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M103 T4 > M103 T4 L12 > Flashcards

M103 T4 L12 Flashcards

1
Q

How is TB spread?

A

by airborne droplets

when it is inhaled, it is deposited in terminal airspaces

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2
Q

How does a patient develop an active primary TB infection?

A

when the TB bacteria transported to the regional lymph node start to multiply inside the macrophage endosome

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3
Q

How does a patient develop an latent TB infection?

A

when the TB bacteria transported to the regional lymph node lie dormant inside the macrophage endosome

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4
Q

If a patient with a latent TB infection is immunocompetent, what is the chance of the bacteria reactivating?

A

15%

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5
Q

If a patient with a latent TB infection is immunocompetent, what is the chance of the bacteria reactivating within the first five years of the primary infection?

A

half of the people that are going to reactivate it will activated within the first five years.

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6
Q

Is TB bacteria aerobic or not?

A

aerobic

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7
Q

How often do TB bacteria divide?

A

16 - 20 hours

slowly

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8
Q

Does TB bacteria have a cell wall and a cell membrane?

A

has a cell wall

doesn’t have a PPLPD cell membrane

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9
Q

Does TB bacteria respond to Gram stains and why?

A

no bc it doesn’t have a PPLPD cell membrane

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10
Q

How is TB bacteria stained?

A

with acid - it is an acid fast bacilli

it retains stains after treatment with acids

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11
Q

What type of necrosis is affiliated with TB?

A

caseation

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12
Q

Where are acid fast bacilli found in TB bacteria when looking down a microscope?

A

in granulomas

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13
Q

Where are acid fast bacilli found in TB bacteria when looking down a microscope?

A

in granulomas

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14
Q

Who are particularly at risk of transmitting TB to others?

A

people who are the close contacts of infectious cases (smear +)
people who have contact with high risk groups
people who are immunedeficient
people who have high risk lifestyle factors

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15
Q

What are two types of high risk groups for TB?

A

High incidence country

Frequent travel to high incidence areas

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16
Q

What conditions would compromise the immunocompetency of pneumonia patients?

A 
HIV
Steroids
Chemotherapy and biologics
Nutritional deficiency (lack of vit D)
Diabetes
End stage renal failure
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17
Q

people who have high risk lifestyle factors

A

Drug/alcohol misuse
Homelessness/hostels/overcrowding
Prison inmates
Genetic susceptibility (twin studies of gene polymorphisms)

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18
Q

Which vitamin is tested for in pneumonia?

A

vitamin D

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19
Q

How is active TB diagnosed?

A

the infected area is identified
the organism is isolated
info regarding susceptibility to antibacterials is obtained

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20
Q

How is latent TB diagnosed?

A

the immune response to TB proteins or TB-specific antigens is identified

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21
Q

What was the most common type of latent screening test?

A

The tuberculin skin test (Mantoux)

22
Q

What are disadvs of the tuberculin skin test?

A

requires a nurse to see the patient on two occasions, one
ideally requires blood tests
the tuberculin can cross react with other mycobacteria antigens
if the patient is really ill or is immunosuppressed, the patient won’t mount a response

23
Q

What is one limitation of the Interferon Gamma Release Assays?

A

cannot tell us is whether there’s active disease

24
Q

What is the most common type of latent screening test?

A

Interferon Gamma Release Assays

25
Q

What does pulmonary TB disease cause?

A

consolidation
cavities (commonly at the top of the lungs)
lung abscesses

26
Q

How does an Interferon Gamma Release Assay work?

A

interferon-gamma is released into the blood following stimulation by specific TB antigen

27
Q

What are two advs of Interferon Gamma Release Assays?

A

More specific than Mantoux

Correlates better with degree of exposure than Mantoux

28
Q

What is a disadv of an Interferon Gamma Release Assay?

A

does not differentiate between latent infection and disease

29
Q

What are the symptoms of pulmonary TB disease?

A 
Cough
Weight loss
Haemoptysis		
Fever
Chest pain			
Night sweats
30
Q

What sites in the body does Extrapulmonary disease occur in?

A 
Lymph nodes
CNS
Bone (Pott’s disease of the spine)
Genitourinary system
GI tract
Disseminated/miliary
31
Q

Which ethnic group is Extrapulmonary disease more common in?

A

non-UK born Asian origin

32
Q

How does TB Lymphadenitis react to treatment?

A

often gets worse on treatment

paradoxical reaction

33
Q

What are the physiological effects of TB Lymphadenitis?

A

Can form sinus tracts with chronic discharge

Cold abscess formation

34
Q

What are the symptoms of TB Lymphadenitis?

A 
fevers
sweats
weight loss 
malaise very common
Respiratory symptoms in majority
GI or CNS symptoms in 20%
35
Q

What are the GI or CNS symptoms in TB Lymphadenitis?

A

Abdominal pain, diarrhoea
Hepatomegaly in 50%
Headache or confusion in 20%

36
Q

How can CNS TB affect the patient?

A

TB meningitis
TB arachnoiditis
Tuberculomas in the brain
Spinal cord compression from extension of discitis

37
Q

What is patient mortality for CNS TB?

A

15-40% (can be high) despite effective treatment

38
Q

How is TB controlled?

A

Government global policy
Early diagnosis AND treatment (even if negative cultures/smear)
Optimal treatment and adherence (DOT/VOT/Section)
Contact tracing

39
Q

How is TB prevented?

A

BCG (Vaccination)

Latent treatment programs - prevent TB becoming active

40
Q

How was TB treated historically?

A

patients sent away to sanatoriums

surgeries to collapse the lung so that the aerobic conditions weren’t as beneficial to the bacteria

41
Q

How long does standard treatment for TB last?

A

a minimum of 6 months

42
Q

What drugs does the initial phase of TB treatment involve?

A

Isoniazid
Rifampicin
Pyrazinamide
Ethambutol

43
Q

How long does the initial phase of TB treatment last?

A

2 months

44
Q

How long does the continuation phase of TB treatment last?

A

4 months

45
Q

What drugs does the continuation phase of TB treatment involve?

A

Isoniazid

Rifampicin

46
Q

How should the patient take TB treatment?

A

they should be taken all together on an empty stomach one hour before breakfast; compliance is essential for cure.

Latent treatment : 3 months Rifampicin/Isoniazid 6 M isoniazid

47
Q

How long does treatment for CNS TB last?

A

12 months

48
Q

How long does the continuation phase of CNS TB treatment last?

A

10 months

49
Q

What are the side effects of Pyrazinamide?

A 
Hepatoxicity
joint pain
N&V
nausea 
skin rashes
50
Q

What are the side effects of Rifampicin?

A

Hepatoxicity
reddish colour to the urine
nausea
skin rashes

51
Q

What are the side effects of Isoniazid?

A 
Hepatoxicity 
fever
peripheral neuropathy 
optic neuritis
nausea 
skin rashes
52
Q

What are the side effects of Ethambutol?

A 
peripheral neuropathy
optic neuropathy 
gout
nausea 
skin rashes

M103 T4 (19 decks)

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