Tuberculosis

Question 1

infected by aerosolized and inhaled particles (few needed) that enter the alveoli and are eaten by macrophages

Answer 1

Mycoplasma tuberculosis

Question 2

Reactivation of TB usually occurs within what time frame of the primary infection?

Answer 2

2 or more years

Question 3

What type of organism is TB

Answer 3

acid fast bacilli

Question 4

Where will TB be most obvious on a CXR?

Answer 4

Apex of the lungs under the clavical(s)

Question 5

What is the most common finding in active TB

Answer 5

Cavitated lesions

Question 6

What induration diameter represents a positive TB skin test in a patient with no exposure HX and low risk?

Answer 6

> 15mm

Question 7

What TB skin test induration is POSITIVE in a PT who is either HIV+, has recent TB contact, fibrotic CXR findings, is immunocompromised, or on prednisone

Answer 7

> 5mm

Question 8

An TB skin test induration of what size is positive in a patient with IV drug use, resident in crowded setting, hospital worker, or immigrated from high TB prevalence country in last 5 years?

Answer 8

> 10mm

Question 9

In the 2-step TST procedure, if a person comes back with an initial positive skin test, the next step is ?

Answer 9

Evaluate for latent TB and treat accordingly

Question 10

In the 2-step TST procedure, if a person comes back with an initial Negative skin test, what are the next steps?

Answer 10

Do a second TB skin test 1-3 weeks later
-If 2nd test negative repeat test at regular intervals if suspected but they probably don’t have TB
-If 2nd test is positive, the person has latent TB and you should treat if needed

Question 11

What is the main adverse reaction for pyrazinamide?

Answer 11

Increased uric acid - be cautious in gout patients

Question 12

Peripheral neuropathy is an adverse effect of what TB medication, and what do you need to ensure the patient is taking to avoid this?

Answer 12

Isoniazid; Give B-6 or Pyridoxine at 25mg/day

Question 13

Hepatitis is an adverse reaction of what three TB drugs?

Answer 13

Isoniazid, pyrazinamide, and rifampin

Question 14

Which TB drug can cause orange urine and sweat?

Answer 14

Rifampin

Question 15

The Intensive Phase of TB treatment lasts how long and includes what drugs for treatment?

Answer 15

2 months; RIPE - all four drugs

Question 16

Continuation Phase of TB treatment lasts how long and includes how many drugs to treat?

Answer 16

4-7 months; Rifampin and Isoniazid (only 2 drugs)

Question 17

What are the goals for treatment of latent TB?

Answer 17

-Controlling, eliminating TB
-Reducing the risk that latent TB will progress to active TB (contagious form)

Question 18

Patients with this type of TB don’t have active disease and cannot transmit to others

Answer 18

Latent TB

Question 19

If a patient has latent TB and is not given preventive drug therapy, they can develop what type of TB?

Answer 19

Active (spreadable)

Question 20

HIV infection, use of corticosteroids, and use of immunosuppressive drugs can cause ______ in patients with latent TB

Answer 20

Reactivated TB (where it is spreadable) (Reactive TB - this is more of a verb to describe TB going from latent to Active)

Question 21

HIV infection, use of corticosteroids, and use of immunosuppressive drugs can cause ______ in patients with latent TB

Answer 21

Reactivated TB (where it is spreadable) (Reactive TB - this is more of a verb to describe TB going from latent to Active)

Question 22

In 5% of patients, the immune response is inadequate to contain the primary infection and they get?

Answer 22

Progressive primary TB; The clinical presentation can look similar to reactivated TB

Question 23

Slowly progressive SX of malaise, weight loss, fever, night sweats, chronic cough

Answer 23

Presentation of active TB

Question 24

For latent TB, what drug(s) are used for treatment and what is the normal duration of treatment?

Answer 24

-isoniazid and rifapentine taken once weekly for 12 weeks

-Can give Rifampin alone, once once a day for 4 months

-Can give Isoniazid alone twice daily for 9 months

Question 25

What are the indications for treating an active TB patient for the full 7 months (as opposed to only 4) in the continuation, or 2nd phase?

Answer 25

Cavitary lesions on CXR & positive sputum culture at the end of the initial phase (2 months)

-You were unable to use pyrazinamide in the first phase

Question 26

What are the different stages of TB and their characteristics?

Answer 26

1. Primary TB: asymptomatic and CXR normal
2. Latent TB: been infected but immune response has captured and held infection inside granulomas so it cannot spread
3. Active (or reactivated) TB: Signs on CXR; will present with physical SX; can spread TB to others
4. Primary progressive TB: when immunocompromised patients get TB; have signs and SX; can spread TB to others