Tuberculosis and Treatment Guidelines Quiz

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Questions and Answers

When should a patient be hospitalized for active TB? (Select all that apply.)

  • When the patient is diagnosed with a drug-resistant strain.
  • When the patient's symptoms persist longer than 2 months.
  • When the patient is thought to be a risk for spreading TB to others. (correct)
  • When the patient is non-compliant with treatment. (correct)

What is the recommended duration of treatment for a person with HIV who has active TB?

  • 9 months (correct)
  • 4 months
  • 2 months
  • 6 months

Which of the following medications is NOT typically used for the initial treatment of active TB?

  • Rifampin
  • Isoniazid
  • Fluconazole (correct)
  • Pyrazinamide

Which of the following is a sign of drug resistance in active TB?

<p>Negative cultures after 3 months of treatment (D)</p> Signup and view all the answers

What is the function of a negative pressure room for a patient with active TB?

<p>To prevent the spread of TB bacteria from the patient to the environment. (A)</p> Signup and view all the answers

What is the recommended duration of INH treatment for an individual with a positive TB skin test who is an immigrant from a high prevalence area?

<p>6 months (A)</p> Signup and view all the answers

Which of the following PFT measures the volume of gas remaining in the lungs after maximal expiration?

<p>RV (B)</p> Signup and view all the answers

What is the name of the bacterium that causes pertussis?

<p>Bordetella pertussis (B)</p> Signup and view all the answers

What is the causative agent of Tuberculosis?

<p>Mycobacterium tuberculosis (B)</p> Signup and view all the answers

Which medical condition carries the highest increased risk for Latent TB to progress to active TB?

<p>HIV Infection (C)</p> Signup and view all the answers

Which of the following is NOT considered diagnostic for active TB?

<p>PPD skin test (C)</p> Signup and view all the answers

What should be given with Isoniazid to decrease the risk of neuritis and other side effects?

<p>Vitamin B6 (pyridoxine) (B)</p> Signup and view all the answers

Which diagnostic tool provides presumptive evidence of active TB but is not definitive?

<p>AFB smears (D)</p> Signup and view all the answers

What is a key characteristic symptom of pertussis during its late stages?

<p>Paroxysms followed by a 'whoop' sound (C)</p> Signup and view all the answers

During which weeks of pregnancy does the CDC recommend that women receive the Tdap vaccine?

<p>27th through 36th week (D)</p> Signup and view all the answers

What is the recommended antibiotic treatment within the first three weeks of a pertussis infection?

<p>Azithromycin (A)</p> Signup and view all the answers

Which of the following statements about pertussis is true?

<p>Vaccination is the best way to protect against pertussis. (B)</p> Signup and view all the answers

What happens to the alveoli in the lungs of the elderly?

<p>Alveolar surface decreases, reducing oxygen uptake. (A)</p> Signup and view all the answers

Which of the following is NOT a common diagnostic method for pertussis?

<p>Blood tests for antibodies (C)</p> Signup and view all the answers

What complication can arise from coughing fits in individuals with pertussis?

<p>Vomiting during and exhaustion after fits (D)</p> Signup and view all the answers

Which of these infections is most commonly associated with pneumonia in elderly patients?

<p>Streptococcus pneumoniae (A)</p> Signup and view all the answers

Which of the following best describes the nature of Mycobacterium tuberculosis?

<p>An acid-fast aerobic bacterium capable of surviving outside a host. (C)</p> Signup and view all the answers

An individual with latent tuberculosis infection (LTBI) would typically present with which of the following symptoms?

<p>Completely asymptomatic. (C)</p> Signup and view all the answers

A patient's chest X-ray shows a small homogeneous infiltrate in the upper lobes. What is the next most appropriate step?

<p>Perform NAAT culture of <em>M.tuberculosis</em> immediately. (C)</p> Signup and view all the answers

During the initial phase of pharmacologic treatment for tuberculosis, which medication requires specific attention to visual acuity and red-green color perception?

<p>Ethambutol. (C)</p> Signup and view all the answers

A patient has positive AFB smears, what does this result indicate?

<p>Presumptive evidence of active TB. (D)</p> Signup and view all the answers

What is a potential side effect of Rifampin in patients undergoing treatment?

<p>Hepatitis (B)</p> Signup and view all the answers

Which PFT measures the maximal airflow rate achieved during forced expiration?

<p>PEFR (B)</p> Signup and view all the answers

For which group is a positive skin test defined as 5 mm?

<p>Persons with HIV (A)</p> Signup and view all the answers

What action should be taken if a patient with active TB continues to show positive cultures after 3 months?

<p>Raise suspicion of drug resistance (C)</p> Signup and view all the answers

What is the minimum duration of treatment for a person with HIV who has active TB?

<p>9 months (B)</p> Signup and view all the answers

What is the purpose of notifying the local health department in cases of TB?

<p>To conduct contact tracing and prevent outbreaks (A)</p> Signup and view all the answers

Which of the following is a typical characteristic of whooping cough?

<p>Severe paroxysmal cough followed by a whoop (A)</p> Signup and view all the answers

In the management of active TB, when should sputum smears and cultures be monitored after initiating therapy?

<p>Weekly for the first 6 weeks, then monthly (D)</p> Signup and view all the answers

What is the primary reason for pregnant women to receive the Tdap vaccine?

<p>To provide the baby with antibodies before birth (C)</p> Signup and view all the answers

Which of the following early symptoms is associated with pertussis?

<p>Low-grade fever (D)</p> Signup and view all the answers

What is a critical aspect of diagnosing pertussis?

<p>Polymerase chain reaction (PCR) (D)</p> Signup and view all the answers

What is NOT recommended in the treatment of pertussis?

<p>Use of cough medication (D)</p> Signup and view all the answers

What are late-stage symptoms of pertussis typically characterized by?

<p>Paroxysms followed by a 'whoop' sound (D)</p> Signup and view all the answers

Which of the following describes pulmonary changes in the elderly?

<p>Decreased alveolar surface area for oxygen uptake (D)</p> Signup and view all the answers

What is a serious risk for children under one year old regarding pertussis?

<p>They are at a higher risk of severe complications (C)</p> Signup and view all the answers

Which common pathogen is associated with pneumonia in elderly patients?

<p>Streptococcus pneumoniae (B)</p> Signup and view all the answers

Flashcards

Tuberculosis (TB)

A bacterial infection that primarily affects the lungs. It is spread through the air when an infected person coughs or sneezes. It can be latent (in the body but not causing symptoms) or active (causing symptoms).

Latent TB

An infection with Mycobacterium tuberculosis bacteria, but not actively causing symptoms. It is often asymptomatic but can progress to active TB if the immune system weakens.

Active TB

Type of tuberculosis that shows symptoms and can spread to others. It can cause symptoms like fever, cough, weight loss, and night sweats.

QuantiFERON-TB Gold Test

A blood test that measures the body's immune response to TB bacteria. It can help determine if a person has been exposed to TB.

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Pharmacologic Treatment for TB

A type of medicine used to treat TB. It is a combination of drugs that usually includes isoniazid, rifampin, pyrazinamide, and ethambutol. It can require months or longer of treatment and can cause side effects.

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Rifampin Side Effects

A reddish-orange color in urine, inflammation of the liver, and a low platelet count are known side effects of Rifampin.

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Monitoring for Rifampin Side Effects

To monitor the potential side effects of Rifampin, laboratory tests like liver function studies, complete blood count, and serum creatinine levels should be conducted before starting treatment.

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Drug Susceptibility in TB Treatment

If the bacteria causing tuberculosis is fully susceptible to isoniazid (INH) and rifampin (RIF), the fourth drug in the treatment regimen can be omitted.

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TB Treatment Duration and Regimen

The initial phase of TB treatment involves taking all three primary drugs daily for two months, followed by a continuation phase of daily INH and RIF for another four months.

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TB Treatment Duration for HIV-Positive Individuals

Individuals with HIV should receive a longer course of TB treatment lasting nine months to ensure a high likelihood of eradicating the infection.

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Tuberculin Skin Test Interpretation: HIV-Infected Individuals

A positive tuberculin skin test result with a reaction of 5 millimeters or larger in HIV-infected individuals, close contacts of known TB cases, or organ transplant recipients.

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Tuberculin Skin Test Interpretation: High-Risk Groups

A positive tuberculin skin test reaction of 10 millimeters or larger in immigrants from high TB prevalence areas, individuals in high-risk groups, healthcare workers, individuals in correctional facilities, those with diabetes, and healthy individuals over four years old.

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Tuberculin Skin Test Interpretation: General Population

A positive tuberculin skin test reaction of 15 millimeters or larger in individuals not classified as high-risk groups.

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What is Pertussis?

Characterized by uncontrollable, violent coughing fits that often make it difficult to breathe. The coughing often makes a "whooping" sound, especially after taking deep breaths. It can be particularly dangerous for babies less than a year old.

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What are the early symptoms of Pertussis?

Early symptoms of Pertussis usually last for 1-2 weeks and include a runny nose, low-grade fever, and occasional coughing.

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What are the late symptoms of Pertussis?

Late-stage symptoms of Pertussis can last for 10 weeks or longer and include paroxysms (violent coughing fits) followed by a 'whooping' sound, vomiting during and exhaustion after coughing fits.

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How can you protect yourself and a baby from Pertussis?

Vaccination is the most effective way to prevent Pertussis. The CDC recommends that all pregnant women receive a Tdap vaccine during the 27th through 36th week of pregnancy.

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How is Pertussis diagnosed?

Pertussis is diagnosed through a Polymerase chain reaction (PCR) test used to detect the bacteria B. pertussis and B. parapertussis from nasopharyngeal swabs.

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How is Pertussis treated?

Treatment for Pertussis includes antibiotic therapy, primarily using azithromycin, clarithromycin, or erythromycin. Cough medication should be avoided. Fluids are important to prevent dehydration and small, frequent meals can help prevent vomiting.

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How do lungs change with age?

In older adults, lungs become stiffer, respiratory strength and endurance decrease, and the chest wall becomes more rigid. These changes contribute to a decline in oxygen uptake.

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What are the gerontology considerations for pneumonia?

Over 50% of pneumonia cases occur in adults over 65 years old. Long-term care facilities have a high risk of pneumonia. Common causes include Streptococcus pneumoniae, gram-negative bacilli, and Staphylococcus aureus.

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What is a Latent TB infection?

A latent TB infection means you have the bacteria but it is not active and causing symptoms. You are not contagious and don't need treatment right away. However, if your immune system weakens, it can become active.

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What is Active TB?

Active TB is when the bacteria is multiplying and causing symptoms. It is contagious and requires treatment with medication. It can affect the lungs and other parts of the body.

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What is the QuantiFERON-TB Gold Test?

The QuantiFERON-TB Gold test is a blood test that detects if you have been exposed to TB bacteria. It measures your immune response to the bacteria. This test is helpful to determine if you have been exposed to TB.

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What is a PPD test?

A PPD test is a skin test to check if you have been exposed to TB. A small amount of TB protein is injected under the skin, and the reaction is observed 48-72 hours later. It's not diagnostic for TB, but it indicates exposure and may require further testing.

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What is the typical treatment plan for TB?

The initial phase of TB treatment involves taking all three primary drugs daily for two months, followed by a continuation phase of daily INH and RIF for another four months. The goal is to eliminate the infection from the body.

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Rifampin's Side Effect?

Rifampin, a medication commonly used for tuberculosis treatment, can lead to a distinctive orange discoloration of urine. This harmless side effect is a visual reminder of the drug's presence.

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TB Diagnosis Reporting?

When tuberculosis (TB) is diagnosed, healthcare providers must promptly notify the local health department. This helps track cases, implement infection control measures, and prevent further spread of the disease.

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TB Test: Immigrant Risk

A positive tuberculin skin test (TST) result of 10 millimeters or greater is significant for immigrants from high-prevalence TB areas. This indicates a heightened risk of exposure and potential infection.

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FVC Lung Function Test

The forced vital capacity (FVC) lung function test measures the maximum amount of air a person can forcefully exhale after a deep breath. It is a key indicator of overall lung capacity.

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What are Pulmonary Function Tests?

Pulmonary function tests (PFTs) are a series of breathing tests used to assess lung function. PFTs are important for diagnosing and monitoring lung diseases, and they measure the volume of air inhaled and exhaled, as well as airflow.

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TB Patient Isolation?

A patient with active tuberculosis should be isolated in a negative pressure room to minimize the risk of spreading infection to others. This helps contain the spread of airborne bacteria.

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Persistent TB Symptoms?

If a patient's sputum culture remains positive after three months of tuberculosis treatment, it may indicate drug resistance. Further investigation is needed to determine the best course of action.

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How can Pertussis be prevented?

Pertussis is best prevented through vaccination. Pregnant women are recommended to receive a Tdap vaccine during their third trimester.

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Explain the treatment for Pertussis.

Azithromycin, clarithromycin, and erythromycin are commonly used antibiotics to treat Pertussis. Cough medication should be avoided. Fluids are essential to prevent dehydration, and small, frequent meals can help reduce vomiting.

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How do aging lungs affect oxygen uptake?

In older adults, lungs become stiffer, breathing capacity diminishes, and the chest wall becomes more rigid. These changes can reduce oxygen intake.

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What are the gerontological considerations for pneumonia?

Pneumonia is more common in older adults, with over half of cases affecting those over 65 years old. Residents of long-term care facilities face a particularly high risk. Common causes include Streptococcus pneumoniae, gram-negative bacilli, and Staphylococcus aureus.

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Study Notes

Tuberculosis (TB)

  • TB is an airborne infectious disease caused by Mycobacterium tuberculosis, an acid-fast aerobic bacterium.
  • The bacterium can survive outside the host for a long time.
  • Certain medical conditions like diabetes mellitus (DM) and HIV infection significantly increase the risk of latent TB progressing to active TB. The risk is 3 times higher with DM and 100 times higher with HIV compared to those without these conditions.

Clinical Presentation of TB

  • Individuals infected with Mycobacterium tuberculosis but without active disease (LTBI) show no symptoms.
  • Symptoms of active TB may include fatigue, anorexia, dry cough that may become productive and sometimes blood-tinged, weight loss, low-grade fever, and night sweats.

Diagnosis of TB

  • Screening is the initial step in diagnosing TB, identifying high-risk individuals and those needing treatment.
  • Definitive diagnosis involves 3 positive results of Nucleic Acid Amplification Test (NAAT) culture of M. tuberculosis.
  • QuantiFERON-TB Gold blood test can be used.
  • AFB smears offer a presumptive indication of active TB, but they are not diagnostic.
  • Chest X-ray (CXR) may show small homogeneous infiltrates in upper lobes, but it's not diagnostic for active disease; repeat CXR in 6 months if needed.

Differential Diagnosis of TB

  • Tuberculosis
  • Pneumonia
  • Acute Bronchitis
  • Carcinoma

Pharmacologic Treatment of TB

  • Initial treatment typically involves Isoniazid (INH) 300 mg, Rifampin (RIF) 600 mg, Pyrazinamide 1.5-2.0 gm, and Ethambutol 15 mg/kg daily for 3-4 months.
  • Vitamin B6 (pyridoxine) is often administered with INH to reduce the risk of neuritis and neuropathy; also hepatitis and seizures need to be monitored closely.
  • Visual acuity (eye health) should be assessed and red-green perception tested before and during treatment with ethambutol.
  • Liver function tests (CBC, serum creatinine) should be done at baseline and monitored regularly during treatment.
  • If the bacteria is shown to be fully susceptible to INH and RIF, the 4th drug may be removed from the treatment regimen.
  • If HIV positive, treatment should continue for 9 months.

Management of TB

  • Notify local health departments of reported cases of TB.
  • Hospitalization is not always required, but should be considered if the patient is non-compliant or is likely to expose susceptible individuals to TB.
  • Patients with active TB should be isolated in a negative-pressure room.
  • Patients with pulmonary TB should be monitored with weekly sputum smears and cultures for the first 6 weeks after treatment then monthly until negative cultures are documented.
  • Continued symptoms or positive cultures after 3 months should raise a high suspicion of drug resistance.

Important Facts to Recall

  • Individuals with a positive TB skin test should receive 6 months of INH treatment.
  • A positive skin test reaction of 5 mm is considered positive for HIV-infected individuals, recent contacts, those with a chest x-ray considered suggestive of TB, or organ transplant recipients.
  • A positive reaction of 10 mm is considered positive for immigrants from high prevalence areas, those in high-risk groups (healthcare workers, incarcerated, those with diabetes or over 4 years of age).
  • A positive reaction of 15 mm is considered positive for all other individuals not in high prevalence groups.

Pulmonary Function Tests (PFTs)

  • PFTs measure how effectively the lungs take in and release air.
  • PFTs evaluate the lungs' transfer of oxygen from the atmosphere into the circulatory system.
  • Key measurements include Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), FEV25-75, Peak Expiratory Flow Rate (PEFR), Total Lung Capacity (TLC), Functional Residual Capacity (FRC), and Residual Volume (RV).

Pertussis (Whooping Cough)

  • Pertussis is a highly contagious respiratory infection (disease) caused by Bordetella pertussis.
  • Symptoms include uncontrollable violent coughing, difficulty breathing, and a "whooping" sound during inhalation.
  • Pertussis can be serious, especially in infants less than a year old.
  • Vaccination is the primary method of protection against pertussis.
  • Diagnosis is performed by PCR (Polymerase chain reaction) tests to detect Bordetella pertussis or Bordetella parapertussis from nasopharyngeal swabs.
  • Treatment involves antibiotic therapy (azithromycin, clarithromycin, or erythromycin) within the first 3 weeks of infection.

Clinical Manifestations of Pertussis

  • Early symptoms (1-2 weeks): runny nose, low-grade fever, and occasional cough.
  • Late-stage symptoms (10 weeks or longer): coughing fits followed by a whoop sound, vomiting, exhaustion.

Pertussis and Pregnant Women

  • Pregnant women should receive a Tdap vaccine during their pregnancy to protect themselves and pass immunity to their infants.
  • The vaccine is most effective when administered during the 27th-36th week of pregnancy.

Pertussis Diagnosis and Treatment

  • Diagnosis is usually made using PCR tests.
  • Antibiotics (e.g., azithromycin, clarithromycin, erythromycin) are typically administered for treatment within the first 3 weeks of infection.
  • Cough suppressants are not recommended during treatment.
  • Adequate hydration should be maintained.
  • Frequent, light meals help prevent vomiting.

Gerontology Considerations for Pulmonary Conditions in the Elderly

  • Lung tissues become stiffer, diminishing respiratory strength and endurance.
  • Chest walls become less flexible and more rigid, increasing the anteroposterior (AP) diameter.
  • Reduced alveolar surface area and susceptibility of alveoli collapsing due to decreased surface tension.
  • Mucus production increases while the cough reflex decreases.
  • Pneumonia risk is significantly higher (over 50%) in adults over 65 years old, especially in Long Term Care (LTC) facilities (over 30% risk over 2 years).
  • Common pneumonia pathogens include Streptococcus pneumonia, gram-negative bacilli, and Staphylococcus aureus.
  • Chest X-rays (CXRs) may show varied presentations depending on the pathogen.

Parotid Gland Swelling

  • A patient with chronic parotid gland swelling not responding to antibiotics, and without increasing swelling, suggests a diagnostic test for diseases other than infections.
  • Fine-needle aspiration (FNA) is the most appropriate diagnostic test.

Chronic Lesions and Fine-Needle Aspiration

  • Chronic lesions in the parotid gland could be due to either tuberculosis or malignancy.
  • Fine-needle aspiration is the most effective method for distinguishing if the lesion is infectious or malignant.
  • Imaging techniques like radiographic studies can identify the extent of the lesion, but they are often not diagnostic.

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