tuberculosis

Question 0

TB-is an ___ ___ disease caused by ____ ____
-from 1985-1993 there was in increase in cases
due to: ___ epidemic, ___ from countries were tb is ___, and trasmission in ___ settings (____ centers, ___, ___ ___)
-even so TB continues to be major problem in US, especially __ __ __ __ of TB (____)

Answer 0

airborne communicable, mycobacterium tuberulosis

• HIV; immigrants, common; instituitional (healthcare, prisons, homeless shelters)
• multiple drug resistant strains (MDR-TB)

Question 1

Transmission: TB is spread from ___ to ___ through the ___

• spread involves complex interplay of ___, ___, and __ __
• the probability a person will become infected depends on: ____ of the person with TB, ___ of the __ __ ___ in the air, and ___ of the ____
• person who have __ __ with __ __ individuals have a higher risk of infection

Answer 1

person to person, air

• enviornment, organism, and host factors
• infectiousness, concentration of the infectious droplet nuclie, duration of exposure
• repeated contact, highly infectious

Question 2

Process of infection:

1) ptns with active pulmonary tuberulosis aerosolize respiratory droplets when ___ or ____
2) as water content of secretions ____, a small residue of particulate matter that contains ___ ___ __ called __ __ is formed
3) these droplets remain __ for ___ periods of time
4) when inhaled, most of these droplet nuclei are deoposited in the __ __ __, however some may reach the ____ of the __ to __ ___
5) the host immune system responds with ___ (usually ___ ___) –> if this is unsuccessful, a small primary __ infection develops at this site
6) over the next few __ the bacilli ___ and ___
7) the initial spread is the the __ __ __ and later throughout the ___–> ________ ______ is responsible for spread throughout the body
8) host immunity deveops through ____ mechanisms and is usually sufficent to control the primary infection after ___ weeks –> usually the exposure is __ and the dx is ___ in this matter
- ptns have ____ symptoms and may not be diagnosted
9) if host fails to develop immunity to primary infection, __ __ tuberculosis results
10) the usual rxn is for host immunity to creat a ____ rxn around the bacilli after prim infection; therefore a ___ ___ infection is prevented
11) the organism can remain __ for ___
* factors that cause reactivation?

Answer 2

1) coughing or sneezing
2) evaporates, viable bacilli nuclei, droplet nuclie
3) viable, variable
4) upper respiratory tract, alveoli, mid to lower lung
5) phagocytes (alveolar machrophages), pulmonary infection
6) weeks, multiply and disemminate
7) hylar lymph nodes, lung; lymphohematogenous dissemination
8) cell-mediated, 4-6, small, controlled
- minimal
9) progressive primary
10) granulomatous, second primary
11) dormant, years
* 1.HIV infection
2. immunosuppressive therapy
3. prolonged corticosterroid therapy
4. end stage renal dx
5. radiation to thorax
6. malnutrition
7. silicosis or pneumonconiosis

Question 3

Pathogenesis:

1) most primary infections are ____
* althose these people test ___ on the tb skin test, they do not have ___ tb and are __ ___
* bacilli may persis in the host for ___ w/o producing ___ TB => known as ___ ___
2) the ___ is the typical early lesion, usually occuring in the ___ and the ___ site of infection
* it is an intense ____,____ rxn that isolates the billi
3) Healing that this stage may result in ___ and ___ which a __ __ visible on the __ ___
4) future _____ of the ___ infection is the usual cause of active TB -> ptns who develop this become _____

Answer 3

1) subclinical
* positive, active, not infectious
* decades, active, tb infection
2) granuloma, lung, original
* necrotizing, inflam
3) scarring and calcification, residual lesion, chest radiograph
4) reactivation, latent; symptomatic

Question 4

Clinical symp of TB:

• the most common presenting symptom of active TB is a ___ ___
• other findings are __ and usually apreciated only with presence of ___ disease, include? (8)
• extrapulmonary tb, w/ or w/o pulmonary tb may occur in virtually __ ___

Answer 4

-chronic cough
-few, extensive
*fever, night sweats, wt loss
central pulmonary necrosis
cavitation in lung
caseation necrosis
exudative lung lesions
hemoptysis
-any organ

Question 5

Screening methods: diagnosis is made through combination of __ ___ and evaluation of ___ ___ , ___ ___, and ___ ___

Answer 5

PPD screening, chest radiograph, sputum culture, clinical symptoms

Question 6

PPD skin test and anergy testing:

• ___ risk groups should be tested with Manatoux test= _____ admin of ___ tuberculin units of ___ ___ ___ tubuerculosis
• usually injected in ____
• rxns are read as the __ ___ of ____
• ____ is disregarded
• ptns with active tb have rxn sizes with average diameter of ___mm
• Anergy- the ____ of dermal tuberlin reactivity in ____ persons occurs in up to ___% of TB-___ infected ptns. this results in a ___ __ skin test

Answer 6

• high, intradermal, 5, purified protein derivative
• forearm
• transverse diameter induration
• erythema
• 17mm
• absence, infected, 60%, TB-HIV, false negative

Question 7

Chest radiograph:
-is the ___ method to identify persons w/ __ ___ TB when risk for infection ___ or consequences of _____ disease are severe as in __ __ and ____

Answer 7

preferred
current pulmonary
high
undiagnosed
homeless shelters and prisons

Question 8

Treatment of active disease:

• involves the ___ admin of several drugs for up to ___ months
• tx based on ___ of organisms -> before this is known, tx based on estimated __ __ in community, ___ status, previous ___, recent ___, and ___ of ptn at time of exposure
• all drugs used to treat tb have seroius side effects including? (7)
• b/c of __ toxicities altered __ __, ___ and __ are of concern for ptns
• more common fist line medications are ____(___), ____ (__), ____, ____ and _____
• most unsuccess tx results from interuption/irregularity of __ ___
• ptn ___ is a big problem b/c of __ periods of ____ required*the most effective method of ensuring adherence is use of __ __ __ (__) after the ptn has been ___ from ___
• the emergense of ____ has possed signif challenge
• the fatality rate can be as high as __% and the time interval b/t diagnosis and death is __ (__ weeks)

Answer 8

-concomitant, 24 months
-susceptibility, INH resistance,HIV, treatment, infection, age
-hepatitis, hepatotoxicity
leukopenia, thrombocytotosis
GI disturbances, nephrotoxicity, ototoxicity
*liver; drug meta, bleeding, infection
-Isoniazid (INH), rifampin (RIF), septomycin, pyrazinamimne, ethambutol
*self medication
*compliance, long, treatment
*directly observed thearpy (DOT), discharged, hospital
-MRTB
*85%, short (4-16 weeks)

Question 9

Dental considerations: management depends on ___ of the dx

1) ptns w/ recent positive PPD skin test: ptns require ____ by ___ to rule out ___ dx
* these ptns have been infected with m. tubercu in the ___
* most never develop __ dx
* ptns placed on __ __ therapy for __ to __ months, are not ___, and can be treated ____

Answer 9

status

1) evaluation by physican, active
* past
* active
* preventive INH, 6-12, active, normally

Question 10

Dent consideration: ptns with signs or symptoms of active TB:

• ptn must be ___ to ___ before they recieve any ____ dental tx
• ___ tx must be provided in an __ __ setting
• this setting will have ___ __ ___ and a minimum of __ __ __ per hour with venting to the outside
• __ ___ attire must be in compliance with __ ___ for prevention of TB, this includes approp ___ protective devices certified by _____
• surgical masks worn routinely in dental practice are ___ ___
• ptns treated in this setting until their ___ has ____ and a ___ ___ test obtained -> usually after ___ weeks of effective therapy the ptn becomes ____ and can be treated on an ___ basis
• physican should be consulted to verify the ptn is __ __ infectious
• children under the age of __ with active tb are not treated on ___ basis b/c they rarely demonstrate __ in the ___, the present a __ risk of ttransmiting infection through ___

Answer 10

• referred, physican, elective
• emergency, isolated hospital
• negative air pressure, 6 air exchangers;
• infection control, CDC guidelines; respiratory, NIOSH
• not adequate
• cough, subsided, negative sputum; 2-3 weeks, noninfectious, outpatient
• no longer
• 6, outpatient, bacilli, sputum, low, cough

Question 11

dental considerations: ptn with hx of tuberculosis:

• ptns should be eval as to the _____ of the ___
• inadequate tx (insuff __ or ___) places ptn at risk for ___ or ___ of the dx
• refer to ptn if ptn is __ ___ or they present with __ ___ of active TB

Answer 11

effectivness, treatment

• dose or duration, reactivation or contiuation
• poor historian, clinical signs

Question 12

oral complications of TB:

• rare oral lesions, less that __% of ptns with TB have oral lesions
• lesions usally present as ___, ___ ulcerations on the __ suface of the ___; closely resembles __ __ ___; the __ area of the ulceration may be ____
• Also seen is Cutix orifacialis- is a ___, ___ ulceration in the ___ __ of the ___
• diagnosis is determined by ___ and ___
• tx results from management of ___ ___
• lymph nodes of __ and ___ region may become ___ and ___ -> called ____ and rarely seen outside the __ __ countries

Answer 12

• 1%
• irregular, deep; doral, tongue; squamous cell carcinoma; central, purulent
• pebbly, shallow; lateral commisure, mouth
• biopsy and culture
• systemic dx
• cervical and submandibular, enlarged and painful -> scrofula; third world