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Phase 2CARDIORESP > TB > Flashcards

TB Flashcards

1
Q

What causes TB?

What type of bacterium is it and name the staining method

A
  • Mycobacterium tuberculosis
  • aerobic, acid fast bacilli
  • stained by Ziehl-Nielsen method
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2
Q

What happens in initial infection with TB?

A
  • M. tuberculosis is phagocytosed by alveolar macrophages
  • GRANULOMATOUS REACTION: get spherical caseous granuloma
  • Formation of Ghon focus
  • Antibodies produced are detectable by skin test
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3
Q

What happends after bacilli drain to hilar lymph nodes?

A

They get seeded to other parts of the lungs and body

  • Activated macrophages get produced which can kill
  • Primary infection can heal or calcify or there may still be some bacteria left in the body
  • After primary infection, latent TB can occur
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4
Q

Describe the primary disease of TB

A

Initial infection is normally asymptomatic

only abut 5% of infected individuals progress to symptomatic disease

The initial complex does not heal

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5
Q

What happends in the latent period and secondary disase?

A

Latent period= months-6o yrs

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6
Q

Give 8 individuals at high risk of TB

A
  1. Residents of high TB prevalence areas; Asia, Africa, Latin America, Eastern Europe
  2. Residents of HIGH RISK CONGREGATE SETTINGS; prisons, nursing homes. shleters
  3. Immunocompromised individuals; HIV, transplant, CKD, long term steroids
  4. Pts with a Hx of inadequately controlled TB
  5. Injecting drug users and some high risk users
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7
Q

Give 4 symptoms of a classical TB presenting complaint

A
  • Unexplained cough
  • Febrile illness
  • Resistance to simple Abx
  • Chest infection
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8
Q

Give 6 symptoms of resp TB

A
  1. Cough
  2. Tiredness and malaise
  3. Weight loss and anorexia
  4. Fever low grade
  5. Haemoptysis
  6. Breathless if pleural effusion
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9
Q

Give 6 signs of resp TB

A
  1. Pallor
  2. Fever
  3. Weight loss
  4. Finger clubbing in long standing disease
  5. May get wheeze
  6. Palpable cervical lymph nodes
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10
Q

What is seen in post-primary TB?

A
  • upper lung zones; bc oxygen rich environment
  • TB bacilli proligerate in caseous centres
  • Rupture spreads infection:
  • Can cause exudate; pneumonia
  • Can cause pleural effusion

May spread to whole body ie miliary TB

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11
Q

Name 3 sites where miliary TB spreads to?

What other parts of the body does it involve?

A

can get more localised reactivation in:

  • Pleura
  • Lymph nodes
  • to parts of the skeleton

lungs are ALWAYS involed; may involve meninges

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12
Q

What is a classic finding of pleural TB? More common in M or F?

A
  • more common in males
  • almost always pulmonary disease
  • TUBERCULOUS EMPYEMA; may burrow through chest wall
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13
Q

Give 5 features of Lymph node TB

A
  1. More common in women and children
  2. More common in Asians
  3. Often painless
  4. Cervical lymph nodes most commonly
  5. Ranges from discrete swelling to marked skin inflammation and rupture
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14
Q

What form of osteo-articular TB is most common?

Give 5 things OA TB can cause?

A
  • Tuberculous spondylitis

can get:

  1. Poncet’s disease-polyarthritis during acute TB
  2. Dactylitis
  3. Osteomylitis
  4. Tenosynovitis
  5. Peripheral arthritis
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15
Q

What is Tuberculous spondylitis also known as?

Describe its disaease pattern

A

Potts disease

  • Starts in subchondral bone
  • Follows longitudinal ligaments
  • Mainly lower thoracic and upper lumbar spine
  • Insidious onset over months–> may progress to paralysis
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16
Q

What clinical sign is common on CXR in Potts disease?

A

Gibbus sign; thoracolumbar kyphosis resulting in sharp angulation

Kyphosis Gibbus; swelling and curvature of spine; sharp angle on spine

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17
Q

Give 4 Investigations for pulmonary TB?

A
  1. CXR
  2. Sputum sample test for acid fast bacilli
  3. Bronchoscopy
  4. Lavage
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18
Q

Describe what this typical CXR shows

A

Pulmonary shadowing which may be:

  • Patchy solid lesions
  • Cavitated solid lesions
  • Streaky fibrosis
  • Calcified flecks
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19
Q

What tests would be done with sputum samples?

What molecular testing could be done?

A

SPUTUM sampling; via microscopy to check for acid fast bacilli

PCR for MTB complex and rifampicin/isoniazid resistance genes

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20
Q

What stain is this?

Describe its use

A

Auramine stain 10 min; uses fluorescence to help you identify TB

  • more sensitive than Ziehl-Neelson method
  • More suitable for assessment of smears from clinical specimens
21
Q

What stain is this and what is it used for?

A

Ziehl-Neelsen Stain-10 mins

looking for pinkish bacilli

  • provides morphological details
  • useful for examination of AFB in POSITIVE cultures
  • may be used to review results from clincial specimens that are positive with auramine-phenol
22
Q

What is IGRA?

What is its advantage over Mantoux?

A
  • Interferon Gamma Release Assay
  • uses different TB antigens to look for T cell reactivity measured by release of Interferon gamma
  • >Mantoux bc no cross reactivity with BCG; no need for 2 visist
  • NICE; part of 2 stage testing after positive Mantoux for latent TB
23
Q

What is the role of steroids in treating TB?

A

prevent complications

eg constrictive pericarditis

hydrocephalus

focal neurological deficits

pleural adhesions

24
Q

What 2 things should be considered re empirica treatment of TB vs waiting for results?

A
  • Index of suspicion
  • Risk/benefit assessment
25
Q

Describe the first line drug regimen for TB?

A

First 2 months RIPE; Rifampicin, Isoniazid, Pyrazinamide, Ethambutol

Continuation for 4 months; Rifampicin+ Isoniazid

26
Q

Define:

  1. MDR-TB
  2. XDR-TB
A
  1. Resistance to isoniazid and rifampicin
  2. MDR TB+ resistance to a second line injectable drug eg amikacin plus a quinolone
27
Q

Name 5 groups of individuals at increasd risk of Drug resistant TB

A
  1. Contacts of patients with drug-resistant TB
  2. Pts with HIV
  3. Pts whose smears remain positive after therapy
  4. Individuals living in high risk MDRTB areas
  5. Pts receiving inadequate treatment for over 2 weeks
28
Q

What do LOW GRADE FEVERS normally present as?

A

Night sweats; body’s attempt to cool pt down

29
Q

Describe findings of this CXR

A

Abnormal CXR

  • small seeds all over the lung fields ie miliary shadowing on the lungs
  • First Dx is Miliary TB
  • spots of whtie all over; diffuse and uniform all over the lung fields
  • left/right hylar masses

Plan: do 2 cultures; 1 24 hrs ordinary cultures and then TB cultures

30
Q

Name the form of TB which spreads but is WITHOUT COUGHING

A

Laryngeal TB

31
Q

What infection control issues should be consider?

A
  • Isolation bc risk of MDRTB
  • Personal protection; PPE and masks
32
Q

What bacterial load is required for a positive TB smear detectiion on microscopy?

What number is required for a positive cultures?

A
  • HIGH bacterial load of 5,000-10,000 AFB/ml is required for detection on microscopy
  • 10-100 bacilli needed for a positive culture; if liquid need 10
33
Q

What should be considered re sputum smear-positive pts?

A

they are 5-10 x more infectious than smear negative patietns

Untreated or treated with an inappropriate regimen; a sputum smear-positive patient may infect 10-15 ppl/yr

34
Q

Which provides more rapid detection of MTB compelx in clinical specimen; AFB smears or PCR?

A

PCR because it has a higher sensitivity and specificity

35
Q

Can pt be started on TB tx before cultures or tests?

A

NO NEVER BECAUSE results willl get botched

36
Q

What is sputum induction used for?

A

For patients who cannot cough up sputum

  • deep sputum-producing coughing may be induced via inhalation of an aerosol of warm, sterile, hypertonic saline
37
Q

What is gastric aspiration?

A

Useful for diagnosis in children who cannot cough up sputum

  • Do in the mornign when the patient gets out of bed or eats, bc this is teh optimal time to collect swallowed resp secretiosn from the stomach
38
Q

What can you see in this Ct of the lungs?

A
  • Miliary shadowing on CT
  • uniform white lesions on both lung fields
39
Q

What is the normal range of WBC’s in the CSF?

A

anything up to 5 is normal but anyting above is bad

ie 0-5 cells/uL

40
Q

What is normal CSF protein count ?

Normal CSF Glucose range?

A

0.15-0.45 g/L

Glucose= 2.8-4.2 mmol/L

41
Q

Intrepret the following LP of a pt

CSF microscopy : Total White Cell Count 241 /uL

100% lymphocytes
CSF Biochemistry : CSF Glucose 1.0 mmol/L

CSF Total Protein 1.12 g/L

Gram : negative
AFB smear : negative TB PCR : negative

A

Raised WCC, low glucose, Raised protein

likely ot be TB meningitis despite negative smears

pt has lymphocytic meningitis

42
Q

What tests should be done pre TB treatment?

A

Baseline LFTs

EYE ASSESSMENT bc Ethambutol can be toxic to eyes and cause blindness so always do an eye checkup before starting pt on it

43
Q

Give 4 general roles of a TB nurse

A
  1. Initial interview; establish a trust based relationship
  2. Educate the pt
  3. Identify and assess physical and psychosocial care needs and potential barriers to completion of diagnosis or tx
  4. Initiate contact investigations as appropriate
44
Q

Give 5 ways a TB nurse educates pts

A
  1. Pill teach – showing medications and how to take it
  2. Promoting ECM including DOT if required
  3. Explaining contact investigation process
  4. Locating information – vital to establish with the patient best method of communication and significant other
  5. Identify who will always know where to find patient and future plans for future management
45
Q

Why does a TB nurse need to do a psychosocial needs assessment of pts?

A

EG pts who are homless or substance users will need detailed MDT assessment to ensure appropriate care plan

Need to also consider:

  • language and literacy barriers
  • housing needs and living situaion
  • mental emotional cognitive status
  • cultural or religious beliefs which could impact on acceptance of diagnosis and adherence
46
Q

How does a TB nurse play a role in contact investigations?

A
  • Emphasise to the patient why it is important that contacts be identified and evaluated ASAP
  • Enquire about all household contacts and other close contacts(often work or social) contacts
  • Obtain names, demographic details, contact information, exposure history and factors for increased risk of TB disease.
  • Patients should be informed about the possibility of home visits and the TB service initiating return to service activities if the treatment is interrupted.
47
Q

How are contact investigations implemented by TB nurse?

A

A risk assessment-based approach is undertaken, where the need to screen contacts is prioritised on the basis of the infectiousness of the index case, intensity of exposure and susceptibility of contacts

• An objective duration of exposure is useful to determine which contacts need to be screened first and to limit the number – The “eight hour cumulative exposure rule” is generally used as a rough guide

48
Q

NICE says which contacts should be screened of TB pts?

A

Household contacts – of any person with active TB(any site)

Close contacts – persons exposed for 8 or more hours during

infectious period

Workplace contacts of infectious cases

Leisure contacts of infectious cases

Phase 2CARDIORESP (11 decks)

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