Chapter 20 Drug Therapy for Tuberculosis and Mycobacterium

1. A patient seen in the clinic has symptoms of persistent cough, fever, and night sweats. He recently entered the United States from the Philippines. Which of the following is the most plausible explanation for the patient’s condition?

1. A)  Latent tuberculosis
2. B)  Bacterial pneumonia
3. C)  Active tuberculosis
4. D)  Emphysema

Ans: C

Feedback:

Emigration from countries where the disease occurs, such as the Philippines, places patients at risk for tuberculosis. Active tuberculosis is characterized by symptoms of cough, fever, and night sweats. Patients with latent tuberculosis exhibit no symptoms and do not feel sick. Bacterial pneumonia is not commonly noted with night sweats. Emphysema is not noted with fever.

2. A college student has a TB test prior to starting the semester. The tuberculin test site is noted with a reddened, raised area. What condition will the student be diagnosed with if the chest radiograph is negative?

1. A)  Transmission
2. B)  Primary infection
3. C)  Latent tuberculosis
4. D)  Active tuberculosis

Ans: C
Feedback:
People with inactive or latent TB have no symptoms and do not feel sick. The transmission of the infection occurs when an uninfected person inhales infected airborne particles that are exhaled by an infected person. Primary infection occurs 6 to 8 weeks after exposure. The patient has a mild, pneumonia-like illness that often is undiagnosed. Active tuberculosis is a result from reactivation of a latent infection.

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3. A patient is hospitalized with active tuberculosis. The patient is receiving antitubercular drug therapy and is not responding to the medications. What do you suspect the patient is suffering from?

1. A)  Human immunodeficiency virus
2. B)  Drug-resistant tuberculosis
3. C)  Methicillin-resistant Staphylococcus aureus
4. D)  Vancomycin-resistant Staphylococcus aureus

Ans: B
Feedback:
A patient who is being treated with antitubercular drug therapy and is not responding to the medication regime is most likely experiencing drug-resistant tuberculosis. Human immunodeficiency virus causes tuberculosis to move more rapidly. This scenario does not provide any indication that the tuberculosis is related to the diminished patient response. The scenario does not identify methicillin- or vancomycin-resistant Staphylococcus aureus.

4. A patient being treated for tuberculosis is determined to be drug resistant. Which of the following medications will the patient be resistant to in the treatment of the tuberculosis?

1. A)  Isoniazid (INH) and rifampin
2. B)  Carbamazepine (Tegretol) and phenytoin (Dilantin)
3. C)  Dextroamphetamine (Dexedrine) and doxapram (Dopram)
4. D)  Propranolol (Inderal) and sotalol (Betapace)

Ans: A
Feedback:
Isoniazid (INH) and rifampin are used to treat tuberculosis. In multidrug resistance, the most effective drugs the patient is resistant to are isoniazid and rifampin. Carbamazepine and phenytoin are used to control seizures. Dextroamphetamine and doxapram are central nervous system stimulants. Propranolol and sotalol are beta-adrenergic blocking agents.

5. A patient who was frequently homeless over the past several years has begun a drug regimen consisting solely of isoniazid (INH). What is this patient’s most likely diagnosis?

1. A)  Active tuberculosis
2. B)  Latent tuberculosis
3. C)  Mycobacterium avium complex
4. D)  Human immunodeficiency virus

Ans: B
Feedback:
Although use of INH by itself for treatment of latent TB is appropriate, use with other anti-TB drugs is essential for treatment of active TB. INH would not be used exclusively in the treatment of HIV or MAC.