Lower Tract Infections

Question 1

how is TB spread

Answer 1

through respiratory droplets in the air

Question 2

what is pulmonary TB

Answer 2

where the infection only effects the lungs

Question 3

where else may be infected in extra pulmonary TB

Answer 3

bone, kidneys, lymph nodes, brain and larynx

Question 4

what is the treatment for TB

Answer 4

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

Question 5

why are 4 drugs given in the treatment of TB

Answer 5

to prevent resistance developing

Question 6

what are the symptoms of TB

Answer 6

fever, night sweats, weight loss, sputum, coughing up blood, pleuritic chest pain, breathlessness

Question 7

what is miliary TB

Answer 7

where the bacteria is spread to all parts of the body through the blood

Question 8

what increases the risk of miliary TB

Answer 8

severe malnourishment or immunosuppression

Question 9

what will be seen on a chest x-ray in TB

Answer 9

consolidation in the apex of the lung

Question 10

why does TB affect the lung apex

Answer 10

as this most oxygenated area of the lung so the aerobic organism moves there

Question 11

what staining is used in TB and why

Answer 11

Ziehl-Neelson staining as gram staining can’t go through the fatty cell wall of the bacteria

Question 12

what organism causes TB

Answer 12

Mycobacterium tuberculosis

Question 13

what is the Tuberculosis sensitivity test

Answer 13

where some TB antigens are injected under the skin - if your T cells are already sensitised then you will get a red circle appear at the site of injection

Question 14

how do you get false positives with the TST

Answer 14

from the BCG vaccination

Question 15

how do you get false negatives from the TST

Answer 15

being immunosuppressed as you can’t amount a T cell response

Question 16

what is the INF Gamma assay

Answer 16

where a sample of blood is taken and TB antigens are added - sensitised T cells will then produce INF gamma

Question 17

what is bronchitis

Answer 17

inflammation of the airways

Question 18

what are the symptoms of bronchitis

Answer 18

cough, fever, breathlessness, sputum (not purulent)

Question 19

what mostly causes bronchitis

Answer 19

smoking

Question 20

what are the natural preventions to respiratory tract infections

Answer 20

normal flora in upper respiratory tract, cilia, mucus, sneezing/coughing and lymph tissue

Question 21

what are the the symptoms of pneumonia

Answer 21

fever, cough, purulent sputum, shortness of breath, nausea, vomiting, rigor

Question 22

what is pneumonia

Answer 22

inflammation of the parenchyma of the lungs

Question 23

what is lobar pneumonia

Answer 23

where a whole lobe of a lung is affected

Question 24

what is the most common organism causing community acquired pneumonia

Answer 24

streptococcus pneumoniae

Question 25

what is the treatment for community acquired pneumonia

Answer 25

amoxicillin (or doxycycline if allergic)

Question 26

what is the treatment for severe community acquired pneumonia

Answer 26

co-amaxiclav and clarithromycin (works for atypical organisms)

Question 27

what are the outcomes of pneumonia

Answer 27

resolution organisation (healed with fibrous scarring) complications

Question 28

what are the complications of pneumonia

Answer 28

lung abscess, bronchiectasis, empyema

Question 29

what is hospital acquired pneumonia

Answer 29

contraction of the infection 48hours after being in hospital

Question 30

what is the most common causative organism of hospital acquired pneumonia

Answer 30

staphylococcus aureus

Question 31

what is the treatment for community acquired pneumonia

Answer 31

co-amoxiclav

Question 32

what is aspired pneumonia

Answer 32

where you breath in exogenous material

Question 33

how does the histology of TB appear

Answer 33

caseating granulomas with langerhan giant cells

Question 34

describe the pathogenesis of TB

Answer 34

- engulfed by alveolar macrophages - inflammatory response causing the formation of a primary complex - either progression to active disease or latent stage - the latent infection then either self resolves or becomes reactivated to cause post-primary infection

Question 35

what is Ghon's focus

Answer 35

the primary complex formed in TB - where inflammation of the lung parenchyma occurs due to the immune system reacting against the bacteria

Question 36

what cells are most important in the immune response in TB

Answer 36

T cells

Question 37

what increases the risk of reactivation of TB

Answer 37

immunosuppression (HIV, chemotherapy, transplant, steroids) diabetes kidney disease