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Semester 3 > Resp Session 7 > Flashcards

Resp Session 7 Flashcards

1
Q

What causes TB?

A

7 closely linked but genetically distinct species of which M.tuberculosis, M.bovis and M.africanum are the most relevant

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2
Q

What is the definition of a clinical case of TB?

A

Infectious individual who is producing infectious droplets

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3
Q

Is M.tuberculosis fast or slow growing?

A

Slow-generation time is 15-20 hrs

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4
Q

How is M.tuberculosis spread?

A

Infected droplets

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5
Q

How easily is M.tuberculosis transmitted?

A

Infectious dose is 1-10 bacilli but needs prolonged exposure

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6
Q

What virulence factors do M.tuberculosis possess?

A

Complex waxes and glycolipids in cell wall
Long-chain mycolic acid in wall
Structural rigidity
Able to survive in lower airway macrophages
Acid and alcohol fast
Doesn’t dry in environment

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7
Q

How does an individual exposed to TB not become infected?

A

Not prolonged enough exposure
Insufficient infecting dose
Mucosal barriers

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8
Q

How does an individual exposed to TB clear the infection?

A

95% of infections will self cure due to effective immune response

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9
Q

How does an individual exposed to TB contain the infection?

A

Mounts T-lymphocyte response to intracellular infection in local lymph nodes to form Gohn’s focus and draining lymph nodes

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10
Q

Describe the epidemiology of TB.

A

1/3 of the world’s population infected with the majority in Africa, Asia and Latin America. In UK leaks of case reports in non-UK born young adults and elderly

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11
Q

How does an individual exposed to TB develop latent infection?

A

Mycobacteria remain in lung focus and multiply but do not cause damage due to immune control by cell-mediated immune response

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12
Q

How does an individual exposed to TB develop active/primary TB?

A

Immune destruction of the lungs by response to causative agent –> S/S and visible X-ray changes

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13
Q

How does primary TB usually present?

A

Usually pulmonary but can be extra-pulmonary in miliary or disseminated TB seen in the larynx, brain, kidney, bone

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14
Q

How does latent TB develop into post primary TB?

A

Exogenous reinfection/reactivation leads to immune destruction of lungs

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15
Q

Why must all suspected and confirmed cases of TB have an HIV test?

A

Risk of post primary TB increases with immunocompromise

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16
Q

How is active TB identified?

A

Blood test usually +ve
CXR abnormal
Smears and cultures +ve
Cough, fever, weight loss

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17
Q

Are pts with primary TB infectious?

A

Yes

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18
Q

How do the tubercle bacilli differ in active and latent TB?

A

Active and multiplying in active

Inactive and contained in latent

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19
Q

How does latent TB present?

A

IFN-alpha results +ve due to immune response
CXR normal
Smears and sputum -ve
No S/S

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20
Q

Are pts with latent TB infectious?

A

No

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21
Q

Where are caseating granulomas found in TB?

A

Anywhere there is infection e.g. Lung parenchyma, mediastinal lymph nodes, hilar lymph nodes, liver

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22
Q

When do cavities form in the pathogenesis of caseating granulomas?

A

When responding cells successfully remove the caseous dead cell material

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23
Q

What are the responding cells present in a caseating granuloma?

A

Lymphocytes
Epithelioid cells
Langhans cells

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24
Q

How is TB controlled in the community?

A

Treat index cases –> notify PHE –> contact tracing –> identify primary and secondary cases

Vaccinate and prevent transmission

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25
Q

Which pts fit into the index of suspicion for TB?

A 
Non-UK born
HIV
Immunocompromise
Homeless
IV drug users
Close, prolonged contacts
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26
Q

What Hx leads to a suspicion of TB?

A 
Ethnicity
Recent arrival/travel
Contact with TB
BCG vaccination
Specific clinical features: fever, weightloss, malaise
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27
Q

What S/S are seen in pts with TB?

A 
General chronic inflammation symptoms +
Cough
Haemoptysis
SoB
\+/- CXR abnormalities and pleural involvement
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28
Q

What does SoB in a pt with TB indicate?

A

Pleural effusion

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29
Q

What investigations can be performed in assessment of suspected TB?

A 
CXR
Microscopy
Culture
Speciation
Tuberculin skin test
Interferon-gamma-releasing assays
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30
Q

How does the CXR of a pt with TB appear?

A

Ill defined, patchy consolidation with cavitation

Healing –> fibrosis

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31
Q

How many samples are taken for microscopy in TB investigation?

A

3xearly morning

32
Q

How long does culture of TB take?

A

6 weeks

33
Q

How does speciation investigate TB?

A

Confirms pathogen identity by examining DNA

Looks at drug sensitivity

34
Q

How does the tuberculin skin test investigate TB?

A

Measures cell-mediated immunity to TB antigen (non-specific as shared between strains)

35
Q

What is a +ve tuberculin skin test?

A

Visible reaction 2/3 days later

36
Q

How does interferon-gamma-releasing assay investigate TB?

A

Measures release of interferon-gamma from interaction between mycobacterium and T-lymph but doesn’t distinguish between latent and active infection

37
Q

What is the first line treatment for TB?

A 
Rifampicin (R)
Isoniazid (H)
Pyrazinamide (Z)
Ethambutamol (E)
3/4 for 2/12 and then R&H for 4/12
Vitamin D and surgery as needed
38
Q

When is first line TB treatment extended to 8/12?

A

In CNS TB

39
Q

What are the S/E associated with each of the drugs used in first line TB Tx?

A 
R= orange secretions
H= peripheral neuropathy and hepatotoxicity
Z= hepatotoxicity
E= visual disturbance
40
Q

When are second line treatments used for TB?

A

Drug resistant strains

41
Q

What are second line treatments for TB?

A

Quinolones

42
Q

How can extra-pulmonary TB present?

A

Lymphadenitis - scrofula, cervical CNS, abscesses
GI
Peritoneal - ascetic or adhesive
GU - renal disease
Bone and joint disease - spine/Pott’s disease
Meningitis

43
Q

How can TB spread to the GI system?

A

Swallowing of tubercles

44
Q

What is the pathogenesis of miliary TB?

A

Bacilli –> bloodstream –> widespread infection

45
Q

When does miliary TB occur?

A

During primary infection or reactivation

46
Q

Describe the organ involvement in miliary TB.

A

Lungs always involved but few resp S/S

Often multiple organ involvement –> meningeal, pericardial, ascites, retinal S/S

47
Q

Why must compliance be carefully monitored in Tb treatment?

A

To decrease risk of MDR strains

48
Q

Describe the epidemiology of lung cancer.

A

Causes most cancer related deaths worldwide
After pancreatic cancer has worst 5yr survival rate
1 yr survival rate is also poor
Most pts 60-80 y.o.

49
Q

What are the risk factors for developing lung cancer?

A 
Smoking
Asbestos
Radon
Occupational carcinogens
Genetics
50
Q

What does TNM staging examine?

A

T: tumour size, number and local invasion
N: nodes involved
M: metastasis in or out of chest

51
Q

How do the treatment options for lung cancer vary with staging?

A

Staging ranges from IA to IV
As staging increases treatment moves from surgical with curative intent –> chemo/radiotherapy with curative intent –> palliative care which may include radiotherapy to Tx symptoms

52
Q

What imagine is used to assess lung cancer?

A

CXR for all pts
CT scan for metastases
PET scan examines whole body
MRI, ultrasound, bone scan, echocardiogram as necessary

53
Q

When is a CT scan not carried out in lung cancer?

A

It curative Tx would not be offered

54
Q

What methods of tissue sampling are used in lung cancer?

A

Bronchoscopy
US guided
Surgical

55
Q

In cases of metastasis in lung cancer would you biopsy the primary tumour or metastasis and why?

A

Metastasis to prove cancer and assess staging with one invasive procedure

56
Q

What are the S/S of lung cancer?

A

Often asymptomatic
Primary tumour: cough, dyspnoea, chest/shoulder pain, weight loss, malaise
Regional metastases: bloated face, LRN obstruction, dyspnoea, dysphagia, chest pain
Distant metastases: CNS symptoms
Hypercalcaemia, hyponatraemia, anaemia, finger clubbing

57
Q

What type of tumour accounts for ~80% of lung cancers?

A

Non-small cell: squamous cell carcinoma, adenocarcinoma, large cell carcinoma

58
Q

What types of tumour form ~20% of lung cancers?

A

Small cell and rare tumours e.g. carcinoid

59
Q

What can be used to give a more personalised Tx in lung cancer?

A

Gene mutations can be detected and utilised to personalise Tx

60
Q

What are the 6 stages of performance status used when assessing a pt with lung cancer?

A

0: fully active with no restriction
1: restricted in physically strenuous work
2: ambulatory and self caring. Mobile >50% of waking hours
3: limited self care. Mobile

61
Q

At what performance stage is no radical Tx considered and therefore no need for biopsy?

A

3-5

62
Q

When is surgery used to treat lung cancer?

A

Mostly non-small cell which gives best chance of cure

63
Q

What is the difference between neoadjuvant and adjuvant chemotherapy?

A 
Neoadjuvant = before surgery to shrink tumour
Adjuvant = after surgery
64
Q

What treatment options are available for lung cancer?

A 
Surgery
Radiotherapy
Combination chemotherapy
Combination therapy
Targeted biological therapies
Palliative care
65
Q

What is the single biggest cause of preventable and avoidable mortality?

A

Smoking

66
Q

What cancers are associated with tobacco smoking?

A 
Head or neck
Lung
Leukaemia
Kidney
Stomach
Pancreas
Colon
Bladder
Cervix
67
Q

What chronic diseases are associated with tobacco smoking?

A 
Stroke
Blindness
Gum infection
Aortic rupture
Heart disease
Pneumonia/chronic lung disease/asthma
Decreased fertility
Hip Fx
68
Q

What causes addiction in tobacco smoking?

A

Nicotine

69
Q

What are markers of addiction?

A

Use despite know,edge of harmful consequences
Cravings during abstinence
Failure of attempts to stop
Withdrawal symptoms during abstinence

70
Q

Why does cigarette smoking cause instant satiety of nicotine addiction?

A

Faster delivery than sprays, gums etc

71
Q

Describe the +ve reflex loop which occurs in nicotine addiction.

A

Nicotine on ACh receptors –> dopamine release –> satiety –> chronic exposure to nicotine causes ACh receptors to be upregulated –> increased affinity and functional sensitivity –> decrease in nicotine causes withdrawal –> nicotine on receptors etc

72
Q

What acts in addition to the +ve reflex loop to provide satiety in cigarette smoking?

A

Sensation of smoke hitting back of throat

73
Q

Ask: record smoking status
Advise: health benefits
Act: build confidence, refer for help, prescribe NRT

A

How should HCPs approach smoking cessation?

74
Q

What is recommended if smoking cessation cannot be completed by pt?

A

Harm reduction by smoking less in the long term/abstinence for an agreed period of time/e-cigarettes

75
Q

Why are e-cigarettes considered to be an effective harm reduction approach to tobacco smoking?

A

They have variable nicotine content and no tobacco

76
Q

How long does it take for ACh receptors to desensitise from nicotine binding?

A

6-12 was

Semester 3 (50 decks)

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