Quiz: Tuberculosis


TuberculosisOnline version PBL quiz by Mimi 1 A 32-year-old man presents with a persistent cough for four weeks, night sweats and weight loss. His sputum microscopy reveals bright red rod-shaped organisms when stained. Which investigation was used to detect these organisms? a Interferon-gamma release assay b Ziehl-Neelsen staining of sputum smear microscopy c Tuberculin skin test d Chest X-ray e CT scan 2 Which individual is at the highest risk of developing active tuberculosis? a Healthy 45-year-old with no known exposures b 25-year-old nurse working in a hospital respiratory ward c 21-year-old university student who smokes occasionally d 30-year-old teacher who travels once yearly e 35-year-old living alone in well-ventilated housing 3 A patient undergoes a tuberculin skin test. Which feature determines a positive test? a Area of redness after 48 hours b Physician’s assessment of pain c Amount of interferon-gamma released d Induration of ≥5mm depending on risk category e Skin ulceration near the injection site 4 Which finding is characteristic of granulomatous inflammation in TB? a Purulent exudate dominated by neutrophils b Caseous necrosis with yellow-white cheese-like appearance c Absence of macrophages d Fibrosis without necrosis e Rapid destruction of bacteria by macrophages 5 A chest X-ray of a TB patient shows a well-defined lung lesion with associated hilar lymph node enlargement. What is the term for this combined finding? a Cavitary lesion b Miliary spread c Ghon focus d Ghon complex e Pott’s disease 6 Which best describes cavitation in active pulmonary TB? a Results only from fibrosis b Formed due to caseous necrosis and tissue destruction c Found only in latent TB d Not associated with transmission e Indicates complete healing 7 A patient with HIV has a CD4 count of 150 cells/ml. What type of TB are they most likely to develop? a Latent TB b TB meningitis only c Primary progressive TB d Secondary TB e Miliary TB only 8 Which factor contributes to the failure to eradicate TB? a High mortality only in wealthy countries b No vaccine available c Latent infection and drug-resistant strains complicate control d Transmission requires direct skin contact e The bacterium survives poorly in dry conditions 9 A 50-year-old man with diabetes presents with cough, fever and night sweats. Which chest X-ray finding is most suggestive of active TB? a Hyperinflated lungs b Increased vascular markings c Consolidation and cavitation d Air-trapping e Calcified pleural plaques 10 A 41-year old man presents with a 6-week history of fatigue, fever, night sweats and significant weight loss. He reports persistent cough producing purulent sputum and occasional blood. On examination, he has enlarged cervical lymph nodes. Chest X-ray shows cavitation in the upper lung fields. His HIV test is positive, and laboratory results show a CD4 count of 180 cells/ml. a His CD4 level suggests typical secondary TB with low likelihood of extra-pulmonary spread b His symptoms indicate latent TB infection controlled by the immune system c His immunosuppression places him at high risk of developing primary progressive TB with increased extra-pulmonary involvement d His disease is unlikely to be infectious due to cavitation e His cavitating lesions indicate miliary TB of the lung and spleen Feedback 1 Sputum smear microscopy detects acid-fast bacilli (AFB) using the Ziehl-Neelsen stain, which appear as bright red rods against a dark background. This is explicitly stated in the transcript: the staining method shows “bright red rods” and confirms active TB. 2 Healthcare workers as a high-risk exposure group because of their increased contact with TB-infected patients. 3 The measurement used is induration (raised area), not redness. A result of ≥5mm may be positive in high-risk individuals (e.g., HIV, recent contacts). The transcript details how different risk groups interpret induration size. 4 TB granulomas may develop caseous necrosis which is yellow-white cheese-like, and is unique to TB infection. 5 A Ghon complex = Ghon focus + affected regional lymph nodes. 6 Cavities form when TB bacteria cause tissue destruction and liquefaction of caseous necrosis, creating hollow spaces that act as reservoirs for bacteria. 7 CD4 >300 - secondary TB CD4 <200 -primary progressive TB, with higher risk of disseminated/extrapulmonary disease. 8 Factors preventing eradication: latent infection, drug resistance, HIV comorbidity, diagnostic difficulty, global movement, and social inequity. 9 Active TB typically shows features such as cavities, infiltrates and consolidation, reflecting tissue destruction and necrosis. 10 TB risk and pattern in HIV depends on CD4 count: CD4 >300 = usual secondary TB CD4 <200 = primary progressive TB, with increased frequency of extra-pulmonary spread. This patient has CD4 = 180, making primary progressive TB most likely. He already shows extra-pulmonary signs (lymphadenopathy) and cavitation on X-ray. Cavitation increases infectiousness, not the opposite. Miliary TB is described separately as tiny seed-like lesions, not cavitation.

1

A 32-year-old man presents with a persistent cough for four weeks, night sweats and weight loss. His sputum microscopy reveals bright red rod-shaped organisms when stained. Which investigation was used to detect these organisms?

a

Interferon-gamma release assay

b

Ziehl-Neelsen staining of sputum smear microscopy

c

Tuberculin skin test

d

Chest X-ray

e

CT scan

2

Which individual is at the highest risk of developing active tuberculosis?

a

Healthy 45-year-old with no known exposures

b

25-year-old nurse working in a hospital respiratory ward

c

21-year-old university student who smokes occasionally

d

30-year-old teacher who travels once yearly

e

35-year-old living alone in well-ventilated housing

3

A patient undergoes a tuberculin skin test. Which feature determines a positive test?

a

Area of redness after 48 hours

b

Physician’s assessment of pain

c

Amount of interferon-gamma released

d

Induration of ≥5mm depending on risk category

e

Skin ulceration near the injection site

4

Which finding is characteristic of granulomatous inflammation in TB?

a

Purulent exudate dominated by neutrophils

b

Caseous necrosis with yellow-white cheese-like appearance

c

Absence of macrophages

d

Fibrosis without necrosis

e

Rapid destruction of bacteria by macrophages

5

A chest X-ray of a TB patient shows a well-defined lung lesion with associated hilar lymph node enlargement. What is the term for this combined finding?

a

Cavitary lesion

b

Miliary spread

c

Ghon focus

d

Ghon complex

e

Pott’s disease

6

Which best describes cavitation in active pulmonary TB?

a

Results only from fibrosis

b

Formed due to caseous necrosis and tissue destruction

c

Found only in latent TB

d

Not associated with transmission

e

Indicates complete healing

7

A patient with HIV has a CD4 count of 150 cells/ml. What type of TB are they most likely to develop?

a

Latent TB

b

TB meningitis only

c

Primary progressive TB

d

Secondary TB

e

Miliary TB only

8

Which factor contributes to the failure to eradicate TB?

a

High mortality only in wealthy countries

b

No vaccine available

c

Latent infection and drug-resistant strains complicate control

d

Transmission requires direct skin contact

e

The bacterium survives poorly in dry conditions

9

A 50-year-old man with diabetes presents with cough, fever and night sweats. Which chest X-ray finding is most suggestive of active TB?

a

Hyperinflated lungs

b

Increased vascular markings

c

Consolidation and cavitation

d

Air-trapping

e

Calcified pleural plaques

10

A 41-year old man presents with a 6-week history of fatigue, fever, night sweats and significant weight loss. He reports persistent cough producing purulent sputum and occasional blood. On examination, he has enlarged cervical lymph nodes. Chest X-ray shows cavitation in the upper lung fields. His HIV test is positive, and laboratory results show a CD4 count of 180 cells/ml.

a

His CD4 level suggests typical secondary TB with low likelihood of extra-pulmonary spread

b

His symptoms indicate latent TB infection controlled by the immune system

c

His immunosuppression places him at high risk of developing primary progressive TB with increased extra-pulmonary involvement

d

His disease is unlikely to be infectious due to cavitation

e

His cavitating lesions indicate miliary TB of the lung and spleen

Feedback

1

Sputum smear microscopy detects acid-fast bacilli (AFB) using the Ziehl-Neelsen stain, which appear as bright red rods against a dark background. This is explicitly stated in the transcript: the staining method shows “bright red rods” and confirms active TB.

2

Healthcare workers as a high-risk exposure group because of their increased contact with TB-infected patients.

3

The measurement used is induration (raised area), not redness. A result of ≥5mm may be positive in high-risk individuals (e.g., HIV, recent contacts). The transcript details how different risk groups interpret induration size.

4

TB granulomas may develop caseous necrosis which is yellow-white cheese-like, and is unique to TB infection.

5

A Ghon complex = Ghon focus + affected regional lymph nodes.

6

Cavities form when TB bacteria cause tissue destruction and liquefaction of caseous necrosis, creating hollow spaces that act as reservoirs for bacteria.

7

CD4 >300 - secondary TB CD4 <200 -primary progressive TB, with higher risk of disseminated/extrapulmonary disease.

8

Factors preventing eradication: latent infection, drug resistance, HIV comorbidity, diagnostic difficulty, global movement, and social inequity.

9

Active TB typically shows features such as cavities, infiltrates and consolidation, reflecting tissue destruction and necrosis.

10

TB risk and pattern in HIV depends on CD4 count: CD4 >300 = usual secondary TB CD4 <200 = primary progressive TB, with increased frequency of extra-pulmonary spread. This patient has CD4 = 180, making primary progressive TB most likely. He already shows extra-pulmonary signs (lymphadenopathy) and cavitation on X-ray. Cavitation increases infectiousness, not the opposite. Miliary TB is described separately as tiny seed-like lesions, not cavitation.

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Tuberculosis

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TuberculosisOnline version

by Mimi

A 32-year-old man presents with a persistent cough for four weeks, night sweats and weight loss. His sputum microscopy reveals bright red rod-shaped organisms when stained. Which investigation was used to detect these organisms?

Which individual is at the highest risk of developing active tuberculosis?

A patient undergoes a tuberculin skin test. Which feature determines a positive test?

Which finding is characteristic of granulomatous inflammation in TB?

A chest X-ray of a TB patient shows a well-defined lung lesion with associated hilar lymph node enlargement. What is the term for this combined finding?

Which best describes cavitation in active pulmonary TB?

A patient with HIV has a CD4 count of 150 cells/ml. What type of TB are they most likely to develop?

Which factor contributes to the failure to eradicate TB?

A 50-year-old man with diabetes presents with cough, fever and night sweats. Which chest X-ray finding is most suggestive of active TB?

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