 28

when effective cell mediated immunity to TB is developed

Answer 28

4-7 weeks after initial infection

Question 29

if CMI defective, when TB becomes symptomatic

Answer 29

3-6 months after primary infection

Question 30

TB risks 2 things to note if primary infection occured

Answer 30

1) More likely to get disease if young but less likely to get disease than not get it overall 2) infants vulnerable to severe TB (disseminated TB or TB meningitis)

Question 31

what we mean by latent, dormant TB

Answer 31

contained in granulomas but keeps fighting to get out. Active immune response

Question 32

how latent TB infection diagnosed **LATENT**

Answer 32

immune tests based on the cell immunity to TB

Question 33

strongest risk factor for dev active TB

Answer 33

HIV/AIDS

Question 34

risk factor of importance for active TB

Answer 34

time since infection. (greater risk in 1-2 years aftrer infection)

Question 35

granuloma: what happens when active TB

Answer 35

hard shell breaks down and tubercle escapes and multiplies

Question 36

when latent TB, risk for active TB if have no risk factor

Answer 36

10% over lifetime

Question 37

when latent TB, risk for active TB if infected with HIV

Answer 37

7-10% per year

Question 38

why younger children more at risk to progress to active TB

Answer 38

immature immune system

Question 39

symptoms of active TB

Answer 39

fever, nigh sweats, cough, sputum, hemoptysis if advanced, lymph node,

Question 40

3 tests for active TB

Answer 40

microscopy (look for acid fast org) culture (gold standard) nucleic acid amplification

Question 41

what tests have no utility to detect latent TB

Answer 41

cultures, chest X ray, all routine tests (smear, nucleic acid amplif.)

Question 42

2 tests for latent TB

Answer 42

immune based: Tuberculin Skin Test (Purified protein derivative or PPD) IF gama release assays (IGRAs)

Question 43

TB treatment: what

Answer 43

2-4 drugs (if 1, TB develops resistance)

Question 44

TB treatment: how long

Answer 44

minimum 6 months

Question 45

3 TB drugs

Answer 45

isoniazid (INH), rifampin (RIF), pyrazinamide (PZA)

Question 46

TB treatment if latent: what

Answer 46

1 drug: no risk of drug resistance

Question 47

serious adverse effect to consider in TB treatment

Answer 47

liver toxicity

Question 48

how TB incidence changing in Canada vs in Inuit communities precisely

Answer 48

decreasing overall | increasing in Inuit communities

Question 49

why Inuit have high incidence of TB

Answer 49

housing conditions, smoking, diabetes, genetic factors, history of colonization and role of TB

Question 50

most important causes of TB worlwide

Answer 50

HIV, smoking and alcohol, malnutrition, chronic illnesses (e.g. diabetes)

Question 51

T-F: TB deaths started declined after first treatment

Answer 51

False, already in decline before

Question 52

non-tuberculous mycobacteria definition

Answer 52

all mycobacteria except mycobacteria TB and mycobacteria leprae

Question 53

T-F: TB infection must be reported toauthorities

Answer 53

True

Question 54

main diff between TB and non-TB mycobacterium

Answer 54

non-TB mycobacterium is not contagious

Question 55

non-TB myco that is most associated with human disease in Canada

Answer 55

mycobacterium avium

Question 56

non-TB myco symptoms and chest X ray

Answer 56

symptoms: cough, sputum, weight loss CXR: nodular infiltrates associated with bronchiectasis cavitary lung disease (mimics TB)

Question 57

non-TB myco treatment

Answer 57

No treatment if simply found in sputum