Pleural Effusion and PTB Flashcards
The membrane covering the lungs
Visceral pleura
The membrane covering the surface of the chest wall
Parietal pleura
Are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing
Pleura
The inflammation of both layers of the pleurae
Pleurisy/ Pleuritis
A collection of fluid in the pleural space
Pleural effusion
The normal pleural fluid amount
10-20 ml
Why is there a need to have a small amount of fluid in the pleural space?
That fluid acts as a lubricant that allows the pleural surfaces to move without friction
Is performed to remove fluid, to obtain a specimen for analysis, and to relieve dyspnea and respiratory compromise caused by pleural effusion
Thoracentesis
Mode of transmission of PTB
Airborne, through an infected person’s cough, sneeze, laugh
An infectious disease caused by M.tuberculosis that primarily affects the lung parenchyma but can also affect the meninges, kidneys, bones, and lymph nodes
Pulmonary Tuberculosis
The causative agent of PTB
Mycobacterium tuberculosis
Risk factors of PTB
TBRISK- CPH Tight living quarters Below or at the poverty line Refugee (immigrant) Immune system compromised Substance abusers Kids below 5 years old Close contact Pre-existing med condition Health worker
Signs and Symptoms of PTB
Low- grade fever
night sweats
cough more than 3 weeks
weight loss
Initial host defense against PTB
Mucociliary System (mucus and cilia) Mucus catches the foreign substance, the cilia navigates the mucus and its entrapped particles upward for removal
Immune system reacting on PTB
Alveolar macrophages- engulf the bacteria
Mycobacterial Lipoarabinomannan- macrophage receptor
Complement protein C3- binds with the cell wall and enhances recognition of the mycobacteria by macrophages
Are readily available phagocytic cells that combat many pathogens without requiring previous exposure to the pathogens
Macrophages
How long is the bacterial cell division after being ingested by macrophages?
25 to 32 hours
Produced by macrophages in an attempt to degrade the bacteria (in PTB)
proteolytic enzymes
cytokines
Assessment and Diagnostic Findings for PTB
History, physical examination Mantoux test/ Tuberculin skin test Chest x-ray Acid-fast bacillus smear Sputum culture and sensitivity
A tool for screening for TB and for TB diagnosis. Named after Charles Mantoux
Mantoux test/ tuberculin skin test
An inactivated purified protein fraction obtained from a human strain of mycobacterium tuberculosis and antigen that induces a delayed hypersensitivity response after a few hours following administration
PPD- purified protein derivatives
Determines if someone has developed an immune response to the bacterium that causes tuberculosis
PPD test
Interpretation of results of the tuberculin test
0-4 mm- not significant
5 mm greater- positive for patients, does not necessarily mean that active disease is present in the body
10mm greater- patient exposed to m.tuberculosis or has been vaccinated with BCG vaccine,
Does positive result PPD indicate active TB?
No, not always. Need to perform cxr and sputum culture
Classifications of TB
Class 0: no exposure; no infection
Class 1: exposure; no evidence of infection
Class 2: latent infection; no disease (positive PPD but no clinical evidence of active TB)
Class 3:disease; clinically active
Class 4: disease; not clinically active
Class 5: suspected disease; diagnosis pending
Resistance to one of the first- line anti tuberculosis agents in a person who has not had previous treatment
Primary drug resistance
Resistance to one or more anti tuberculosis agents in a patient undergoing therapy
Secondary or acquired drug resistance
Resistance to two agents: INH and rifampin
Multidrug resistance
Where do you put a patient with possible TB?
Private room with negative pressure
COntinue isolation until sputum smears are negative for ______.
3 consecutive determinations; usually after approximately every 2-4 weeks
The five first-line medications for PTB
PERIS Pyrazinamide Ethambutol Rifampin Isoniazid (INH) Streptomycin
After 8 weeks of this medication regimen, _______ can be discontinued and _____ and ______ are administered for an additional 4 months.
Pyrazinamide
INH and rifampin
