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Infection And Clinical Practice > Respiratory Infection > Flashcards

Respiratory Infection Flashcards

1
Q

What is the primary TB infection?

A

Host macrophages engulf organisms in the lungs and carry them to hilar lymph nodes. These can disseminate to leave tubercules (granulomas) around the body.

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2
Q

How can a primary TB infection result?

A

Active TB symptomatic infection
Miliary TB (bloodstream spread)
LTBI

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3
Q

Risk factors for TB?

A 
Social deprivation factors - homelessness, IVDU, alcohol
Close contact incl healthcare workers
Ethnic minority groups
Immunocompromised incl HIV
Elderly and very young
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4
Q

Are most symptomatic cases of TB from primary infection or secondary re activation of LTBI?

A

Re activation of LTBI

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5
Q

How does symptomatic TB most often present?

A

Pulmonary TB - cough - productive +/- blood

Lobar collapse, Bronchiectasis, pleural effusion, pneumonia

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6
Q

Second most common TB presentation?

A

GU ‘sterile pyuria’

Kidney lesions, salpingitis, abscesses, infertility, epididymitis

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7
Q

MSK TB presentations?

A

Bone - Potts vertebra (collapse -> gibbus)

Pain, osteomyelitis, arthritis

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8
Q

CNS TB presentations?

A

TB meningitis

Tuberculomas

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9
Q

GI TB presentations?

A

Ileocoecal lesions - pain, bloating, obstruction

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10
Q

Lymphadenopathy in TB?

A

Hilar, para tracheal and superficial Alan’s

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11
Q

Skin presentations of TB?

A

Erythema multiforme, nodosum, induratum

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12
Q

What is the typical CXR finding for a primary TB infection?

A

Central apical portion with left lower lobe infiltrate +/- pleural effusion

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13
Q

CXR findings for reactivated TB?

A

Apical lesions

NO pleural effusion

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14
Q

Microbiological investigation of TB?

A

Sputum samples - 3, at least 1 early morning sample
Bronchoscopy +/- lavage
Biopsy LNs

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15
Q

How long does TB sputum culture take? How long for sensitivities?

A

Culture 4-8 weeks

Sensitivities further 3-4 weeks

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16
Q

Which drug resistance in TB can be detected quicker than the usual culture and sensitivity?

A

Rifampicin

17
Q

What does BCG stand for?

A

Bacillus Calmette-Guerin

18
Q

Screening for TB?

A

Mantoux test for close contacts unless known to be immune or vaccinated, in which case interferon gamma testing

19
Q

Drug management of TB?

A

Pyrazinamide and ethambutol for first 2 months

Rifampicin and isoniazid for first 2 months then a further 4 months

20
Q

How long should Rifampicin and isoniazid be given in acute meningeal TB? What else should be given?

A

12m, alongside steroids (prednisolone)

21
Q

What is DOT and what is it for?

A

Direct observed therapy - to ensure good compliance for TB treatment

22
Q

What side effects do all TB drugs generally have in common?

A

Liver derangement

23
Q

Rifampicin side effects?

A

Orange tears and pee
Liver enzyme derangement and drug interactions - lower active availability of e.g. Warfarin, steroids, oestrogen, phenytoin
Flu like Sx

24
Q

Liver derangement in Rifampicin use - what is okay and what isn’t?

A

Mild rise in AST fine.

Stop if bilirubin rises or major transaminase derangement

25
Q

What alternatives to Rifampicin are second line for TB?

A

Macrolides and quinolones

26
Q

Side effects of ethambutol?

A

Visual disturbance

Renal impairment

27
Q

Side effects of isoniazid?

A

Peripheral neuropathies - comorbid RFs

28
Q

What drug is given to prevent peripheral neuropathy in isoniazid use?

A

Pyridoxine

29
Q

What is TB and how is it spread?

A

A chronic granulomatous disease caused by mycobacterium tuberculosis bacteria
Spread by infected droplets

30
Q

What is the specific pathogen often implicated in pneumonia associated with exposure to sick birds?

A

Chlamydophila Psittaci

31
Q

What does coxiella burnettii cause?

A

Q fever

32
Q

3 most important causes of atypical pneumonia?

A

Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumophila

33
Q

Which common causative agent of a typical pneumonia is often difficult to treat with antibiotics?

A

Haemophilus influenzae

34
Q

What atypical pneumonia pathogen is implicated in disease with history of water risk-factors incl foreign travel and faulty air con?

A

Legionella pneumophila

Infection And Clinical Practice (13 decks)

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