Chapter 27: TB

Question 1

Identify the risks factors for TB (8)

Answer 1

1. Homeless
2. Residents of inner-city neighborhoods
3. Foreign-born persons
4. Living or working in institutions
5. IV injecting drug users
6. Overcrowded living conditions
7. Poverty, poor access to health care
8. immunocompromised

Question 2

List 4 causes of multidrug resistant tuberculosis.

Answer 2

1. Incorrect prescribing,
2. lack of public health case management,
3. pt nonadherence to the prescribed regimen
4. lack of funding for education and prevention

Question 3

Describe the characteristics of Mycobacterium tuberculosis

Answer 3

Characteristics: gram-positive, aerobic, acid-fast, bacillus usually spread person to person by airborne droplets expectorated when breathing, talking, singing, etc.

Question 4

Describe Mycobacterium tuberculosis and transmission of this bacteria.

Answer 4

number of organisms expelled into the air, concentration of organisms, length of time of exposure, and immune system of the exposed person

Question 5

Describe how tuberculosis infiltrates the body and develops into a primary TB infection.

Answer 5

Bacteria are inhaled, inflammatory response occurs, if adequate immune response infection does not progress to disease

Question 6

Contrast primary, reactivation, and latent TB infections.

Answer 6

1. Primary: Bacteria are inhaled, inflammatory response occurs, if adequate immune response infection does not progress to disease
2. Reactivation: TB occurring 2 or more yrs after the initial infection
3. Latent: occurs in a person who does not have active TB disease. These ppl have positive skin tests but are asymptomatic

Question 7

Describe clinical manifestations of pulmonary TB. (4)

Answer 7

1. Takes 2-3 wks to develop symptoms
2. Initial s/s: dry cough that becomes productive
3. Other: fatigue, malaise, anorexia, wt loss, low-grade fever, night sweats
4. Late s/s: dyspnea and hemoptysis

Question 8

Give an example of extrapulmonary TB and its manifestations.

Answer 8

Dependent on the organs affected: renal TB -> dysuria and hematuria, bone and joint TB -> severe pain, TB meningitis -> HA, vomiting, lymphadenopathy (lymph node swelling).

Question 9

Review the 2 complications: miliary TB

Answer 9

widespread dissemination of the mycobacterium. The bacteria spread through the bloodstream to several distant organs. Occurs with primary TB or reactivation of LTBI. Fatal if untreated. Manifestations progress slowly and vary depending on which organs are infected (fever, cough, lymphadenopathy). May include hepatomegaly or splenomegaly.

Question 10

Review the 2 complications: pleural TB

Answer 10

specific type of extrapulmonary TB, can result from either primary disease or reactivation of a latent infection. (manifestations: chest pain, fever, cough, and presence of unilateral pleural effusion are common)

Question 11

Explain what a positive test reaction to tuberculin skin test means and what are the actions after an initial positive test. (3)

Answer 11

*Indication: induration - a palpable, raised, hardened area or swelling (not redness) at the injection site means the person has been exposed to TB and has developed antibodies.
*If the initial test is positive, the person needs further evaluation for active disease.
*A positive reaction to a subsequent test could be a new infection or the result of the boosted reaction to an old infection

Question 12

Cite the advantage and disadvantage of using the QuantiFERON-TB Gold in-tube test as a screening tool for TB. (5)

Answer 12

1. available in a few hours
2. Require only 1 visit
3. Are not subject to reader bias
4. Have no booster phenomenon, are not affected by prior bacillus Calmette-Guerin (BCG) vaccination
5. Dis: expensive

Question 13

Discuss what is the gold standard test for diagnosing TB infection.

Answer 13

cultures

Question 14

Describe the initial and continuation drug therapy used to treat active TB infections

Answer 14

1. Initial (8wks to 3 mon): 4 drugs
2. Continuation (18 wks): 2 drugs (isoniazid and rifampin)

Question 15

Cite the major factor that influences emergence of multidrug resistant TB

Answer 15

Non Adherence to drug therapy

Question 16

Cite a major side effect of some of the TB drug therapies.

Answer 16

Non Viral hepatitis

Question 17

List pertinent social determinants of TB that need to be addressed to decrease transmission of TB

Answer 17

1. Reducing HIV infections, poverty, overcrowded living conditions, malnutrition, smoking, and drug and alcohol use can help minimize TB infection rates.
2. Improving access to healthcare and education is important

Question 18

Cite 4 expected outcomes of care for persons diagnosed with TB. (4)

Answer 18

1. Resolution of the disease
2. Normal pulmonary function
3. Absence of any complications
4. No further transmission of TB