Tuberculosis

Question 1

Define Tuberculosis?

Answer 1

It is a serious chronic pulmonary and systemic disease caused most often by M. Tuberculosis

Question 2

Who discovered tuberculosis?

Answer 2

Dr. Robert Koch

Question 3

Describe the genus mycobacterium?

Answer 3

The genus mycobacterium are slender aerobic rods that grow in straight or branching chains

Question 4

Mycobacteria have a unique waxy cell wall composed of unusual glycolipids and lipids including ?

Answer 4

Mycolic acid

Question 5

Mycobacteria are acid-fast and weakly gram positive, true or false?

Answer 5

True

Question 6

Tuberculosis is the most common cause of death from infectious disease in the world, true or false?

Answer 6

False
Second-most common

Question 7

What is the reservoir for M. Tuberculosis?

Answer 7

Humans are the only reservoir.

Question 8

How can oropharyngeal and intestinal tuberculosis be contracted?

Answer 8

By drinking milk contaminated with Mycobacterium Bovis

Question 9

About the pathogenesis of M. Tuberculosis, It enters macrophages mediated by several factors expressed on the phagocyte, they include?

Answer 9

1. Mannose-binding lectin
2. CR3

Question 10

About the pathogenesis of M. Tuberculosis, replication takes place in macrophages by?

Answer 10

Inhibiting maturation of phagosome and formation of phagolysosome.

Question 11

About the pathogenesis of M. Tuberculosis, when does it occur in primary tuberculosis?

Answer 11

the first 3 weeks of infection (non-sensitized individuals)

Question 12

What happens 3 weeks post infection in tuberculosis?

Answer 12

Multiple pathogen associated molecular patterns of M. Tuberculosis, including lipoproteins and glycolipids are recognized by the innate immune receptors e.g. toll-like receptors like TLR2

This initiates and enhances the innate and adaptive immune responses to m. Tuberculosis

Question 13

About tuberculosis, Stimulation of TLR2 by mycobacterial ligands promotes production of …… by antigen presenting cells?

Answer 13

IL-12

Question 14

About tuberculosis, ……………… recognize peptides displayed by APC and the IL-12 secreted by them?

Answer 14

Naive CD4+ T-cells

Question 15

About tuberculosis, Naive CD4+ T-cells differentiates into?

Answer 15

TH1 subset

Question 16

About tuberculosis, TH1 cells secrete ………. Which activates………..?

Answer 16

IFN-gamma
Macrophages

Question 17

About tuberculosis, the ability of classically activated macrophages to phagocytose and kill microorganisms is markedly augmented by?

Answer 17

Maturation of phagolysosome in infected macrophages

Question 18

About tuberculosis, classically activated macrophages are altered by stimulation of inducible……?

Answer 18

Nitric oxide synthase

Question 19

About tuberculosis, classically activated macrophages are altered by expression of more …………. Molecules on their surface?

Answer 19

Class II MHC

Question 20

About tuberculosis, classically activated macrophages are altered by secretion of ….., ……… and ……… which promotes inflammation)

Answer 20

TNF
IL-1
Chemokines

Question 21

About tuberculosis, classically activated macrophages are altered by stimulating the formation of granuloma and ………….?

Answer 21

Caseous necrosis

Question 22

About tuberculosis and classically activated macrophages. macrophages activated by INF-gamma are transformed into …….. cells which aggregate to form ……..?

Answer 22

Epitheloid
Granulomas

Question 23

About tuberculosis and classically activated macrophages. Some epitheloid cells fuse to form giant cells of which type?

Answer 23

Langhan type

Question 24

Describe the fever in tuberculosis?

Answer 24

The fever is low grade and remittent (appearing each late afternoon and then subsiding) and night sweats.

Question 25

Systemic symptoms of tuberculosis are related to ……?

Answer 25

Cytokines released by activated macrophages e.g TNF and IL-1

Question 26

List the two pathophysiological types of clinical tuberculosis?

Answer 26

1. Primary (in non-sensitized individuals) 2. Secondary (in sensitized individuals)

Question 27

The source of infection in primary pulmonary TB is?

Answer 27

Exogenous

Question 28

Primary pulmonary TB resembles an acute bacterial pneumonia with ……?

Answer 28

Lobar consolidation Hilar adenopathy Pleural effusion

Question 29

In miliary tuberculosis, organisms draining through lymphatics may enter ?

Answer 29

The venous blood and circulate back to the lung.

Question 30

In miliary TB, describe the microscopic lesions?

Answer 30

1. Microscopic or small 2. Visible lesions (2 mm) 3. Foci of yellow-white consolidations scattered through the lung parenchyma

Question 31

In miliary TB, later consolidation of large regions or even…..?

Answer 31

Whole lobes of the lung will be involved

Question 32

With progressive pulmonary tuberculosis, the pleural cavity is invariably involved, list other findings?

Answer 32

1. Serous pleural effusion 2. Tuberculosis empyema or 3. Obliterative fibrous pleuritis

Question 33

When does systemic miliary tuberculosis occur?

Answer 33

When bacteria disseminates through the systemic arterial system

Question 34

Miliary TB is most prominent in what organs?

Answer 34

Liver Bone marrow Spleen Adrenals Meninges Kidneys Fallopian tubes Epididymis

Question 35

Secondary pulmonary TB may follow …?

Answer 35

Shortly after primary tuberculosis

Question 36

Secondary pulmonary TB occurs most often years after initial infection by?

Answer 36

Reactivation of latent infection or by exogenous re-infection

Question 37

Secondary pulmonary TB is characterized mostly by?

Answer 37

Cavitations in the apex of upper lobes and erosion of cavities into airways

Question 38

What is assman focus?

Answer 38

Cavitations in the apex of upper lobes and erosion of cavities into airways

Question 39

In secondary TB, with progressive pulmonary involvement, there is?

Answer 39

Increasing amounts of sputum, at first mucoid and later purulent

Question 40

Some degree of hemoptysis is present in about ….. of all cases of pulmonary TB?

Answer 40

Half

Question 41

How can CNS TB present?

Answer 41

With meningitis or intracranial tuberculomas

Question 42

How can abdominal TB present?

Answer 42

It includes peritonitis and TB of the GIT

Question 43

List the organs (in order) most commonly involved in disseminated TB?

Answer 43

Lungs Liver Spleen Kidneys Bone marrow

Question 44

What is Pott disease?

Answer 44

It is a presentation of extrapulmonary tuberculosis whereby disease is seen in the spinal vertebrae

Question 45

TB lymphadenitis is known historically as?

Answer 45

Scrofula or the kings evil (this refers to TH of the superficial lymphatics usually of the neck)

Question 46

How is TB diagnosed?

Answer 46

It is diagnosed by finding mycobacterium tuberculosis bacteria in a clinical specimen taken from a patient

Question 47

Which methods has the highest sensitivity for diagnosing and confirming TB?

Answer 47

Mycobacterial culture

Question 48

How long does mycobacterial culture require for interpretation?

Answer 48

2 - 6 weeks

Question 49

What other investigations can diagnose and confirm TB?

Answer 49

While other investigations may strongly suggest tuberculosis as the diagnosis, they cannot confirm it

Question 50

A complete medical evaluation for TB must include?

Answer 50

1. Medical history 2. Physical examination 3. Chest xray 4. Microbiological exam of sputum or some appropriate sample 5. Tuberculin skin test

Question 51

What stages of HIV infection are associated with an increased risk of tuberculosis?

Answer 51

All stages

Question 52

HIV-positive people have an increased frequency of …….?

Answer 52

False-negative sputum smears and tuberculin tests

Question 53

What is anergy?

Answer 53

Negative tuberculin test

Question 54

Particularly In the late stages of HIV, there is absence of???

Answer 54

Characteristic granulomas in tissues

Question 55

When is world TB day commemorated?

Answer 55

24th march each year