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Questions and Answers
What is the first action taken if a patient presents with a petechial rash and low platelet count due to rifamycin use?
What dose of pyridoxine (VIT-B6) is recommended for patients at risk of developing peripheral neuropathy?
Which condition is related to optic neuritis during EMB treatment?
When should EMB be discontinued to prevent permanent visual deficits?
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At what rate does EMB-related visual impairment occur during the treatment of active tuberculosis?
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Which antibiotic class does not require dose adjustment for renal function?
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What is a common side effect associated with Fluoroquinolones?
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Which of the following factors is NOT a contraindication for Tetracyclines?
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Which generation of Cephalosporins is Cefepime classified under?
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Which condition is associated with an increased risk for Clostridioides difficile associated diarrhea?
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What is the Pneumonia Severity Index (PSI) used for?
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Which beta-lactam antibiotic is NOT a Carbapenem?
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Which of the following is a natural penicillin?
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Which class of antibiotics does NOT include Azithromycin?
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Which of the following conditions does NOT typically indicate the need for antibiotic therapy in LRTI?
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What characterizes extensive drug resistance TB (XDR-TB)?
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Which of the following is NOT a known risk factor for developing XDR-TB?
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Which symptom is commonly associated with extrapulmonary TB affecting the kidneys?
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Which site is significantly involved in extrapulmonary TB?
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What type of TB is characterized by the absence of symptoms?
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Which test is used to diagnose latent TB?
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What can lead to a false-positive result in the tuberculin skin test?
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What is the preferred treatment duration for latent TB in patients not infected with HIV?
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What alternative test is available for diagnosing latent TB in those vaccinated with BCG?
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Which medication is NOT included in the treatment of extrapulmonary TB?
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What combination is suggested for directly observed therapy (DOT) in treating latent TB for HIV co-infected patients?
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Which treatment duration is recommended for extrapulmonary TB with bone or joint involvement?
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What treatment regimen is recommended for pregnant women with latent TB?
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In patients with extrapulmonary TB, how many first-line medications are used during the two-month intensive phase?
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What additional supplement should pregnant or breastfeeding women taking isoniazid include in their regimen?
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What is a controversial medication inclusion for pregnant women with tuberculosis in the United States?
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Which of the following medications is not recommended during pregnancy?
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What is the primary benefit of using corticosteroids in TB meningitis?
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What is the recommended dosage regimen for dexamethasone in adults during the first three weeks of treatment for TB meningitis?
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Under what condition should anti-TB drugs be stopped immediately?
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What constitutes severe hepatotoxicity in the context of drug-induced liver injury?
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Which of the following is appropriate management for a rash induced by antituberculosis drugs?
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Which ALT level indicates moderate toxicity in the context of drug-induced liver injury?
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What should be considered in smear-positive TB cases where discontinuation of therapy is unsafe?
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Study Notes
Lower Respiratory Tract Infections (LRTI)
- Antibiotic Classification and Pharmacology: Beta-lactams (penicillins, cephalosporins, carbapenems, monobactams), macrolides, tetracyclines, and fluoroquinolones are discussed, along with their respective subclasses, examples, side effects, and dose adjustments. Noteworthy side effects include gastrointestinal issues, nervous system effects, hematological effects, and allergic reactions. Renal dose adjustments are needed for most Beta-lactams except Ceftriaxone.
Community-Acquired Pneumonia (CAP)
- Severity and site of care determine treatment: Outpatient, non-severe inpatient (general ward), and severe inpatient (ICU).
- Pneumonia Severity Index (PSI) is a scoring system to assess severity and predict outcomes.
Tuberculosis (TB)
- Sites Involved: Pulmonary TB and extrapulmonary TB (lymph nodes, genitourinary tract, bones, joints, meninges, intestine, skin).
- Risk Factors: Weakened immune systems (HIV, immunosuppressants), healthcare workers, travel to high-incidence areas, alcoholism, transplantation, low body weight, injection drug use, diabetes, severe kidney disease, leukemia, lymphoma, head and neck cancer.
- Clinical Presentations: Pulmonary TB (shown in images), extrapulmonary TB (bone/joint pain, painful/cloudy urination, headaches/stiff neck), and latent TB (asymptomatic).
- Transmission: Primarily airborne; pulmonary TB is most contagious. Extrapulmonary TB is generally not contagious.
- Diagnosis: Latent TB diagnosed via tuberculin skin test (TST) or interferon-gamma release assay (IGRA). TST interpretation varies based on induration size and risk factors. BCG vaccination can cause false positives in TST.
- Latent TB Treatment: Regimens vary by HIV status and involve isoniazid, sometimes with rifampin or rifapentine. Directly Observed Therapy (DOT) may be used.
- Extrapulmonary TB Treatment: Typically involves a four-drug regimen (isoniazid, pyrazinamide, ethambutol, rifampicin) for an intensive phase, followed by a continuation phase adjusted for affected site. Duration varies from 6–12 months dependent on site and severity.
- TB During Pregnancy: Treatment regimens are adapted for pregnancy and breastfeeding, often including pyridoxine (vitamin B6). Second-line drugs are generally avoided.
- Tuberculosis Meningitis: Corticosteroids are recommended (dexamethasone or prednisolone) to reduce mortality.
- Management of Adverse Effects: Hepatotoxicity (monitoring ALT levels, drug discontinuation if elevated), rash (management depends on severity and may lead to drug discontinuation ), peripheral neuropathy (pyridoxine supplementation), and optic neuritis (monitor vision, discontinue ethambutol if abnormalities occur).
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Description
Test your knowledge on lower respiratory tract infections, including antibiotic classifications, community-acquired pneumonia, and tuberculosis. Explore details such as treatment options, scoring systems, and risk factors associated with these conditions. Enhance your understanding of pharmacology and patient care for respiratory infections.
