TB

Question 1

progression to lung pneumonitis

Answer 1

1. inhaled
2. macrophages eat–> blood
3. lung pneumonitis, lymph nodes, etc

Question 2

what makes it “latent” TB

Answer 2

lung pneumonitis gets resolved

Question 3

list 3 things that can activate LTBI

Answer 3

pregnancy
HIV or DM
taking immunomodulators

Question 4

how is TST read? (3)

Answer 4

measure induration perpendicular to long axis
ignore redness
record in mm

Question 5

induration cut off for high pretest probability vs middle vs very low

Answer 5

• high: 5mm
• middle: 10
• very low: 15

Question 6

examples of people w/ high pretest probability (4)

Answer 6

• ppl w/ HIV
• close contacts
• immunocompromised/using steroids
• fibrotic change on CXR/ old TB

Question 7

examples of people w/ “mid” pre-test prob (5)

Answer 7

• healthcare workers or long term facility ppl
• recent immigrants
• injection drugs
• younger exposed to high risk adults
• underlying illness

Question 8

Having these conditions can cause false ____ with TST

general illness, steroids, immunosuppression, long duration since infection, malnutrition

Answer 8

false negative

Question 9

Having these conditions can cause false ____ with TST

nontuberculous mycobacteria

Answer 9

false positive

Question 10

list some P.E. findings with TB (5)

Answer 10

• dullness to percussion
• rales
• tubular breath sounds
• whispered pectoriloquy
• distant hollow/amphoric breath sounds

Question 11

6 radiographic findings

Answer 11

• infiltrates in upper lobes
• Cavity formation esp at the apical area
• Hilar adenopathy
• Atelectasis
• Pleural effusion
• Miliary TB

Question 12

list 5 extrapulmonary findings w/ TB seen more in kids

Answer 12

• meningitis
• osteomyelitis
• GI issues
• renal issues or GU tract
• scrofula– isolated infected neck node

Question 13

4 diagnostic tests/procedures used for TB

Answer 13

• TST
• IGRA
• sputum smear
• culture

Question 14

media used to culture TB

Answer 14

AFP culture on jensen media

Question 15

when do you get sputum smear?

Answer 15

(+) PPD or IGRA
AND
abnormal CXR

Question 16

Whole blood assay that measures immune response to M. TB antigens

Answer 16

IGRA

Question 17

which test shows no response to non-TB mycobacteria or BCG

Answer 17

IGRA

Question 18

4 limitations of IGRA

Answer 18

• LTBI has no gold standard
• not standard
• may be falsely negative in active dz
• not reliable for kids under 5

Question 19

3 situations where we use IGRA

Answer 19

• at risk over 5yo
• confirm positive TST in BCG
• confirm TST when non-TB mycobacteria suspected

Question 20

if patient has negative TST, negative IGR but you think they might have TB, can you r/o TB?

Answer 20

no, investigate more

Question 21

list the first line agents (5)

Answer 21

Isoniazid (INH), Rifampin (RIF), Pyrazinamide (PZA), Ethambutol (EMB), Streptomycin (STM)

Question 22

can you treat close contacts?

Answer 22

yes w/ prophylactic abx

Question 22

medication regimen in first 2 months of tx of active TB

Answer 22

INH + RIF + PZA + (EMB* or STM*)

drop last two after confirming susceptibility

Question 23

medication regimen for last 4 months for active TB

Answer 23

INH + RIF

Question 24

total tx duration for **active** TB

Answer 24

6 months

Question 25

while doing sputum smears Q 2 wks, if it doesn't become negative, what does that mean?

Answer 25

non adherence or drug resistance

Question 26

two things to do during treatment of active TB other than sputum smears

Answer 26

* toxicity labs PRN * CXR at end to establish new baseline

Question 27

first line treatmetn (& duration) in LTBI vs alternative

Answer 27

1. INH x 9 months 2. rifampin x 4-6months or INH + rifapen. x 3 months (DOT)

Question 28

things to monitor during LTBI tx

Answer 28

liver panel in adults & symptomatic kids

Question 29

what to do if trying to get sputum from uncooperative pt

Answer 29

gastric aspirates bronchoalveolar lavage

Question 30

limitation of sputum smears

Answer 30

tells that its mycobacteria but not if its the TB one specifically

Question 31

should you do next if theres positive TST?

Answer 31

get xray to see if active or latent

Question 32

go review meds

Answer 32

ok!