Tuberculosis Flashcards Preview

Pulmonology > Tuberculosis > Flashcards

Flashcards in Tuberculosis Deck (36)
Loading flashcards...
1
Q

What are the 4 recommended first-line anti-TB medications?

A

Isoniazid, Rifampin, Pyrazinamide, Ethambutol

2
Q

Why is a multi drug regimen approach used to treat TB?

A

to delay or prevent resistant strains

3
Q

True/False: Anti-TB meds can be discontinued as soon as symptoms subside

A

False. They are continued for at least 6 months to make sure all persistent organisms are eradicated.

4
Q

What is the most serious side effect of the anti-TB meds?

A

Liver dysfunction/hepatitis

5
Q

Because of their potential liver harming effects, which labs should be performed on patients on these meds?

A

ALT/ASTs for a baseline and then while taking as well

6
Q

What is the most serious side effect of Ethambutol? How do we monitor for it?

A

Loss of visual acuity as well as loss of ability to tell the difference between green and red. Need to perform vision tests monthly.

7
Q

What is the most common side effect of Isoniazid? How do we treat it?

A

Peripheral neuritis/neuropathy. Will feel paresthesias in their hands and feet. Can supplement with Vitamin B6.

8
Q

If a patient is on a Cytochrome P450 med (warfarin, oral contraceptives, prednisone, etc), would you need to adjust their dose if starting a anti-TB regimen?

A

Yes. Rifampin decreases the half-life of these meds and might need to increase dose.

9
Q

What other baseline labs should be performed on patient before starting a anti-TB drug regimen?

A

CBC (including platelets), creatinine, serum bilirubin, and urate level

10
Q

What is the preferred method of TB testing for patients who have received the BCG shot?

A

Interferon gold blood test

11
Q

After how many hours after placement does a skin PPD test need to be read?

A

48-72 hours.

12
Q

Can PPD skin testing be used to test for active TB in persons with symptoms?

A

Yes, but a positive test does not differentiate between active and latent infection

13
Q

True/False: If a patient has a negative Interferon gold (IGRA) negative blood test, active or latent TB is highly unlikely.

A

True

14
Q

True/False: A patient with a latent TB infection is symptomatic.

A

False

15
Q

What drug do you give for Latent TB infection prophylaxis?

A

Isoniazid

16
Q

How long is the prophylaxis for Latent TB infection?

A

at least 9 months

17
Q

Common SX of someone with active TB?

A

Chronic dry cough that progresses to productive then may have hemoptysis PLUS malaise, loss of some lbs, fever, night sweats (appears chronically ill and malnourished)

18
Q

What is a good lab test you could do to detect M. Tuberculosis?

A

Acid fast! But definitive diagnosis requires culture.

19
Q

How long is the typical tx for someone with active TB?

A

6-9 months of the 4 drug regimen

20
Q

In which populations is the highest incidence of TB recorded?

A

malnourished, homeless, living in overcrowded and substandard housing, and HIV-positive.

21
Q

What conditions can re-activate a latent TB infection?

A

gastrectomy, silicosis, DM, therapy with steroids, HIV infection

22
Q

What are risk factors for TB-drug resistance?

A

Immigration from countries with prevalence of drug-resistant TB, close and prolonged contact with individuals with drug-resistant TB, unsuccessful therapy, and non adherence to treatment

23
Q

What are diagnostic physical exam findings for TB?

A

none specific. Exam may be normal.

24
Q

How do you collect a culture on a patient that cannot produce enough sputum or acid-fast was negative?

A

Sputum induction with 3% hypertonic saline

25
Q

True/False. Current corticosteroid use can result in a false negative TB skin test

A

True.

26
Q

True/False. Patients with latent TB who test negative on a skin test, proves that the infection is gone.

A

False. May be negative many years after exposure but not gone.

27
Q

Can an interferon gamma test tell the difference between active and latent TB?

A

No, should not be used to exclude active TB

28
Q

Which TB test is preferred in patients < 5 years old?

A

TB skin test

29
Q

Is TB a reportable disease?

A

YES, ACTIVE ONLY

30
Q

What are ways to improve adherence with TB meds?

A

provide detailed patient education about TB, assign a case manager. Directly observed therapy (DOT) physically observes them taking meds.

31
Q

Who does the CDC recommend Direct observed therapy (DOT) for?

A

all patients with drug-resistant TB and for those receiving intermittent therapy.

32
Q

What is extra pulmonary TB?

A

TB spreads across body and can affect any organ system - bone, brain, liver, GI, GU, kidneys, etc

33
Q

How is treatment of extra pulmonary TB different to regular TB?

A

It’s not, in most cases the same regimens are effective. 9 months of therapy may be needed if bone, joint, or meningeal disease is present. May need early surgery and debridement of necrotic bone.

34
Q

Which TB med can precipitate a gout attack?

A

Ethambutol

35
Q

T/F: you have to report latent TB to health department

A

FALSE

36
Q

Which race has the highest incidence of TB?

A

Asian Americans