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RESP > 10. TB > Flashcards

10. TB Flashcards

1
Q

What are the risk factors for TB?

A 
Endemic areas
History of TB or exposure
HIV/AIDS or immunosuppression
Overcrowding
Drug use, homelessness
TNF inhibitors
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2
Q

How is TB spread?

A

Droplets

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3
Q

What factors in a history cause a suspicion of TB?

A

Cough that has lasted weeks to months, not responding to antibiotics
Haemoptysis
Spiking fever
Night sweats and weight loss

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4
Q

What signs can be seen in TB?

A

Clubbing
Monoarthropathy
Erythema nodosum
Scrufuloderma

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5
Q

What is a scrufuloderma?

A

Skin lesions from underlying TB in a lymph node, bone or joint

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6
Q

What other diseases are included in the differential for TB?

A

Lung cancer
Sarcoidosis
Lymphoma

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7
Q

What is the spectrum of disease caused by TB?

A 
Pulmonary
Pleural
Extra-pulmonary
Meningeal
Miliary
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8
Q

Which form of TB produced a very strong antimicrobial response?

A

Pleural

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9
Q

What are common sites of extra-pulmonary TB?

A

Bone
Kidneys
Skin

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10
Q

What investigations should be done into TB?

A

Sputum for ZN stain and culture or PCR for rapid diagnosis
CXR
Mantoux test

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11
Q

What does a positive smear and culture of TB mean?

A

Very infective

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12
Q

What does a negative smear but positive culture mean?

A

Latent TB

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13
Q

What does a positive smear and negative culture mean?

A

Treatment is working as the bacteria are dead

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14
Q

Why does TB often infect the upper lobes of the lung?

A

High V/Q ratio: brought in on high airflow and not cleared due to lower blood flow

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15
Q

What does a 5mm Mantoux test mean?

A

Positive in HIV and recent contacts

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16
Q

What does a 10mm Mantoux test mean?

A

Positive in moderate risk (travel, IVDU)

17
Q

What does a 15mm Mantoux test mean?

A

Positive in no known risk factor

18
Q

What is measured in the Mantoux test?

A

Elevation

19
Q

What causes a false positive Mantoux test?

A

Other mycobacterial infection

BCG vaccine

20
Q

What causes a false negative Mantoux test?

A 
Anergy
Recent TB infection
Very young
Live-virus vaccine
Overwhelming TB
21
Q

What is the treatment for pulmonary TB?

A

Isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months
Isoniazid and rifampicin for 4 months

22
Q

What is the treatment for neuro and miliary TB and why is it given?

A

Corticosteroids: dampen the immune response to dead TB

23
Q

How long is the course of antibiotics for extra-pulmonary TB?

A

9-12 months

24
Q

What are the side effects of isoniazid?

A

Hepatotoxicity

Peripheral neuropathy

25
Q

What is given to prevent peripheral neuropathy in isoniazid treatment?

A

Pyridoxine (vit B6)

26
Q

What are the side effects of rifampicin?

A

Hepatotoxicity

Turns secretions orange

27
Q

What are the side effects of ethambutol?

A

Optic neuritis

28
Q

What are the side effects of pyrazinamide?

A

Hepatotoxicity

29
Q

What TDM is done for a patient being treated for TB?

A

Monitor pre-treatment LFTs and 2 weeks after starting
Drugs should be discontinued if transaminases are >5 times normal
Drugs reintroduced individually and sequentially

30
Q

Define multi-drug resistant TB

A

Resistant to isoniazid and rifampicin

31
Q

Define extremely drug resistant TB

A

Resistant to isoniazid, rifampicin and 3+ classes of second line agents

32
Q

How is latent TB diagnosed?

A

Mantoux test

IGRA

33
Q

What is the treatment for latent TB?

A
  1. isoniazid for 9/12
  2. rifampicin for 4/12
  3. rifapentine and isoniazid for 3/12
34
Q

What is the difficultly in treating someone with TB and HIV?

A

Interactions between HAART and anti-TB drugs

35
Q

What is the BCG vaccine effective in preventing?

A

Childhood miliary TB and TB meningitis

RESP (17 decks)

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