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TB Flashcards

1
Q

TB MO

A

Mycobacterium tuberculosis

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2
Q

Mode of transmission of TB

A

spread by the inhalation of
aerosolised droplet nuclei from other infected patients

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3
Q

Pathophysio of TB

A

1.inhaled MOs enter the alveoli
2.Recruitment of macrophages and lymphocytes
3.macrophages transform into epitheliod and langerhans cells
4.they accumulate with lymphocytes and from granuloma.

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4
Q

Ghon focus

A

Numerous granulomas aggregate to
form a primary lesion

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5
Q

color of the ghon focus

A

pale yellow, caseous granuloma

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6
Q

location of the ghon focus

A

characteristically situated in the periphery of the lung

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7
Q

Ghon focus

A

combination of the primary lesion
and regional lymph nodes

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8
Q

why are most ABx ineffective against TB

A

1.intrinsic resistance
2.slow growth and dormancy
3.lipid rich cell wall is impermeable to ABx
4.can survive within macrophages and resist phagocytic killing

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9
Q

function of catalase in MTB

A

resist oxidative injury

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10
Q

function of lipoarabinomannan

A

induce cytokines and resist oxidative injury

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11
Q

Primary pulmonary TB

A

infection in individuals lacking previous sensitization

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12
Q

location of MTB deposition in lungs

A

inhaled bacilli implant in the distal air spaces .lower part of upper lobe or upper part of lower lobe

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13
Q

Reparative processes of the body against MTB

A

encase the primary complex in a fibrous capsule, limiting the spread of bacilli

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14
Q

manifestations of primary TB infection

A

Usually asymptomatic , but small transient pleural effusion or erythema nodosum – both are
representative of hypersensitivity manifestations

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15
Q

main complication of primary TB

A

can erode into bronchial tree lead to acute
TB bronchopneumonia. And also erode into blood vessels leads to miliary TB

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16
Q

Primary TB disease Sx

A
  • Lymphadenopathy: hilar (often
    unilateral), paratracheal or
    mediastinal
  • Collapse (especially right
    middle lobe)
  • Consolidation (especially right
    middle lobe)
  • Obstructive emphysema
  • Cavitation (rare)
  • Pleural effusion
  • Miliary
  • Meningitis
  • Pericarditis
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17
Q

HSR in Primary TB

A

Erythema nodosum
Dactylitis
Conjunctivitis

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18
Q

Risk factors of TB

A

1.Extremes of age
2. 1st Gen immigrants of high- prevalence countries
3.Close contact
4.CXR evidence of self-healed TB
5.Smoking
6.Immunosuppression
7.Malignancy
8.DM
9.CKD

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19
Q

Cryptic TB

A
  • Age over 60 years
  • Intermittent low-grade pyrexia of unknown origin
  • Unexplained weight loss, general debility (hepatosplenomegaly in
    25–50%)
  • Normal chest X-ray
  • Blood dyscrasias; leukaemoid reaction, pancytopenia
  • Negative tuberculin skin test
  • Confirmation by biopsy with granulomas and/or acid-fast bacilli in
    liver or bone marrow
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20
Q

Auscultation findings of miliary TB

A

normal

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21
Q

Bone marrow involvement of miliary TB

A

Anemia, leucopenia

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22
Q

TB meningitis in miliary TB

A

headache

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23
Q

Post- primary TB

A

Due to reactivation of previous asymptomatic disease

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24
Q

MC location of post-primary TB

A

Apex of the upper lobe - oxygen tension favors the survival of aerobes

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25
post- primary TB can occur in
when defenses are weakened Old age Pregnancy Malnutrition Steroids,immunosuppressive agents DM, HIV Lymphoma
26
clinical presentation of post- primary TB
* Cough * Prolonged fever * Haemoptysis * Poorly resolving pneumonia * Unexplained fever , night sweats * Nonspecific symptoms - weight loss, anorexia * Pleuritic pain * Incidental finding on CXR * Others – breathlessness, wheeze
27
Physical examination of Post-primary TB
* may be normal * RS - pleural effusion, apical cavitation, consolidation * General - fever, wasting, pallor
28
Extrapulmonary TB forms
Lymph node TB TB pleural effusion TB of upper airways Skeletal TB- Pott's disease GUT TB GI TB TB meningitis Miliary TB
29
Routine tests of TB
ESR CRP FBC CXR AFB Mantoux Gene XPert/TB- PCR Gold- Quantiferon TB gold test
30
findings of Post- primary TB Ix
high ESR High CRP CXR- not confirmatory
31
Why is CXR not confirmatory in TB
cannot differentiate from healed and active lesions
32
normal CXR in TB excludes?
endobronchial tuberculosis, military tuberculosis, HIV positive patients
33
sputum examination for AFB
D1- supervised sample, D2 - patient brings an early morning sample, D3 – supervised second sample when the patient returns
34
Dx TB
* Bacteriologically confirmed tuberculosis o 2 sputum DS positive for AFB o 1 sputum DS positive with CXR suggestive of pulmonary TB o Culture positive TB o WHO recommended Rapid diagnostic test positive- X Pert MTB/RIF+ * Clinically diagnosed tuberculosis o Diagnosis on clinical features/ radiology/histology without bacteriological confirmation
34
Mantoux Test
0.1ml of PPD solution is injected in the flexor aspect of the forearm, reading taken after 48-72 hours .induration >10mm will confirm the disease
35
when to suspect TB
Suspect in a person who is having a persistent cough for > 3 weeks
36
Treatment category I in TB
New sputum positive TB New smear- negative PTB w extensive pulmonary involvement New cases of severe extra- pulmonary TB
37
Category I TB Intensive phase
2HRZE – Isoniazid(H), Rifampicin(R), Pyrazinamide(Z), Ethambutol(E)
38
Category I TB continuation phase
4HR – Isoniazid(H), rifampicin(R)
39
What is given to reduce the risk of isoniazid induced neuropathy
Pyridoxine 10mg daily
40
Category II TB
Relapses Treatment failure Return after default treatment
41
Category II TB Intensive phase
2SHRZE + 1HRZE
42
Category II TB continuation phase
5HRE
43
Category III TB
Sputum negative pulmonary TB with limited parenchymal involvement Extra-pulmonary TB
44
Category III Intensive Phase
2HRZ
45
Category III Continuation Phase
4HR
46
Category IV TB
chronic cases
47
Category IV TB intesive phase
Treatment w at least 3 new drugs which were not previously used
48
Category IV TB continuation phase
Treatment continued for 24 months
49
all patients should be referred to the
National TB program of the respiratory disease control program of the MOH for follow-up
50
patients of anti-TB treatment should be isolated for
two weeks
51
Patients for two months can be treated in
Welisara
52
what should be employed in the community
DOTS - direct observed treatment strategy
53
Isoniazid ADRS
Liver toxicity Peripheral neuropathy Mental Retardation Incordination Drug interaction-enzyme inhibitor
54
Rifampicin ADRS
Liver toxicity Orange discolouration of body fluids Skin rashes, thrombocytopenia Oral contraceptive failure
55
Pyrazinamide ADRS
Liver toxicity, Hyperuricaemia
56
Ethambutol ADRS
Optic neuritis
57
Doses of Anti- TB drugs
Isoniazid- 5mg/kg Rifampicin - 10mg/kg Pyrazinamide- 25mg/kg Ethambutol - 15mg/kg
58
how to decide if it's active or inactive TB
* Radiology not reliable * High ESR alone does not suggest activity * Clinical and microbiological o Sputum smear +ve for AFB o Symptoms o Progression of CXR lesions o New cavitations or fluid levels o Response to therapeutic trial
59
ADRS of Streptomycin
Ototoxicity Nephrotoxicity
60
miliary TB spreads by
blood
61
Symptoms of miliary TB
Nonspecific symptoms – fever, malaise, weight loss, cough, headache
62
Signs of miliary TB
Normal chest, hepatosplenomegaly, choroid tubercles
63
Ix findings of miliary TB
High ESR, pancytopenia, hyponatraemia, military mottling on CXR
64
Mantoux can be negative on miliary TB
True
65
Sputum DS is always positive in miliary TB
False (10% can be positive)
66
additional tests done on miliary TB
BM, CSF cultures
67
Mx of miliary TB
Treat on suspicion. Category I Drugs
68
besides category I drugs what else can be given for acutely ill miliary TB patients
steroids
69
atypical features are seen in .....HIV patients with TB
late HIV
70
atypical features seen in HIV patients with TB
o Extra-pulmonary involvement common o Unusual or absent radiological features o TST positive in <40%, often mildly (<5 mm)
71
Rx challenge in HIV patients with TB
drug resistance
72
Sx of Pleural effusion in TB
Insidious onset – low grade fever, general ill health, night sweats, pleuritic pain, dyspnoea
73
Ix findings in PE due to TB
High ESR, normal WCC, positive mantoux
74
Pleural fluid analysis in TB
o Straw coloured o High protein content o High lymphocyte count o AFB is often negative o M. tuberculosis culture positive in 30% o ADA (Adenosine deaminase) may be positive
75
pleural biopsy in TB
caseating granuloma
76
Mx on PE due to TB
standard category 1 treatment, a short course of steroids may be given
77
Drug- resistant TB is most commonly seen in
More in HIV, Health care workers
78
MDR TB
resistant to both Isoniazid and Rifampicin
79
Extensive Drug Resistance(XDR) TB
-resistant to both isoniazid and Rifampicin with resistance to any of the quinolones(such as levofloxacin or moxifloxacin) and atleast one of the second line injectable drug- Kanamycin, Capreomycin, Amikacin
80
second line drugs used in TB
Quinolone-ofloxacin,ciprofloxacin Aminoglycoside- Kanamycin, Amikacin, Capreomycin Para amino salicylic acid-cicloserine, Ethiopromide Macrolide- Clarithromycin, Azithromycin

Pulmonology (13 decks)

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