PPS Tb Guidelines Flashcards Preview

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Flashcards in PPS Tb Guidelines Deck (60):
1

MDR-Tb

Resistant to at least isoniazid and rifampin

2

XDR-Tb

Resistant to HR + Fluoroquinolone + at least 1 second-line injectable agent (amikacin, kanamycin, and/or capreomycin)

3

Primary mode of transmission of Tb bacilli

Airborne droplet nuclei

4

Tb transmission from children aged less than ___ is rare, since most children cannot expectorate sputum

10

5

Associated with virulence of Tb bacilli

1) Trehalose dimycolate (cord factor) 2) Sulfatides

6

Responsible for morphologic appearance of cell serpentine cords of Tb bacilli in close, parallel arrangements

Cord factor

7

Peripherally located glycolipids that inhibit fusion secondary lysosomes with Tb bacilli-containing phagosomes within a macrophage, possibly promoting INTRACELLULAR SURVIVAL of the organisms

Sulfatides

8

Gold standard for diagnosis of Tb

Demonstration/isolation of the organism by culture

9

Doubling time of Tb bacilli

18-24 hours

10

Cells responsible for containment of Tb bacilli as local pulmonary infiltrates and hilarity adenopathy

Th1 cells

11

Progression from Tb infection to Tb disease occurs in ___% of affected individuals

10

12

Key risk factors for Tb (4)

1) Household contact with a newly diagnosed smear (+) case 2) Age less than 5 years 3) HIV infection 4) Immunocompromised state

13

Size of the infective droplet nucleus of Tb

5 micra

14

5 stages of pulmonary pathology of Tb

1) Scavenging non activated alveolar macrophages digest tb bacillus 2) (Symbiosis) Macrophage fails to destroy the bacillus undergoing replication destroying the macrophage; other macrophages are attracted leading to development of GRANULOMA 3) Increase in number of tubercle bacilli inhibited by development of CELL-MEDIATED IMMUNITY and DELAYED-TYPE HYPERSENSITIVITY 4a) Enlargement of tubercle and its caseous center with hematogenous spread in weak immunity 4b) Stabilization or regression of tubercle in hosts with strong immunity 5) CASEOUS CENTER LIQUEFACTION, extracellular bacillary growth, cavity formation, and bronchial dissemination

15

Lung lesion of primary Tb

Ghon focus

16

Most frequent site of scrofula

Nodes in the ANTERIOR TRIANGLE of the neck

17

MCC of mortality from Tb in children below 3 years of age

Tb meningitis

18

T/F Tb men is ALWAYS secondary to a tuberculous process elsewhere in the body

T

19

Tb of the long bones usually start as

Area of endarteritis in the metaphysis of the long bone

20

Pott's disease has a predilection for

Lower thoracic, upper lumbar and lumbosacral vertebrae

21

Tb of the joints is rare in children; it has a predilection for

Joints of the upper extremities with monoarticular involvement

22

Initial radiographic picture of primary tb

Parenchymal infiltration accompanied by ipsilateral LN enlargement

23

LN in this area appear to be the ones most often affected in Tb lymphadenopathy

Right upper paratracheal area

24

Why the right upper paratracheal LN are most often affected in Tb lymphadenopathy

Lymphatic drainage of the lungs occurs predominantly from left to right

25

Radiologic finding that clearly differentiates primary from post primary/reactivation tb

Hilar or paratracheal LN enlargement

26

MC radiographic manifestation of reactivation pTB

Focal or patchy heterogeneous calcification in the apical and posterior segments of the upper lobes and superior segments of the lower lobes

27

Radiologic hallmark of reactivation TB

Cavities

28

Phemister triad

1) Juxtaarticular osteoporosis 2) Peripherally located osseous erosions 3) Gradual narrowing of interosseous space

29

What is the Phemister triad

Characteristic radiologic finding in tuberculous arthritis

30

Most specific finding in diagnosis of CNS Tb

Basal cistern hyperdensity

31

MC complication of TB meningitis

Communicating hcp

32

Vaccine category that may suppress tuberculin reaction

Live virus vaccine

33

DOH HTP recommends that TST be delayed for ___ after a bout of measles, mumps, chicken pox, or whooping cough

2 months

34

An induration of ___ is considered a (+) TST

≥10 mm

35

An induration ≥5mm is considered a positive TST in the presence of

1) History of close contact with a known or suspected infectious case of TB 2) Clinical findings suggestive of Tb 3) CXR suggestive of TB 4) Immunocompromised condition

36

Clinical manifestations which, when taken together, are most suggestive of childhood Tb disease

History of recent weight loss or failure to gain weight

37

Spectrum of TB

1) Exposure 2) Infection 3) Disease

38

Spectrum of TB: Exposed but no signs/symptoms, negative TST CXR sputum AFB and other diagnostics

Exposure or Class I

39

Spectrum of TB: Only one with signs and symptoms

Disease or Class III

40

Spectrum of TB: TST may be positive but negative in most children

Infection or Class II

41

Anti Tb drugs: Bactericidal

H, R, Z (weakly), S

42

Anti Tb drugs: Bacteriostatic

Ethambutol

43

Anti Tb drugs: Inhibits nucleic acid synthesis

H, R

44

Anti Tb drugs: Potent sterilizing activity within macrophages

Z

45

Anti Tb drugs: Dose

HRZES in order: 10-15mg/kg, 10-20, 20-40, 15-25, 20-40

46

Anti Tb drugs: Max dose

HRZES in order: 300mg, 600, 2g, 1.2g, 1g

47

D/C INH if transaminase levels is ___ from normal or with hepatitis

>3.5x

48

Adverse reactions to Streptomycin

1) Sterile abscess 2) Auditory function impairment

49

Algorithm for Preventive Therapy of Childhood TB: TB exposure, less than 5 years old

INH x 3 months

50

Algorithm for Preventive Therapy of Childhood TB: TB exposure ≥ 5 years old

Mantoux test, if (+) with radiologic findings plus signs and symptoms, treat as TB disease; if (+) with no radiologic findings, signs or symptoms, treat as latent TB infection; if (-) with no BCG scar, give BCG after 2 weeks

51

After 3 months INH for TB exposure less than 5 years old

Repeat Mantoux test, if (-) with no BCG scar, give BCG after 2 weeks; if (+) with radiologic findings plus signs and symptoms, treat as TB disease; if (+) with no radiologic findings, signs or symptoms, treat as latent TB infection

52

Treatment for latent TB infection

9-12 months INH including 3 months initially given for exposure

53

Standard treatment for TB in pregnant women

HRZE

54

Can a woman breastfeed while treating for TB

Breastfeeding is encouraged because only minimal amounts of the drug are excreted in breastmilk

55

Treatment for mothers with latent TB infection

INH IMMEDIATELY WITHOUT DELAY

56

T/F The mother who has current TB disease but has undergone treatment for 2 weeks or more is presumed to be no longer contagious at the time of delivery

T

57

Management of newborn of mother with TB disease

Give INH for 3 months then TST; if TST (-) D/C INH and give BCG; if TST (+) with no radiographic findings, signs, and symptoms, complete 9 months of INH

58

Recommended for infants whose mothers have TB disease and has not yet undergone treatment

1) Separation from mother 2) Give INH or rifampicin if INH-resistant for 3 months 3) Do TST, if (+) but CXR (-) complete 9 months of INH or RIF; if (-), repeat after 3 months

59

Recommended for infants if CXR and TST of mother are negative and has completed treatment

Give BCG and D/C INH

60

Treatment for congenital TB

2 HRZS, 4-7 HR