CMN 568 Final Exam Questions
and Answers All Correct
Interferon Gamma Release Assays (IGRAs) - Answer ✔ IGRAs detect M. tb infection by
measuring immune response in blood
Cannot differentiate between TB and LTBI; other tests needed
May be used for surveillance/screening, or to find those who will benefit from treatment
FDA-approved IGRAs are QFT Gold In-Tube and T-Spot.TB test
BCG Vaccine - Answer ✔ Vaccine made from live, attenuated (weakened) strain of M.
bovis
Medical evaluation for TB (CXR) - Answer ✔ Chest abnormalities suggest, but do not
confirm, TB disease
Posterior-anterior view is standard
Apical/posterior areas of upper lobe or superior areas of lower lobe often show
abnormalities
In immunosuppressed (e.g., HIV infected), lesions may have atypical appearance
Treatment for Latent TB Infection (LTBI) - Isoniazid (INH) - Answer ✔ Isoniazid (INH)
9-month daily regimen is preferred: 270 doses within 12 months
Effective for HIV-infected as well as HIV-uninfected persons
Can be given twice weekly via DOT: 76 doses within 12 months
Preferred for children 2-11 years of age
DOT: Directly Observed Therapy: Patient takes medication in front of a medical
provider. Recommended for all regimes.
6-month regimen also generally acceptable: 180 doses within 9 months
Can be given twice weekly via DOT: 52 doses within 9 months
Shorter regimen not recommended for children, immunosuppressed persons, persons
whose x-rays suggest previous TB
Candidates for LTBI treatement - Answer ✔ High-risk persons with positive IGRA test or
TST reaction of ≥5 mm:
HIV-infected persons
Recent contacts of persons with infectious TB
Persons with fibrotic changes on chest radiograph consistent with prior TB
Patients with organ transplants and other immunosuppressed patients
High-risk persons with positive IGRA test or TST reaction of ≥10 mm:
,Recent arrivals (<5 yrs) from high-prevalence areas (e.g., Asia, Africa, Eastern Europe,
Latin America, and Russia)
Injection drug users
Residents and employees of high-risk congregate settings (e.g., correctional facilities,
homeless shelters, hospitals, and long term care facilities)
Mycobacteriology laboratory personnel
Persons with conditions that increase risk for TB:
Silicosis
Diabetes mellitus
Chronic renal failure
Certain cancers (e.g., leukemia and lymphomas, or cancer of the head, neck, or lung)
Gastrectomy or jejunoileal bypass
Weight loss of at least 10% below ideal body weight
Young children <5 years of age; children/adolescents exposed to adults in high-risk
categories
Low-risk persons with positive IGRA test or TST reaction of ≥15 mm:
Persons with no known risk factors for TB generally should not be tested
Targeted testing programs should only be conducted among high-risk groups
If low-risk persons are tested and have positive IGRA test or TST reaction ≥15 mm,
evaluate for LTBI treatment
Close Contacts with Negative IGRA or TST Result - Answer ✔ Some contacts should
be evaluated and treated for LTBI even with negative TB test results:
Young children <5 years of age
Immunosuppressed persons
Others at risk for rapid progression to TB disease once infected
Always rule out TB disease with chest radiograph and medical evaluation before
treating for LTBI
Give LTBI treatment (window prophylaxis) regardless of test result
Retest 8-10 weeks after last exposure to allow for delayed immune response
Treatment for Latent TB Infection (LTBI)- INH-rifapentine (RPT) regimen - Answer ✔
INH-rifapentine (RPT) regimen (12-dose regimen)
INH and RPT given in 12 once-weekly doses under DOT
Offers equal option to 9 months daily INH, but does not replace other treatment options
for LTBI (Table 5.3)
Recommended for treating LTBI in otherwise healthy people ≥12 years of age who had
recent contact with infectious TB, or who had a tuberculin skin test conversion or a
positive blood test for TB infection
INH-RPT regimen (12-dose regimen) (cont.)
Can be considered for specific groups that would benefit (e.g., need to complete
treatment in short time)
12-dose regimen is not recommended for children <2 years, HIV-infected persons on
ART drugs, patients with presumed INH or RIF resistance, women who are or might
become pregnant during treatment
,Patients should be monitored monthly; ask about side effects and assess for signs of
adverse effects
Treatment for Latent TB Infection (LTBI) -Rifampin (RIF) - Answer ✔ Alternative to INH
is 4 months daily RIF: 120 doses within 6 months
Should not be used in HIV-infected persons being treated with some antiretroviral
therapy(ART)
In some instances where RIF cannot be used, rifabutin can be substituted
Special circumstances LTBI treatment - Answer ✔ Pregnancy and Breast-Feeding
9 months of INH daily or twice weekly; give with vitamin B6
If cannot take INH, consult with TB expert
12-dose INH-RPT regimen not recommended for pregnant women; its safety in
pregnancy is not known
Women at high risk for progression to TB disease, especially HIV infected or diabetic,
should not delay LTBI treatment; monitor carefully
Breast-feeding not contraindicated
Incidence of Fever - Answer ✔ One of most common reasons for parents to seek
medical care.
Preschoolers have an average 6-8 febrile illnesses a year.
Definition of fever - Answer ✔ Rectal temperature ≥ 100.4°F
Tympanic temperature - Answer ✔ Not accurate in infants under 3 months
Fever Causes - Answer ✔ Most common Benign viral illness, can also caused by
bacterial or fungal infections, drug reactions including immunizations, malignancies,
autoimmune or metabolic disorders, CNS disorders, excessive environmental
temperatures.
Factors that increase likelihood of serious bacterial illness - Answer ✔ Age under 3
months, history of prematurity, chronic medical conditions such as immunosupression
or aspenia, previous hospitalizations, daycare. Toxic appearance
Non-Toxic appearance - Answer ✔ Strong cry
Consolable
Alert and easy to arouse
Pink skin tones
Good hydration; good turgor, tears, moist mucous membranes
Smiles, responsive to environment
Toxic appearance - Answer ✔ Weak or high pitched cry
Inconsolable
Difficult to arouse
, Pale, ashen, cyanotic, or mottled skin tones
Poor hydration; poor turgor, dry mucous membranes, no tears
No smile, listless, dull, infant won't alert to environment
Signs of serious illness - Answer ✔ Fever greater than 40 (105)
Nuchal rigidity
Petechial skin rash
Seizure activity
Stridor or increased WOB
Physical exam signs of serious infection: Skin - Answer ✔ Petechiae, rashes
Physical exam signs of serious infection: head/neck - Answer ✔ Sunken or bulging
fontanelles, nuchal rigidity
Physical exam signs of serious infection: ears - Answer ✔ Bulging TM, AOM, mastoiditis
Physical exam signs of serious infection: Chest - Answer ✔ Tachypnea, wheezing,
rales, rhonchi
Physical exam signs of serious infection: Heart - Answer ✔ Murmurs
Physical exam signs of serious infection: Abdomen - Answer ✔ Tenderness, distension
Physical exam signs of serious infection: Musculoskeletal - Answer ✔ Refusal to bear
weight or use an extremity, erythema/warmth over joint
Diagnostic tests for fever in infant and young child - Answer ✔ CBC w/ Diff (WBC >
15,000 may indicate SBI. Child with overwhelming sepsis my have WBC <5,000)
UA/ C&S: R/O UTI
CXR: R/O Pneumonia
Lumbar Puncture: R/O meningitis
Blood cultures: R/O Bacteremia
Stools for C&S: R/O Infectious diarrhea
Management of fever in infant < 4 weeks - Answer ✔ Refer to pediatrician
Hospitalization
Full septic workup
IV antibiotics pending culture results
Management of fever in infant 4 weeks - 3Mo - Answer ✔ Toxic appearance:
Refer to pediatrician
Hospitalization
Full septic workup
IV antibiotics pending culture results
