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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
Q

Give six signs of respiratory TB

A
  • Non-specific
  • Pallor
  • Fever
  • Weight loss
  • Clubbing
  • Palpable lymph nodes
26
Q

Give seven symptoms of respiratory TB

A 
• Primary usually asymptomatic
• Post Primary
	○ Tiredness and malaise
	○ Weigth loss and anorexia
	○ Fever
	○ Cough 
	○ Breathlessness

Haemoptysis

27
Q

Give six x-ray changes in Respiratory TB

A
  • Shadowing
  • Cavities
  • Consolidation
  • Calcification
  • Cardiomegaly
  • Miliary seeds
28
Q

Who is pleural TB more common in?

A

Males

29
Q

Give two mechanisms by which pleural TB occurs?

A

• Hypersensitivity response in primary infection
• Tuberculosis epyema with ruptured cavited
○ Burrows through chest wall

30
Q

What is lymph node tuberculosis?

A

• More common in children, women and Asians. Painless, occurs most commonly in the neck

31
Q

What are two types of osteo-articular TB?

A
  • Tuberculous Spondylitis

* Poncet’s disease

32
Q

What is tuberculosis spondylitis?

A
  • 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
Q

What is poncet’s disease?

A

• Aseptic polyarthritis

Knees, ankles and elbows

34
Q

What is miliary tuberculosis?

A

• 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
Q

Give four symptoms of miliary tuberculosis

A
  • Headaches which suggest meningeal involvement
  • Few respiratory symptoms
  • Ascites may be present
  • Retinal involvement in children
36
Q

What are the three factors which need to be investigated to give a TB diagnosis?

A
  • Clinical features
  • Radiological features
  • Microbiology
37
Q

Give three of the main clinical features of TB

A
  • Cough
  • Night fever
  • Weight loss
38
Q

What are five main radiological features of TB?

A
  • Shadowing
  • Cavities
  • Consolidation
  • Cardiomegaly
  • Miliary seeds
39
Q

What does microbiology need to achieve in order to diagnose TB?

A
  • Identification of bacillus
  • Direct smear and subsequent culture of the appropriate body fluid
  • Important to isolate organism and determine it susceptibility to drugs
40
Q

Outline treatment of patients with TB

A
  • Initially treated with four drugs for 2 months

* 2 drugs are then dropped, and the other two continue to be used to treat

41
Q

Why are multiple drugs used in TB?

A

• To combat resistance (5-10% patients TB resistant to isoniazid)

42
Q

Why are there problems with compliance, and what can be done to solve these problems?

A

• Long drug regime with several different pills to take

Patients instead put on directly observed therapy

43
Q

What does directly observed therapy do?

A

• Increases adherence to antibiotic treatment

44
Q

What are four drugs given in the initial phase of TB treatment?

A
  • Riampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
45
Q

What are the two drugs given in the continuation phase of TB treatment?

A
  • Rifampicin

* Isoniazid

46
Q

Give six side effects of rifampicin

A
  • Hepatitis
  • Rash
  • Flu-like symptoms
  • Shock
  • Acute Renal Failure
  • Thrombocytopenic purpura
47
Q

What three side effects of pyrazinamide

A

• Rash, hepatitis, athralgia

48
Q

Give a side effect of ethambutol

A

• Optic neuritis

49
Q

Describe the mechanism of multidrug-resistant TB

A
  • Caused by incompleted treatment
  • Residence in a country with a high incidence of MDRTB
  • Failure to response clinically to an adequate regimen
50
Q

How is multidrug resistant TB treated?

A

• A grueling regimen of several drugs at once

51
Q

What is the BCG vaccine?

A
  • Attenuated Live Bovine Tuberculosis Bacillus

* Bacteria retain a strong enough antigenicity to act as a vaccine for human TB

52
Q

What are two issues with BCG?

A
  • Has variable efficacy depending on genetic variation of population and BCG strain
  • Efficacy lasts 15 years at most
53
Q

What were UK regulations on vaccination up to 2005?

A
  • 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
Q

Give five groups which are at risk of TB

A
  • HIV patients
  • Those suffering from malnutrition
  • People living in overcrowded accommodation
  • IV drug abusers
  • Smokers
  • Diabetics
  • Asians
55
Q

What is the link between HIV and TB?

A
  • 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
Q

Describe what occurs when a case of TB is suspected

A
  • 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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