Tuberculosis

Question 1

What virus is contributing to the global rise of TB?

Answer 1

HIV

Question 2

What bacteria causes the tuberculosis disease?

Answer 2

Mycobacteria from the M.tuberculosis complex

Question 3

Name three bacteria in the Mycobacterium tuberculosis complex?

Answer 3

1. M.tuberculosis
2. M.bovis
3. M.africanum

Question 4

What does M.leprae cause?

Answer 4

Leprosy

Question 5

What infects cows and is killed by pasteurisation of milk?

Answer 5

M.bovis

Question 6

What does not cause TB outside of northwest africa?

Answer 6

M.africanum

Question 7

List 5 risk factors for tuberculosis

Answer 7

1. Contacts of patients with tuberculosis (smear positive)
2. Children with a positive skin test (Heaf) for tuberculosis
3. Immigrants from Africa and the Indian Subcontinent
4. Poverty and homelessness
5. HIV infection

Question 8

What is the primary test for TB?

Answer 8

PCR for MTB

Question 9

Name two other tests other than PCR for detecting TB

Answer 9

1. Microscopy for AAFB

2. Liquid culture for mycobacteria

Question 10

In the modern detection of tuberculosis - what is it critically important to get?

Answer 10

Tiisue diagnosis

Question 11

What 4 samples can you get for testing of TB?

Answer 11

Sputum
Bronchial washings
Pleural effusion
Cold abscess

Question 12

What does IGRA stand for?

Answer 12

Interferon Gamma Release Testing

Question 13

What is IGRA testing for TB?

Answer 13

Quantification of how much Gamma-interferon is released from circulating T-lymphocytes in response to specific stimuli.

Question 14

Name two antigens from M.tuberculosis

Answer 14

ESAT-6

CFP-10

Question 15

What only determines if the patient has T-lymphocytes primed to respond to MTB stimulus?

Answer 15

IGRA testing for TB

Question 16

What 3 states of TB will test positive with IGRA testing?

Answer 16

Current TB
Previous, treated TB
Latent TB

Question 17

Name a reportable illness?

Answer 17

Tuberculosis

Question 18

Who must be informed of any case of highly suspected TB and confirmed cases of TB?

Answer 18

Public health

Question 19

Are patients with ‘open TB’ contagious?

Answer 19

Yes - smear positivity

Question 20

Can patients with ‘open TB’ be detained in hospital until they no longer have ‘open TB’?

Answer 20

Yes

Question 21

Can you force patients to take TB treatment?

Answer 21

No

Question 22

What does modern management of tuberculosis start with?

Answer 22

4 Antituberculosis drugs

Question 23

What are the 4 antituberculosis drugs?

Answer 23

Rifampicin (R)
Isoniazid (H)
Pyrazinamide (Z)
Ethambutol (E) (15mg/kg body weight)

Question 24

For respiratory and non-respiratory TB patients - describe the initial and continuation phase of treatment (including drugs and timeframe)

Answer 24

Initial phase: 2 months (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) 2RIPE

Continuation phase: 4 months (Rifampicin and Isoniazid) 4RI

Question 25

For meningitis/CNS TB what is the treatment? (Including initial phase and continuation phase)

Answer 25

Initial phase: 2 months (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) *2RIPE* Continuation phase: 10 months (Rifampicin and Isoniazid) *10RI*

Question 26

What does modern management of tuberculosis prevent?

Answer 26

Multi-drug resistant tuberculosis

Question 27

To preveny multi-drug resistant tuberculosis what 3 steps are taken?

Answer 27

1. In vitro drug susceptibility testing on all isolates 2. Initial treatment of 4 drugs to cover unsuspected resistance 3. If compliance is a problem, in underdeveloped contries use Directly Observed Therapy Short-Course (DOTS)

Question 28

What is the term for a responsible observer administering the drugs and observing ingestion of the drugs, ensuring compliance?

Answer 28

Directly Observed Therapy Short Course (DOTS)

Question 29

Name three adverse drug reactions of Isoniazid

Answer 29

1. Hepatitis 2. Cutaneous hypersensitivity 3. Peripheral neuropathy (Vit B6 co-factor)

Question 30

Give 4 adverse side effects of Rifampicin

Answer 30

1. Hepatitis 2. Cutaneous reactions 3. GI upset 4. Febrile reactions/flu syndrome

Question 31

Give 5 adverse reactions of pyrazinozide

Answer 31

1. Anorexia and vomiting 2. Flushing 3. Hepatitis 4. Hyperuricaemia 5. Arthralgia

Question 32

Give 2 adverse effects of ethambutol

Answer 32

1. Retrobular neuritis (colour vision at first) | 2. Arthralgia

Question 33

In the UK is latent TB treated?

Answer 33

No, transmission rates are low

Question 34

What four drugs would you use to treat latent TB prior to immunosuppressive therapy?

Answer 34

Infliximab Etanercept Adalimumab Rituximab

Question 35

If treating latent TB, after initial 4 drug treatment what do you give three months of?

Answer 35

Isoniazid and Rifampicin

Question 36

Which type of drug resistant TB is resistant to first line therapy?

Answer 36

MDR-TB

Question 37

Which type of drug resistant TB is resistant to second line therapy?

Answer 37

XDR-TB

Question 38

Name 4 drugs XDR-TB is resistant to?

Answer 38

Isoniazid Rifampicin Fluoroquinolones Injectables - amikacin, capreomycin, kanamycin

Question 39

Name two drugs MDR-TB is resistant to?

Answer 39

Isoniazid | Rifampicin

Question 40

In what 3 types of patients should you suspect TB?

Answer 40

1. Returning travellers 2. Immunocompromised patients 3. Non-resolving pneumonia patients

Question 41

Where are most TB cases?

Answer 41

India and China