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Semester 3 - Respiratory > Session 7 - TB > Flashcards

Session 7 - TB Flashcards

1
Q

What was the biggest advance in TB treatment in the 1900’s?

A

• Development of the BCG vaccine

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2
Q

Where is TB most prevalent?

A

• India and China

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3
Q

What area has the highest incidence of TB?

A

Subsahran Africa

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4
Q

Outline two usual treatments of TB

A
  • Thoracoplasty (crushing of the chest, reduces area for TB to thrive)
  • Exercise

Phrenic nerve crush - Paralyzed diaphragm, reduces ability of lung to expand

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5
Q

What does the BCG vaccine prevent?

A

• Childhood TB

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6
Q

Why are Mycobacteria hard to stain?

A

• Lipid-rich cell wall that retains some dyes, and resists decolourisation with acid

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7
Q

What is TB latency?

A
  • First encounter may not cause disease

* Mycobacterium lives in system, can be reactivated spontaneously or as a result of a new encounter

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8
Q

When is risk of developing TB greatest after initial infection?

A
  • First 2 years - 5%

* Rest of lifetime - 5%

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9
Q

What are the two main stages of tuberculosis infection?

A
  • Primary complex

* Post-primary infection

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10
Q

What is the primary complex in TB?

A

• Infection begins with local scarring

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11
Q

What is post primary infection of TB?

A
  • Refers to development of TB beyond the first few weeks

* Infection may spread throughout the body via blood (miliary spread) or develop into localised infection (meningitis)

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12
Q

Outline the pathology of TB infection

A
  • Mycobacterium Tuberculosis phagocytosed
  • Escapes from phagolysosome to multiply in the cytoplasm
  • Causes intense immune response, which damages lung
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13
Q

How does intense immune response damage the body?

A
  • Local tissue destruction - Cavitation in the lung

* Cytokine mediated systemic effects - Fever and weight loss

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14
Q

Why are the symptoms of late stage TB so varied?

A

Can effect every organ in the body, mimicking inflammatory and malignant disease

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15
Q

Give five main structures which can be affected by TB

A
  • Pulmonary tuberculosis
  • Tuberculous meningitis
  • Lymph node tuberculosis (Often painless, most commonly in non-asians)
  • Kidney infection
  • Lumbosacral spine
  • Inflammation of large joints
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16
Q

Give some symptoms of pulmonary tuberculosis

A
  • Chronic cough
  • Haemoptysis
  • Fever
  • Weight loss
  • Recurrent bacterial pneumonia
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17
Q

What does tuberculous menigitis present with?

A
  • Fever

* Slowly detriorating level of conciousness

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18
Q

What are the symptoms of kidney infection with TB?

A
  • Signs of local infection
  • Fever
  • Weight loss
  • Ureteric fibrosis
  • Hydronephropathy
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19
Q

What are the two main symptoms of lumbosacral spine infection with TB?

A
  • Vertebral collapse

* Nerve compression

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20
Q

What can inflammation of the large joints due to TB cause?

A

• Destructive arthritis

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21
Q

Outline what occurs after mycobacterium tuberculosis enters lung tissue in terms of immune response

A
  • Ingested by macrophages, escapes from paholysosome to multiply in cytoplasm
  • Immune response provoked via IL-12
  • IL2 drives the release of IFN-y and TNF-a from Natural Killer and CD4+ T helper cells
  • Cytokines activate and recruit more macrophages from the site of infection, resulting in formation of Granulomas
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22
Q

Give some primary changes in TB

A
  • Few symptoms

* Lymph nodes often enlarge

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23
Q

Outline some post-primary changes in TB

A

• Cough (not always productive)
• Fever (towards the end of the day or at night)
Weight loss and general debility

24
Q

What does chest x-ray of post primary TB cause?

A
  • Patchy solid lesions
  • Cativated solid lesions
  • Streaky fibrosis

Flecks of calcification

25
Give six signs of respiratory TB
* Non-specific * Pallor * Fever * Weight loss * Clubbing * Palpable lymph nodes
26
Give seven symptoms of respiratory TB
``` • Primary usually asymptomatic • Post Primary ○ Tiredness and malaise ○ Weigth loss and anorexia ○ Fever ○ Cough ○ Breathlessness ``` Haemoptysis
27
Give six x-ray changes in Respiratory TB
* Shadowing * Cavities * Consolidation * Calcification * Cardiomegaly * Miliary seeds
28
Who is pleural TB more common in?
Males
29
Give two mechanisms by which pleural TB occurs?
• Hypersensitivity response in primary infection • Tuberculosis epyema with ruptured cavited ○ Burrows through chest wall
30
What is lymph node tuberculosis?
• More common in children, women and Asians. Painless, occurs most commonly in the neck
31
What are two types of osteo-articular TB?
* Tuberculous Spondylitis | * Poncet's disease
32
What is tuberculosis spondylitis?
* Most common form of osteoarticular TB * Starts in sub-chondral bone and spread to vertebral bodies and join space, before following the longitudinal ligaments anterior and psoterior to the spine * Mainly occurs in the lower thoracic and lumbar spine and can be very high
33
What is poncet's disease?
• Aseptic polyarthritis Knees, ankles and elbows
34
What is miliary tuberculosis?
• Bacili spread through blood stream during primary infection of reactivation • Lungs are always involved ○ Spread throughout both lungs, as it is in the blood ○ Many visible through the lungs on an x-ray
35
Give four symptoms of miliary tuberculosis
* Headaches which suggest meningeal involvement * Few respiratory symptoms * Ascites may be present * Retinal involvement in children
36
What are the three factors which need to be investigated to give a TB diagnosis?
* Clinical features * Radiological features * Microbiology
37
Give three of the main clinical features of TB
* Cough * Night fever * Weight loss
38
What are five main radiological features of TB?
* Shadowing * Cavities * Consolidation * Cardiomegaly * Miliary seeds
39
What does microbiology need to achieve in order to diagnose TB?
* Identification of bacillus * Direct smear and subsequent culture of the appropriate body fluid * Important to isolate organism and determine it susceptibility to drugs
40
Outline treatment of patients with TB
* Initially treated with four drugs for 2 months | * 2 drugs are then dropped, and the other two continue to be used to treat
41
Why are multiple drugs used in TB?
• To combat resistance (5-10% patients TB resistant to isoniazid)
42
Why are there problems with compliance, and what can be done to solve these problems?
• Long drug regime with several different pills to take | Patients instead put on directly observed therapy
43
What does directly observed therapy do?
• Increases adherence to antibiotic treatment
44
What are four drugs given in the initial phase of TB treatment?
* Riampicin * Isoniazid * Pyrazinamide * Ethambutol
45
What are the two drugs given in the continuation phase of TB treatment?
* Rifampicin | * Isoniazid
46
Give six side effects of rifampicin
* Hepatitis * Rash * Flu-like symptoms * Shock * Acute Renal Failure * Thrombocytopenic purpura
47
What three side effects of pyrazinamide
• Rash, hepatitis, athralgia
48
Give a side effect of ethambutol
• Optic neuritis
49
Describe the mechanism of multidrug-resistant TB
* Caused by incompleted treatment * Residence in a country with a high incidence of MDRTB * Failure to response clinically to an adequate regimen
50
How is multidrug resistant TB treated?
• A grueling regimen of several drugs at once
51
What is the BCG vaccine?
* Attenuated Live Bovine Tuberculosis Bacillus | * Bacteria retain a strong enough antigenicity to act as a vaccine for human TB
52
What are two issues with BCG?
* Has variable efficacy depending on genetic variation of population and BCG strain * Efficacy lasts 15 years at most
53
What were UK regulations on vaccination up to 2005?
* All children ages 13 were immunised along with all neonates born into high risk groups * Now only high risk groups given, as cost effectiveness has fallen due to falling incidence rates of TB
54
Give five groups which are at risk of TB
* HIV patients * Those suffering from malnutrition * People living in overcrowded accommodation * IV drug abusers * Smokers * Diabetics * Asians
55
What is the link between HIV and TB?
* Much more likely to develop TB if already have HIV * Risk estimated to be 20-37 times greater in HIV infected people than uninfected people * Leading cause of morbidity and mortality among HIV patients
56
Describe what occurs when a case of TB is suspected
* Contact is immediately made with TB radiology * Patient goes straight to TB clinic and given a questionnaire and asked to give sputum samples * Treatment within 7 days

Semester 3 - Respiratory (18 decks)

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