Nelson Ch. 215 Flashcards Preview

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Flashcards in Nelson Ch. 215 Deck (52):
1

Specialized culture medium for M. tuberculosis

Lowenstein-Jensen

2

Lowenstein-Jensen: Carbon source

Glycerol

3

Lowenstein-Jensen: Nitrogen source

Ammonium salts

4

Hallmark of all mycobacteria

Acid fastness

5

Capacity to form stable mycolate complexes with aryl methane dyes and resist decoloration with ethanol and hydrochloric acids

Acid fastness

6

Hallmark of latent Tb

Reactive tuberculin test and absence of clinical and radiographic manifestations

7

Primary complex or Ghon complex is the combination of

1) Parenchymal pulmonary lesion 2) Lymph node site

8

PTb that occurs >1 year after the primary infection, usually caused by endogenous REGROWTH of bacilli persisting in partially encapsulated lesions

Reactivation Tb

9

MC form of reactivation Tb

Infiltrate or cavity in the apex of the upper lobes, where O2 tension and blood flow are great

10

MC result of female genital tract Tb

Infertility

11

Reason why congenital Tb is rare

Because MC result of female genital tract Tb is infertility

12

MC infectious route of neonatal Tb infection

POSTNATAL airborne transmission from adult with infectious PTb

13

Conditions that adversely affect ___ immunity predispose to progression from Tb infection to disease

Cell-mediated

14

TST is what type of hypersensitivity

Delayed type or Type IV

15

Approximately ___% of infants who receive a BCG vaccine never develop a reactive TST

50

16

Usually, reactivity to TST of infants who receive a BCG vaccine wanes in ___ years

2-3

17

Most crucial risk factor for development of tuberculosis in children

Possible exposure to an adult with or at high risk for infectious PTb

18

Preferred test in determining patient's T cell response to specific M. tb antigens in cases where specificity is important as in patients who received a BCG vaccination

IFN-γ release assays

19

Hallmark of primary PTb

Relatively large size of regional lymphadenitis compared with relatively small size of the initial lung focus

20

Sequence of primary PTb lesion

Hilar lymphadenopathy > focal hyperinflation > atelectasis (collapse-consolidation) or segmental tuberculosis

21

The presence of calcification implies that a Tb lesion has been present for at least ___

6-12 months

22

MC symptoms of pulmonary tuberculosis

Nonproductive cough, mild dyspnea, and CLADs

23

Reactivation Tb or Chronic PTb is uncommon in this age group

Healed Tb infection acquired less than 2 years

24

Reactivation Tb or Chronic PTb is more common in those who acquire the initial infection > ___ years of age

7

25

MC pulmonary sites of reactivation Tb

1) Original parenchymal focus 2) Lymph nodes 3) Apical seedings

26

Apical seedings of Tb established during the hematogenous phase of the early infection

Simon foci

27

MC radiographic presentations of reactivation Tb

Extensive infiltrates or thick-walled cavities in the upper lobes

28

Pleural fluid findings in tuberculous pleurisy (6)

1) Yellow 2) SG 1.012-1.025 3) Protein 2-4 g/dL 4) Glucose low to normal (20-40 mg/dL) 5) Hundreds to thousands of WBCs per mm3 with early predominance of PMNs followed by a high percentage of lymphocytes 6) AFB RARELY POSITIVE

29

MC form of cardiac Tb

Tb pericarditis

30

Most clinically significant form of disseminated Tb

Miliary Tb

31

MC form of extra pulmonary Tb in children

Scrofula or Tb of the SUPERFICIAL LNs

32

Scrofula: Unilateral vs Bilateral

Unilateral

33

Most serious complication of Tb in children

Tb of the CNS

34

Tb of the CNS: Often the site of greatest involvement

Brainstem

35

3 stages of CNS Tb

St 1 (stage of irritability) - nonspecific, St 2 (pressure or convulsive stage) - generalized and focal neurologic signs, St 3 (paralytic or terminal stage) - Coma, hemiplegia or paraplegia, hen, decerebrate posturing, deterioration of vital signs and death

36

Most important lab test for diagnosis of Tb men

CSF studies

37

CSF findings in Tb men

1) WBC 10-500 cells/mm3 with PMNs predominant in the early phase and lymphocytes later in the disease process 2) CSF glucose less than 40 but rarely less than 20 mg/dL 3) Protein markedly high 400-5000 mg/dL

38

Brain CT or MRI findings in Tb meningitis

1) Basilar enhancement 2) Communicating hcp 3) Cerebral edema 4) Early focal ischemia

39

MC location of brain tuberculoma in children

Infratentorial or at the base of brain near the cerebellum

40

Classic manifestation of Tb spondylitis

Pott's disease

41

Tb enteritis usually involves

Jejunum and ileum near Peyer patches and the appendix

42

Standard therapy for intrathoracic Tb in children

2 HRZE, 4 HR

43

Adverse reactions to commonly used Tb drugs: Ethambutol

1) Reversible optic neuritis 2) Decreased red-green color discrimination 3) GI disturbances 4) Hypersensitivity

44

Adverse reactions to commonly used Tb drugs: INH

1) Hepatitis 2) Peripheral neuritis 3) Hypersensitivity 4) Optic neuritis

45

Adverse reactions to commonly used Tb drugs: Pyrazinamide

1) Hepatotoxicity 2) Hyperuricemia 3) Arthralgias 4) GI tract upset

46

Adverse reactions to commonly used Tb drugs: Rifampin

1) Orange discoloration of secretions 2) Vomiting/GI intolerance 3) Hepatitis, increased if given with INH 4) Influenza-like reaction 5) Thrombocytopenia 6) Pruritus 7) Oral contraceptives may be ineffective

47

Duration of treatment for bone and joint, disseminated and CNS Tb

9-12 months

48

Interaction of some antiretrovirals and rifampin

1) Subtherapeutic blood levels of protease inhibitors and non-nucleoside reverse transcriptase inhibitors 2) Toxic levels of rifampin

49

Corticosteroids are beneficial in patients with what types of Tb

1) Meningitis 2) Endobronchial 3) Acute tb pericardial effusion 4) Miliary tb

50

Highest priority of any Tb control program

Case finding and treatment

51

Official recommendation of WHO for BCG in high risk Tb populations

Single dose BCG during infancy

52

Best use of BCG vaccination

Prevention of life-threatening forms of Tb in infants and young children