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Respiratory pathology 2 Flashcards

1
Q

Total time for the treatment if Tb

A

6 months if medication and rehabilitation which involves other members of the MDT

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2
Q

Determinants of Tb

A

Lower income regions
Under nourishment of food
Immunosuppressed people eg HIV
Elderly , neonates and the diabetics
Those with mental health conditions and those in prisons

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3
Q

National epidemiology of Tb

A

Most prevalent in London
With most people being people who were not vaccinated gainst tb with the BCG vaccine

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4
Q

Summary of epidemiology

A

TB incidence over time is falling, 2% per year. But, recent rise ​
TB is still a disease of the poor / social risk factors​
TB is the number 1 killer of communicable diseases​
TB kills more than HIV and Malaria together​
TB is not evenly distributed, globally or nationally​
2/3 of all TB cases (prevalence) in 8 countries​
An estimated 2 billion people are infected worldwide​

​

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5
Q

Cause TB

A

mycobacteria species for example tuberculosis , M. africanum and mycobacterium.bovis
PRESENT IN SOIL AND WATER

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6
Q

other species of non-tuberculosis mycobacteria

A

Non-tuberculous mycobacteria, NTM-infections / ‘Atypical mycobacteria​
Leprosy (M.leprae)​

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7
Q

characteristics of mycobacteria that cause tuberculosis (AAFBs)

A

Uniquely has a very thick fatty cell wall​
Resistant to acids, alkalis and detergents​
Resistant to neutrophil and macrophage destruction ​
Acid - and alcohol - fast bacilli (AAFB) (Ziehl Neilson stain)​
however not all AAFB are mycobacterium

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8
Q

transmission of tuberculosis

A

airborne only through the laryngeal and pulmonary system
TB in the lymph nodes cannot be spread in other regions in the body

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9
Q

non medicated management of TB

A

good circulation of air in the house ; TB bacteria will remain suspended in air for many hours
outdoors mycobacteria is eliminated by UV radiation and dilution.

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10
Q

ways in which TB is not spread

A

Shaking hands​
Sharing food​
Touching surfaces​
Sharing toothbrushes​
Kissing​

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11
Q

spread of mycobacterium bovis

A

spread through drinking of unpasteurized milk

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12
Q

cells involved in the defence against TB

A

as TB is not sensitive to destruction of macrophage and neutrophils , it can only be destroyed by T helper cells that is lymphocytes.

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13
Q

immunopathology of TB

A

many activated macrophages form epithelioid cells and forms langhan”s giant cells which form granuloma with central necrosis

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14
Q

consequences of the immunological response of t helper cells

A

Eliminates / Reduces number of invading mycobacteria​
Tissue destruction is a consequence of activation of macrophages​

​

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15
Q

history of dvlpmt of tuberculosis

A

primary infection - helps to build immunity and they are drained on the lymphatic nodes that is the hila lymph nodes , and there are no symptoms , there is development of immunity against tuberculoprotein

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16
Q

primary infection of tuberculosis

A

progressive disease
contained latent
cleared cured

​

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17
Q

types of primary TB infection

A

tuberculosis bronchopneumonia
miliary tuberculosis

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18
Q

tuberculosis bronchopneumonia

A

there is abnormal enlargement of the hilar node which leads to compression of the bronchi and later on collapse of the lobe has a poor prognosis

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19
Q

milliary tuberculosis

A

there is spread of the bacteria to multiple organs by blood ; presents with widespread small granulomata

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20
Q

post primary disease

A

only present in humans the bacteria enters dormant stage with little to no replication over a prolonged period of time
there is a balanced replication and destruction of the immune mechanisms

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21
Q

spread of tuberculosis

A

primary - progressive primary - milliary , meningeal , pleural TB - post primary pulmonary and skeletal disease - genitourinary and cutaneous TB

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22
Q

clinical presentation of TB

A

Coughing
fever
sweats at night
weight loss

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23
Q

methods of diagnosing active TB

A

chest x ray

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24
Q

presentation of mediastinal lymphadenopathy

A

there is a white patch at the mediastinum just next to the heart

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25
presentation of miliary tuberculosis in an x ray
presents as spots on the lung
26
tests performed to test for TB
Sputum; 3 samples, 8-24hrs gap, at least 1 early morning sample​ Induced sputum​ Bronchoscopy with BAL​ Endobronchial ultrasound (EBUS) with biopsy​ Lumbar puncture in CNS TB / biopsy​ Urine in urogenital TB​ Aspirate/biopsy from tissue ( lymph-node, bone, joint, brain, abscess …
27
clinical management of TB
isoniazid pyrazinamide rifampicin ethambutol
28
rules for prescription of TB
Test for HIV, Hepatitis B and C​ Single agent treatment leads to drug resistant organisms within 14 days​ Therapy must continue for at least 6 months​
29
Standard treatment of TB
12 tablets a day for 6 moths 2 moths of all the tablets 4 months of rifampicin and isoniazid pyridoxine with isoniazid which reduces risk of neuropathy steroids cause side effects of the CNS , milliary TB , pericardial vitamin D substitution
30
side effects of ethambutol
Optic neuropathy (check visual acuity)​
31
Pyrazinamide side effects
hepatitis gout
32
Isoniazid side effects
Hepatitis​ Peripheral neuropathy (pyridoxine B6)​
33
rifampicin side effects
Orange ‘Irn Bru’ urine/tears/lenses ​ Induces liver enzymes, prednisolone, anticonvulsants​ All hormonal contraceptive methods ineffective​ Hepatitis​
34
side effects of all drugs
rashes
35
vaccination against TB
BCG vaccination
36
screening of latent TB
Contacts of people with active pulmonary or laryngeal TB who are aged ≤65 years As hepatotoxicity risk increases with age those aged 66 years or older: CXR only to rule out active TB only ​ New entrants to Grampian from high incidence areas​ ‘Pre-biologics’ (TNF-alpha inhibitors)
37
screening of latent TB
Mantoux skin test or Interferon Gamma Release Assay (IGRA) blood test​
38
treatment of latent tuberculosis
Rifampicin & Isoniazid for three months, or ​ Isoniazid or Rifampicin only for six months or ​ Rifapentine & Isoniazid once weekly for 12 weeks​
39
possible causes of lung infections
microorganism pathogenicity capacity to resist infection population at risk that is the removal of the commensal flora
40
upper respiratory tract infections
common cold sore throat acute laryngotracheobronchitis (croup) laryngitis sinusitis acute epiglottitis
41
acute epiglottitis causative agent
haemophilus influenzae ( Virus) group A beta haemolytic streptococci ( bacteria )
42
lower respiratory tract infections
bronchitis bronchiolitis pneumonia
43
mechanisms of defence of the respiratory tract
macrophage engulfs and destroys the bacteria and the foreign particles , production of mucus , the foreign material is wafted away , coughed up through the cough reflex
44
influenza viral pneumonia
influenza virus during a primary attack causes a destruction of the mucociliary escalator system , because of this the commensal flora staph aureus can thrive and not be removed leading to an acute inflammation
45
viral infections in the lungs
bronchiolitis pneumonitis
46
SARS-CoV-2 (COVID19)
viral infection where there is inflammation of the bronchioles leading to pneumonia of the lungs
47
classification of pneumonia
part of the lung affected the circumstances that is hospital acquired or community acquired the type of causative agent
48
hospital acquired pneumonia
not sensitive to antibiotics
49
types of pneumonia based on the cause
Community Acquired Pneumonia Hospital Acquired (Nosocomial) Pneumonia Pneumonia in the Immunocompromised Atypical Pneumonia Aspiration Pneumonia Recurrent Pneumonia
50
anatomical classification of pneumonia
bronchopneumonia segmental pneumonia lobar pneumonia
51
hypostatic pneumonia
fluid retention at the bottom of the lung that causes an optimum environment for the growth of bacteria
52
aspiration pneumonia
aspiration of contents that lead to movement of fluids into the inner tubes
53
bronchopneumonia
( exudation ) fluid in the bronchi seen on the x ray as basal patchy opacification vasodilation of the bronchioles from the inflammatory response
54
lobar pneumonia
collapse of an entire lobe caused by an inflammatory response a whole lobe collapses exudation of fluid and bleeding vasodilation of the bronchioles
55
complications of pneumonia
1.lung abscess form necrosis of the lung tissue 2.pleural effusion caused by infection of the pleura 3.pleurisy which is the inflammation of the pleura 4.bronchiectasis which is the widening of the bronchi such that there is build up of fluid for bacterial growth . 5.empyema which is collection of pus in the pleural cavity 6.organisation which leads to development of fibrotic tissue such as the case of cryptogenic organising pneumonia
56
causes of lung abscess
1.aspiration pneumonia 2.tumor 3.organism eg staph 4.metastatic pyaemia that is pus movement 5.necrotic lung
57
bronchiectasis
Pathological dilatation of Bronchi
58
causes of bronchiectasis
Severe Infective Episode Recurrent Infections - many causes Proximal Bronchial Obstruction Lung Parenchymal Destruction
59
most common age group affected by bronchiectasis
most start in childhood
60
bronchiectasis
COUGH, ABUNDANT PURULENT FOUL SPUTUM, haemoptysis, signs of chronic infection Coarse crackles, clubbing Thin section CT Postural Drainage, Antibiotics, Surgery
61
diagnostic method of bronchiectasis
a thin CT section located at the edge of the lung
62
complications of bronchiectasis
suppuration that is the filling up of the bronchi with pus. haemorrhage - excessive bleeding from systemic blood supply ( blood supply in the bronchi is from brachial artery and therefore high pressure blood )
63
aspiration pneumonia
Vomiting Oesophageal Lesion Obstetric Anaesthesia Neuromuscular Disorders Sedation
64
opportunistic infections
infections only present in the immunocompromised such as HIV Low grade bacterial pathogens CMV Pneumocystis jirovecii Other fungi and yeasts
65
causes of recurrent lung infection
Local Bronchial Obstruction Local Pulmonary Damage Generalised Lung Disease COPD? Non-Respiratory Disease (HIV, other)?, Aspiration?
66
abnormal gas exchange
type 1 lower partial pressure for oxygen type 2 lower partial pressure for carbon dioxide both in the arterial blood
67
consequences of abnormal pulmonary gas exchange
shunt ventilation perfusion mismatch alveolar hypoventilation diffusion impairement
68
ventilation perfusion normal values
Normally breathing ~4 l/min. Cardiac Output is ~5 l/min so normal V/Q is 4/5 or 0.8
69
what is ventilation perfusion mismatch
blood is sent to regions of the lungs where there is less ventilation leading to flow of not fully oxygenated blood back to the lungs oxygen is given to reverse
70
shunt
blood passing too the lungs without any oxygenation right side of the heart has deoxygenated blood increase in oxygen doesn`t solve this
71
diseases that display ventilation perfusion abnormality
there is oxygenation although the alveoli is abnormal Bronchitis / Bronchiolitis Bronchopneumonia COPD
72
diseases that display shunt system
there is no ventilation of the abnormal alveoli Severe bronchopneumonia Lobar pattern with large areas of consolidation
73
alveolar hypoventilation
Hypoventilation increases PACO2, and thus increases PaCO2 Increase in PACO2 decreases PAO2, which causes PaO2 to fall Fall in PaO2 due to hypoventilation is corrected by raising FIO2
74
causes of alveolar hypoventilation
1.Upper airway or tracheal obstruction 2.Mechanical problems with breathing mechanism (chest wall damage) 3.Functional problems with breathing mechanism (muscle paralysis, diaphragmatic damage) 4.Neurological problems with breathing mechanism 5.Peripheral nerve damage or loss of function CNS malfunction – opiate poisoning, COPD
75

MBCHB 1 (62 decks)

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