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Block 13 - The Development of Cardiorespiratory Disease > ALS Lecture 4 - Tuberculosis DONE > Flashcards

ALS Lecture 4 - Tuberculosis DONE Flashcards

1
Q

factors that contribute to a person’s likelihood of contracting TB (4)

A

homelessness, IV drugs, AIDS, neglect of TB control programs

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2
Q

look at figures from TB lecture

A

done

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3
Q

TB is concentrated in certain medically underserved populations (6)

A

urban poor, alcoholics, IV drug users, homeless, prison inmates, people born abroad

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4
Q

TB occurs in

A

contact-based micro-epidemics

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5
Q

in first few weeks, host has almost no

A

immune defence against TB

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6
Q

TB bacteria

A

Mycobacterium tuberculosis

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7
Q

unrestrained bacterial multiplication proceeds for weeks, progressing as (3)

A
  1. initial focus
  2. lymphohaematogenous metastatic foci
  3. tissue hypersensitivity, cellular immunity
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8
Q

label the diagram of phagocytosis of mycobacterium tuberculosis by macrophages

A

done

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9
Q

CD4+ cells have a T-cell receptor capable of recognising

A

TB antigens presented by macrophages1

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10
Q

look at pictures of TB granulomas

A

done

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11
Q

label the chest x-rays of primary (miliary) and post-primary TB

A

done

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12
Q

in primary TB (2 steps)

A
  1. rapid destruction of bacteria

2. infective process stopped

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13
Q

after primary TB, what would be the only remaining evidence of infection?

A

positive skin test

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14
Q

miliary TB

A

blood dissemination of TB

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15
Q

post-primary TB infection usually presents in

A

immune deficiency, e.g. old age, alcohol

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16
Q

TB becomes reactivated as (2 steps)

A
  1. macrophage/granuloma break up

2. bronchial spread as necrosis occurs

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17
Q

extra-pulmonary TB is when TB spreads metastatically to

A

any organ, e.g. abdomen, bone, brain, muscle

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18
Q

approximately 30% of TB cases are exclusively

A

extrapulmonary

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19
Q

spinal TB

A

may cause back pain

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20
Q

kidney TB

A

blood in urine

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21
Q

specimen collection in TB

A

3 sputum, smear and culture

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22
Q

bronchoscopy can be done if there is suspicion of

A

TB, no sputum

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23
Q

method to obtain specimens, especially used in children

A

gastric aspiration, get swallowed sputum

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24
Q

CEPHAID test detects

A

TB specific DNA sequences

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25
Q

CEPHAID test is a simple

A

nucleic acid amplification test

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26
Q

CEPHAID test is easy and so good to do in

A

developing countries

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27
Q

Heaf test results

A

bigger the skin reaction (induration), more likely you are to have been exposed to TB

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28
Q

label the diagram of the CEPHAID test

A

done

29
Q

label the diagram of Heaf test grades

A

done

30
Q

IFN-g tests measure cell mediated immune response by measuring

A

IFN-g released by T cells in response to stimulation by Mycobacterium tuberculosis antigens

31
Q

look at the diagram of IFN-g test

A

done

32
Q

baseline diagnostic examinations for TB (3)

A

CXR, sputum specimens, drug susceptibility testing for INH, RIF and EMB

33
Q

other examinations to conduct when TB treatment is initiated (5)

A

HIV test, CD4+ test in HIV, HepB, liver tests, colour vision tests

34
Q

usually in TB, there will be a history of

A

TB exposure

35
Q

to find out whether someone has been exposed to TB we can contact the

A

local health department

36
Q

in TB, we must always consider

A

demographic factors

37
Q

symptoms of TB (4)

A

productive prolonged cough, chest pain, haemoptysis, systemic symptoms (fever, weight loss, night sweats)

38
Q

standard view used for the detection and description of chest abnormalities

A

posterior-anterior radiograph

39
Q

in pulmonary TB, radiographic abnormalities are often seen in

A

apical and posterior segments of upper lobe, superior segments of lower lobe (but may be anywhere)

40
Q

what kind of bacteria is TB?

A

obligate, intracellular (grows inside macrophages)

41
Q

how does TB bacteria grow?

A

slowly

42
Q

how does TB spread?

A

airborne droplets, gets to alveolus

43
Q

Mycobacterium tuberculosis is inhaled, then can be (3 options)

A
  • cleared from body by macrophages, 90%
  • heal with scarring, Gohn focus lies dormant
  • primary progressive disease in immunocompromised
44
Q

primary TB reminds me of… because…

A

shingles, lies dormant and comes back when body is stressed

45
Q

the risk of TB reactivation is highest in the

A

first few years post infection

46
Q

prolonged exposure

A

increases risk and multiple aerosol inocula required

47
Q

brief contact with someone with TB carries

A

little risk

48
Q

infection is unlikely to occur outdoors as

A

aerosol disseminates

49
Q

fomites pose what level of risk?

A

not huge

50
Q

caseous necrosis is inherently unstable, especially in the lungs, where it tends to

A

liquify and discharge through bronchial tree, producing tuberculous cavity

51
Q

we should consider TB treatment initiation when we have a

A

positive AFB smear

52
Q

treatment should not be delayed because of ______ ___ _____ if there is high _____ ____

A

negative AFB smears, clinical suspicion

53
Q

high clinical suspicion includes (3)

A

history of cough/weight loss, CXR findings, emigration from high-incidence country

54
Q

label the 1st line TB drugs mechanism of action diagram

A

done

55
Q

first line drug treatments in TB are (6)

A

Isoniazid, Rifampin, Pyrazinamide, Ethambutol, Rifabutin, Rifapentine

56
Q

Isoniazid MOA

A

targets cell wall synthesis

57
Q

Rifampin MOA

A

inhibits RNA

58
Q

Ethambutol MOA

A

targets cell wall synthesis

59
Q

first 2 months of Tb treatment

A

rifamycin (or Rifampicin/Rifabutin) + isoniazid + pyrazinamide + ethambutol

60
Q

in the next 4-7 months after the first 2

A

rifamycin + iosoniazid

61
Q

in TB treatment we give a _____ supplement, e.g. ____

A

B6, pyridoxin

62
Q

rifampin turns bodily secretions _____, which is good for ______

A

orange, monitoring

63
Q

groups at increased risk for drug-resistance TB include (5)

A
  • history of TB treatment
  • contact with person with drug-resistant TB
  • foreign-born persons from areas with drug-resistantTB
  • smears positive despite 2 months of drugs
  • inadequate treatment for >2weeks
64
Q

multi-drug resistant TB is defined as being resistant to (2)

A

isoniazid, rifampicin

65
Q

multi-drug resistant Tb can be due to (5)

A

poor compliance, single drug therapy, poor calculation, malabsorption, prescribing errors

66
Q

extensively drug resistant TB (XDR TB) is resistant to

A

any fluoroquinolone, at least one injectable second-line drug (capreomycin, kanamycin, amikacin), plus MDR-TB

67
Q

TB is the main opportunistic infection for

A

HIV positive patients

68
Q

look at the table and diagram of map TB

A

done

Block 13 - The Development of Cardiorespiratory Disease (14 decks)

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