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Tuberculosis

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morauch630's version from 2017-11-15 05:00

Section 1

Question Answer
TB is the leading infectious killer on earthTrue
Rates of TB decrease with overcrowdingFalse
Higher incidence of TB in latinos and african americansTrue
TB is more common in womenFalse
The risk of developing an active TB infection is greatest in the first 2 yearsTrue
Susceptibility results for mycobacterium tuberculosis result quicklyFalse
TB is transmitted via droplets, with 30% exposed day to day being infectedTrue
Reinfection of TB is commonFalse
Granulomas form around bacteria True
Extra pulmonary disease is common in normal hostsFalse
Goals of treatment include: killing bacilli, preventing drug resistance and relapseTrue
Duration of TB treatment is 3 monthsFalse
In the beginning of treating active TB recommend using 4 drugsTrue
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Section 2

Question Answer
S/sx of TBweight loss, malaise, fever, night sweats, cough, insidious onset
Chest examination includesrales, increased fremitus with cavitary lesions, dullness to percussion
Chest xray findingspatchy or nodular infiltrates in the apical areas of the upper lobes. Cavitation may be seen
Chest examination in elderlyfindings may be muted
Presentation in elderlymental status changes
Presentation in childrenmay present as progressive primary TB, they may go directly to active and skip latent
CXR in childrenoften involves lower and middle lobes, rather than apical like adults
Chest xray findings in childreninvolves lower and middle lobes
Extrapulmonary diseaseTB that involves organs other than the lungs
Miliary TBwidely disseminated disease. involves both lungs and other organs
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Section 3

Question Answer
Positive skin test: >5mm in what population?HIV, recent contacts of TB cases, organ transplants, immunosuppressed
Positive skin test: > 10mm in what population?recent immigrants, IV drug users, healthcare workers, inmates, DM, renal failure, cancer
Positive skin test: > 15mm in what population?those with no risk factors
DX of TBculture, CXR, skin testing
How many consecutive days do you need to collect culture3
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Section 4

Question Answer
Drugs used to treat TBIsoniazid, rifampin, pyrazinamide, ethamnutol, streptomycin
Second line agents for treating TBpara-aminosalicylic acid, cycloserine, ethionamide, clofazimine, quinolones, macrolides
Treatment of latent TBisoniazid and pyridoxine
Treatment of extra pulmonary disease- CNSisoniazid and pyrazinamide for 9-12 mo
Treatment of extra pulmonary disease- soft tissuenormal regimen
Treatment of extra pulmonary disease- bone9-12 mo
Treatment of TB during pregnancyIsoniazid and ethambutol
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Section 5

Question Answer
Isoniazid mechanism of actioninterferes with cell wall mycolic acid synthesis
Rifampin mechanism of actioninhibits transcription of DNA to RNA
Pyrazinamide mechanism of actionunknown
Ethambutol mechanism of actioninterferes with incorporation of arabinoglactan
Streptomycin mechanism of actionbinds to 30S ribosome leading to inhibition of protein synthesis
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Section 6

Question Answer
Isoniazid kineticsrapidly absorbed, decreased absorption with food, liver metabolism
Rifampin kineticswell absorbed except in AIDS, DM, GI disease, excreted in bile
Pyrazinamide kineticswell absorbed, low protein binding, liver metabolism, excreted in kidneys
Ethambutol kineticsabsorbed well except in AIDS, DM, GI disease, renally excreted
Streptomycin kineticsrenally excreted, given IM
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Section 7

Question Answer
Isoniazid adverse effectshepatotoxicity, neurotoxicity, peripheral neuropathy (require pyridoxine to prevent)
Rifampin adverse effectshepatotoxicity, rash, fever, GI distress, turns body fluids organ
Pyrazinamide adverse effectsGI distress, arthralgias, uricemia (bring on gout attack)
Ethambutol adverse effectsrash, fever, GI irritation, visual disturbances, inability to see the color green,
Streptomycin adverse effectsnephrotoxicity, ototoxicity
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Section 8

Question Answer
Isoniazid drug interactionsinhibition of metabolism of drugs that use CYP2E1
Rifampin drug interactionsincreased metabolism of protease inhibitors, BCP
Pyrazinamide drug interactionsother hepatotoxic drugs
Ethambutol drug interactionsdecreases absorption of antacids
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