Tuberculosis

Question 1

What is the causative organism for TB?

Answer 1

Mycobacterium tuberculosis

Question 2

What population is mainly affected by TB?

Answer 2

Adults >65
HIV
Foreign born

Question 3

Define primary TB

Answer 3

Limited to no clinical symptoms
Limited infection and spread of the disease

Question 4

Describe progressive primary TB

Answer 4

Inadequate immune response to contain the primary infection
Spreads more easily

Question 5

Latent TB definition

Answer 5

Do not have active disease
Cannot transmit

Question 6

Active TB definition

Answer 6

Reactivation of the disease, latent not adequately treated
Contagious

Question 7

Describe the transmission of TB

Answer 7

Droplet, aerosolized by coughing, sneezing, or speaking, those with AFB are even more contagious

Question 8

S/S of TB

Answer 8

Fever, night sweats, chills, weight loss, anorexia, general malaise, weakness
Hemoptysis
Pleuritic chest pain and dyspnea (ARDS)
Anemia, leukocytosis, thrombocytosis, ESR, and CRP, hyponatremia

Question 9

Describe TB lymphadenitis

Answer 9

Most common presentation in HIV patients
Lymph nodes matted no tender mass
Diagnosis established by FNA biopsy.

Question 10

How to manage pleural effusions in TB patients, describe the fluid including color, protein concentration, glucose, pH

Answer 10

Thoracentesis
Pleural fluid straw colored
Protein concentration >50%
normal to low glucose
Ph 7.3
AFB

Question 11

What bones are most commonly involved in skeletal TB and how to manage it

Answer 11

Lower thorasic and upper lumbar vertebra
If paraparesis present then rapid surgical drainage is needed,
Synovial fluid will be high in protein concentration

Question 12

TB meningitis s/s and diagnostics

Answer 12

S/S: headache, AMS, low grade fever, malaise, anorexia, irritability, confusion, lethargy, neck rigidity
Diagnostics: LP (CSF high lymphocytes, low glucose), CSF culture GOLD STANDARD

Question 13

Pericardial TB s/s and diagnostics

Answer 13

Develops mostly with HIV patients
S/S: subacute with dyspnea, fever, dull retrosternal pain, and pericardial friction
Diagnostics: Pericardiocentesis: Exudative, high lymphocytes, high monocytes, biopsy yields Mycobacterium TB

Question 14

Genitourinary TB UA results and s/s

Answer 14

UA: negative pyuria in acidic urine, hematuria
S/S: urinary frequency, dysuria, nocturia, hematuria, and flank pain, calcifications

Question 15

TB diagnostics

Answer 15

CXR: high sensitivity, poor specificity
CX: 3 separate specimens
X pert MTB/RIF assay: detects TB and rifampin resistance

Question 16

TB treatment plus durations

Answer 16

6 months total
First 2 months: Isoniazid, Rifampin, Pyrazinamide, Ethambutol
4 Months: Isoniazid, Rifampin

Question 17

Treatment of TB if resistant to rifampin

Answer 17

Bedaquiline and Delamanid