Respiratory Flashcards
What is tuberculosis?
an infectious disease caused by the mycobacterium tuberculosis bacteria
What is the most common cause of TB?
mycobacterium tuberculosis is the most common causative organism and is an aerobic acid-fast bacilli which is turned bright red against a blue background using the Ziehl-Neelson stain
What are some other mycobacteria which cause TB?
M. africans
M. microtis
M.bovis
What are the risk factors for TB?
Immunocompromised (e.g. HIV or immunosuppressive meds)
Close contacts with TB
Recent travel or immigration from areas of high TB prevalence
People with relatives or close contacts from countries with a high rate of TB
Homeless people, drug users, alcoholics
IVDU
Older age
What is active TB?
active infection in various areas within the body
What is latent TB?
where the immune system encapsulates sites of infection and stops the progression of disease
What is miliary TB>
severe, disseminated disease when the immune system is unable to control the spread/progression
What is extrapulmonary TB?
When infection spreads outside of the lungs (most common site of infection) to lymph nodes, pleura, CNS, pericardium, GI system, GU system, bones + joints, skin (cutaneous TB)
What is the immune response to TB?
- TB phagocytosed but resist killing –> formation of granulomas
- T cells are recruited and central region of granuloma undergoes caseating necrosis (primary Ghon focus, in upper parts of the lung)
- Ghon focus spreads to nearby lymph nodes –> Ghon complex (focus + lymph node spread)
- in most cases, infection is contained within granulomas –> latent TB
- If TB spreads systemically –> miliary TB
What are the key presentation sof TB?
chronic, gradual onset of symptoms
lethargy
fever or night sweats
weight loss
cough +/- haemoptysis
lymphadenopathy
erythema nodosum
spinal pain in spinal TB (Pott’s disease of spine)
What are the investigations for TB?
1st line: Purified Protein Derivative (PPD) - intradermal skin test which looks for previous immune response to TB
GS: Interferon Gamma Release Assay
Other: CXR , cultures
What are the CXR signs of primary TB?
patchy consolidation, pleural effusions and hilar lymphadenopathy
What are the CXR signs of reactivated TB?
patchy or nodular consolidation with cavitation typically in the upper zones, disseminates
What are the CXR signs of miliary TB?
‘millet seeds’ distributed uniformly throughout the lung fields
What are the 4 drugs used to treat acute pulmonary TB?
R - rimfampicin (6mo)
I - isoniazid (6mo)
P - pyrazinamide(2mo)
E- ethambutol (2mo)
What is TLCO?
Total lung diffusion capacity for carbon monoxide - shows how much carbon monoxide is taken into body during inhalation/exhalation
What is the BCG vaccination?
intradermal infection of live attenuated Tb which offers protection against severe and complicated TB but is less effective at protecting against pulmonary TB (for patients at higher risk of contact with TB)
What is pneumonia?
infection of the lung tissue which causes inflammation of the lung tissue and sputum filing the airways and alveoli
What are the causes of pneumonia?
streptococcus pneumoniae (50%)
haemophilus influenzae (20%)
moraxella catarrhalis (in immunocompromised patients/pts with chronic disease)
pseudomonas aeruginosa (pts with CF or bronchiectasis)
staphylococcus aureus (pts with CF)
What are the risk factors for pneumonia?
Bronchiectasis
Asthma
Cystic fibrosis
COPD
Malnutrition
Diabetes
Heart failure
Sickle cell disease
Liver or kidney disease
Hospitalisation
Older age
What is pleuritic chest pain?
pain on deep inspiration (feels like sandpaper on lungs during breathing)
What is the definition of hospital acquired pneumonia?
pneumonia which develops more than 48hrs after hospital admission
What are the key presentations of pneumonia?
Shortness Of breath
Cough productive of sputum
Fever
Haemoptysis (coughing up blood)
Pleuritic chest pain (sharp chest pain worse on inspiration)
Delirium (acute confusion associated with infection)
Sepsis
What are the signs of pneumonia?
Tachypnoea
Tachycardia
Hypoxia
Hypotension
Fever
Confusion