Resp-TB, RF... Flashcards
What is latent TB?
Infected with the TB bacteria but do not have the signs and symptoms of the active disease. Only 1 in 10 infections result in disease
What is the primary complex of TB?
Lesion (Ghon focus) and draining gland
Usually asymptomatic
Skin text conversion
What are the symptoms of respiratory TB?
Primary infection usually asymptomatic May be non-specific Often constitutional only Tirednedd and malasia Weight loss and anorexia Fever (low grade or hectic) Cough most common Breathlessness indicative of pleural effusion Haemoptysis occasionally
What are the signs of resp TB?
Nonspecific
Pallor
Fever
Evidence of weightless
Clubbing in extensive or longstanding disease only
Often no signs in the chest despite marked radiological abnormality
Localized wheezing if bronchial narrowing
Cervical nodes palpable
Who is at risk of developing active disease after latent infection of TB?
IV drug abusers HIV cases Solid transplant recipients Haematological malignancy Chronic renal failure/haemodialysis Anti TNF alpha treatment Silicosis Underweight Vitamin D deficiency? Iron deficiency?
What is erythema nodosum?
Red nodules beneath the skin, commonly on the shins. Often no trigger but TB can
What are the mechanisms of post-primary TB?
Direct progresion
Reactivation
Haematogenous spread
Exogenous reinfection
What is haemoptysis?
Coughing of blood from the respiratory tract below the level of the larynx
When might haemoptysis occur in TB?
May occur in active cavitating disease More common in post-TB bronchiectasis Rausmussen's aneurysm in old TB cavity Mycetoma in old TB cavity Broncholithiasis
What is a Rasmussen’s aneurysm?
Pulmonary artery aneurysm adjacent or within a TB cavity
Is pleural TB more common in males or females?
Males
What are the mechanisms for pleural involvement in TB?
- Hypersensitivity response in primary infection may cause acute pleuritic price with fever
- TB empyema with ruptured cavity - has tendency to burrow through chest wall
Who is lymph node TB most common in?
Females
Asians
How does Lymph TB present/
Often painles
Most commonly in neck
Discrete swelling to marked inflammation of the rupture
Intra-thoracic node may collapse bronchi
What can osteo-articular TB cause?
Peripheral arthritis Osteomyelitis Dactylitis Tenosynovitis Poncet's disease - aseptic polyarthritis of knees, ankles and elbows. Cultures negative and X-rays normal
What is TB spondylitis?
Most common form of osteo-articuar TB
Starts generally in sub-chondral bone and spreads to vertebral bodies and joint space
Follows longitudinal ligaments
Mainly lower thoracic and upper lumbar spine
What causes miliary TB?
Bacilli spreading through the blood stream, either during primary infection or as reactivation (elderly in low prevalence countries)
What organs are involved in miliary TB?
Lungs always involved, other organ involvement variable.
Headaches sugget meningeal involvement
How doe miliary TB present?
Headache (suggests meningeal involvement) Few resp symptoms Pericardial, pleural effusions small Ascites may be present Retinal involvement (children)
Discuss chronic “cryptic” miliary TB.
Usually in over 60s High mortality Insidious onset Weightloss, lethargy and interittent fever High index of suspicion required Not infrequently found at post-mortem
WHat is the ABC of chest imaging?
Airway - trachea Breathing - lungs Circulation - heart Disability - bones Everything else
WHy might there be no air in the lung?
Removed
Collapsed
Consolidated
Fluid filled
What is the interstitium and what does it do?
Between the alveoli and capillaries. Trafficking of cells between them, inflammatory cells in response
What other structures does interstitial disease effect?
Acini Alveoli lumen Bronchiolar lumen Bronchioles Epithelial, endothelial, mesenchymal, macrophages and recruited inflammatory cells affected
