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Respiratory > 1: Pulmonary TB > Flashcards

1: Pulmonary TB Flashcards

1
Q

What is TB

A

Infection mycobacterium tuberculosis

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2
Q

In which gender is TB more common

A

Males

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3
Q

Which countries have a higher incidence of TB

A 
India 
Indonesia
China
Nigeria 
Pakistan
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4
Q

What type of organism is mycobacterium TB

A

Gram positive acid-fast bacilli

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5
Q

what causes TB in 95%

A

Mycobacterium tuberculosis

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6
Q

what does mycobacterium bovis cause

A

GI TB

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7
Q

what causes mycobacterium bovis infection

A

Ingestion cow’s milk

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8
Q

what are 5 RF for mycobacterium TB

A
  • Immunosuppressed
  • Alcoholism
  • DM
  • Malnutrition
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9
Q

what are at-risk groups for TB

A
  • Healthcare workers
  • Prison workers
  • Immigrants
  • Alcoholics
  • HIV
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10
Q

when is TB contagious

A

during active infection

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11
Q

what are constitutional of TB

A
  • Weight Loss
  • Night sweats
  • Lymphadenopathy
  • Malaise
  • Fever
  • Fatigue
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12
Q

what are pulmonary symptoms of TB

A

Dyspneoa

Haemoptysis

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13
Q

how does TB lymphadenitis present

A

painless enlarged cervical and supra-clavicular nodes

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14
Q

which region does GI TB usually affect

A

ileocaecal valve

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15
Q

how does GI TB present clinically and why

A
  • colicky abdominal pain and vomiting. Inflammation leads to strictures which causes secondary BO
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16
Q

what is pott’s disease

A

Tuberculosis spondylitis

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17
Q

how does spinal TB present

A

Tenderness and pain over spine

Rare to have neurological symptoms

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18
Q

what is miliary TB

A

Dissemination multiple foci (2mm) around the lung - giving a millet seed appearance on CXR

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19
Q

what is CNS TB

A

infection brain and meninges

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20
Q

what are 3 risks for CNS TB

A

HIV
Immunocompromised
Under 3-years

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21
Q

what is GU TB

A

Infection GU tract presents with flank pain, dysuria and haematuria

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22
Q

what can GU TB cause in women

A

Infertility

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23
Q

what can GU TB cause in men

A

Prostatitis

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24
Q

what is cardiac TB

A

Pericarditis

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25
Q

what skin deformity does TB cause

A

lupus vulgaris: red-brown nodules on the face which then rupture and develop into ulcers

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26
Q

Explain primary tuberculosis infection

A

TB enters lungs (Inferior) where it is phagocytosed by macrophages. TB inhibits fusion of lysosome and phagosome enabling proliferation of bacteria = primary infection

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27
Q

What happens after primary infection

A

3W later: cell mediated response amounts which forms a granuloma surrounding TB. Cells in middle die making it a caseous necrosis

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28
Q

Explain Ghon Focus

A

Granuloma and caseous necrosis

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29
Q

What is a Ghon complex

A

TB in granuloma may spread directly to lymph nodes which is then termed a goon complex

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30
Q

What happens if individual becomes immunocompromised

A

TB may re-activate and spread to upper part of the lung

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31
Q

Why does TB spread to upper region of lung

A

More aerated

32
Q

What happens once TB has spread

A

May spread haematogenously - causing miliary TB

33
Q

what will be seen on CXR in TB

A
  • Hilar lymphadenopathy

- Ghon complex (Lower/Middle lobe)

34
Q

what does upper lobe cavitation on CXR indicate

A

re-activation of TB

35
Q

what else can be seen on CXR in TB

A

miliary seed appearance

36
Q

what investigations are ordered in TB

A 
CXR 
Sputum Smear 
- and NAAT
Sputum Culture 
HIV Test
37
Q

how many specimens are required for sputum smear

A

3 specimens - one must be early morning sample

38
Q

what is used to test for TB on sputum smear

A

Zeihl-Neelsen stain

39
Q

how will TB present on ziehl nelson stain

A

Red

40
Q

what medium is used to culture TB

A

Lowenstein-Jensen

41
Q

what is gold-standard for TB diagnosis

A

Sputum culture

42
Q

what is problem with sputum culture

A

Liquid: 1-3W

Solid culture: 4-8W

43
Q

how will TB present in lowenstein-jensen agar

A

Rough, Buff and Tough

44
Q

what test is used for rapid TB diagnosis

A

NAAT

45
Q

explain nucleic acid amplification testing

A
  • looks for DNA or RNA of M.tuberculosis in sputum.

- results take less than 8h

46
Q

what test should be offered for all individuals with TB

A

HIV Test

47
Q

what is offered to household contacts of someone with TB

A

Mantoux testing

48
Q

what is tuberculin skin testing also called

A

Mantoux testing

49
Q

what is the Mantoux test

A

Purified protein derivative of TB is injected into the skin. Left 48-72h and then size of induration is measured

50
Q

what is the Mantoux test used for

A

Screen for latent TB

51
Q

what diameter of induration is negative for TB

A

<6mm

52
Q

what does 5mm diameter on Mantoux mean

A
  • Has not been exposed to TB or is unvaccinated
53
Q

how should those less than 6mm be managed

A
  • Give BCG vaccine
54
Q

what does induration 6-15mm mean

A

Hypersensitive to TB - either due to previous vaccination or exposure

55
Q

what does induration more than 15mm mean

A

Hypersensitive to TB - due to previous infection

56
Q

what is a test used when Mantoux test is equivocal

A

Interferon gamma release assay (IGRAS)

57
Q

what does IGRAS do

A

Measures concentration of interferon released from T-cells

58
Q

explain notification of TB

A

TB is a notifiable disease - inform CDC in 3-days

59
Q

what are 5 causes of false negatives on Mantoux test

A
  • Lymphoma
  • Miliary TB
  • Sarcoidosis
  • Young Child
  • HIV
60
Q

explain drug management in TB

A

4 for 2 and 2 for 4:

Give rifampicin, isoniazid, pyrazinamide and ethambutol for two months.

Give rifampicin and isoniazid for 4-months

61
Q

how is treatment success defined

A

completion therapy and negative sputum smear

62
Q

how is CNS TB managed

A

RIPE - for 2 months
RI for 10 months
+ dexamethasone

63
Q

why are steroids given in CNS TB

A

as TB cells rupture release antigens causing further immune response which can cause oedema and raise ICP

64
Q

what are 2 side effects of rifampicin

A
  • Orange secretions

- Hepatotoxicity

65
Q

what are 2 side effects of isoniazid

A
  • Hepatoxocitioy

- Peripheral polyneuropathy

66
Q

what is given with isoniazid to prevent peripheral polyneuropathy

A

Pyroxidine (vitamin B6)

67
Q

what. are 4 side effects of pyrazinamide

A
  • High Uric Acid
  • Hepatotoxicity
  • Arthralgia
  • Myopathy
68
Q

what is a side effect of ethambutol

A

Optic neuritis

69
Q

how is ethambutol monitored

A

Decease colour vision

70
Q

what is multi drug-resistant TB

A

Resistant to rifampicin and isoniazid

71
Q

what is extensively drug resistant TB

A

Resistant to rifampicin, isoniazid, one other injectable agent and fluoroquinolone

72
Q

how is TB infection prevented

A

BCG vaccine

73
Q

what infants are vaccinated against TB

A

Infants born in region where TB incidence is more than 40 in 100,000

74
Q

if exposure to someone with TB how is person investigated

A

CXR

Tuberculin skin test

75
Q

if positive following exposure what is done

A

treat for active TB

76
Q

if negative following exposure what is done

A

treat for latent TB (vaccinate)

Respiratory (19 decks)

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