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Respiratory > TB > Flashcards

TB Flashcards

1
Q

What is TB?

A

An infectious disease of the respiratory tract due to the airborne spread of mycobacterium tuberculosis
It often presents in the upper lung but systemic and circulatory problems can occur and it can spread to other organs

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2
Q

Where is TB common?

A

Africa, India, the indian subcontinent, China, Aisa and Indionesia

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3
Q

Does TB have an environmental reservoir?

A

Not that we know of

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4
Q

Where are the cases in Tayside presenting from?

A

Eastern Europe or Pakistan

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5
Q

What happens after TB exposure?

Describable latent TB.

A

Tb infects the upper zone of the lungs- latent infection
Travels to the distal alviolus and phagacytosed by alveolar macrophages and dendritic cells
Transendothilial migration leads to the formation of a granuloma. The infection can grow and multiply here
The granuloma walls are very think and if contained the infection remains latent here

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6
Q

What happens during active TB?

A

If the gramuloma walls break the infection will be released into the lungs

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7
Q

What percentage of those with TB infection will remain well and what is the lifetime risk of tuberculosis for them?

A

90% will remain well

10% lifetime risk of infection. 5% primary TB and 5% reactivation of latent disease

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8
Q

What are the clinical features of Primary pulmonary TB?

A

1) Sub acute disease, gradual onset
2) Weight loss, malaise, night swears
3) Cough, haemoptysis, breathlessness
4) Upper zone crackles and tubercles (white dots) and cavity formation

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9
Q

What are the clinical features of meningeal TB?

A

Headache, drowsy, fits and TB in CSF

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10
Q

What are the clinical features of gastrointestinal TB?

A

Pain, bowel obstruction, perforation and peritonitis

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11
Q

What are the clinical features of spinal TB?

A

Pain, deformatity and paraplegia

Antibiotics for 12 months

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12
Q

What are the clinical features of pericardial TB?

A

Tamponade

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13
Q

What are the clinical features of renal TB?

A

Renal failure

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14
Q

What are the clinical features of adrenal TB?

A

Hypoadrenalism

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15
Q

Why should you never inject steroids into a solitary arthritic joint?

A

It may be septic arthritis caused by TB

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16
Q

What form of TB is lymphadenopathy associated with?

A

Mediastinal TB

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17
Q

A cold abscess can appear on the chest. What is this a sign of?

A

Dormant TB- no pain or associated inflammation

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18
Q

How is TB diagnosed?

A

Culture
PCR- 90% sensitive (can give false positives for current infection and does not give antibiotic sensitivities but rapid)
Zeil Nelson stain- 50% sensitive (Gives infectivity data

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19
Q

What are the advantages and limitations of sputum culture for TB?

A

Most sensitive but takes time and requires skilled people

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20
Q

What are the advantages and limitations of PCR for TB?

A

90% sensitive- can give false positives for current infection
Does not give all antibiotic sensitivities. Will show if rifampicin sensitive
Rapid

21
Q

What are the advantages and limitations of zeil Nelson stain for TB?

A

50% sensitive
Gives infectivity data- smear positive or smear negative
Rapid and cheap

22
Q

What does ‘smear positive’ imply?

A

TB and infectious

23
Q

What does ‘smear negative, culture positive’ imply?

A

TB and needs treatment but not infectious

24
Q

What would you see on a histology slide of someone with TB?

A

Multinucleating giant cell granulomas
Caseating necrosis
Sometimes visible mycobacterium

25
Q

What would you see on a CXR of someone with TB?

A

Upper lobe predominance
Cavity formation and tissue destruction
Scarring and shrinkage
Heals with calcification- often in lymph nodes

26
Q

What is milliary TB?

A

Wide spread dissemination of mycobacterium TB via blood stream spread.
Can rapidly be fatal

27
Q

What are the 4 drugs used to treat smear positive TB?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethanbutol

28
Q

If the patient becomes smear negative, what is the step down treatment?

A

Rifampicin

Isoniazid

29
Q

What are the side effects of rifampicin?

A

Colours urine and body fluids orange/pink
Potent inducer of cytochrome enzymes
=> Breakdown of all steroids inc oral contraceptive
=> Breakdown of opiate analgesics

30
Q

What are the side effects of ethanbutol?

A

Optic neuritis- inflammation of the optic nerve- must ensure patients are not colour blind before treatment

31
Q

What are the side effects of izoniazid?

A

Hepatitis, renal failure and neuropathy

B6 deficiency and given peridoxine

32
Q

What is DOT and when is it used?

A

DOT = Directly observed therapy
As compliance is poor you receive your medication at a pharmacy and must be supervised
Used when you suspect medications not being taken

33
Q

When TB is diagnosed, who must be informed?

A

Public health for contact tracing

34
Q

Who must be detained in hospital in an infection control side room?

A

Anyone who is smear positive

35
Q

What is single drug resistant TB?

A

Resistant to izoniazid

36
Q

What is MDR TB and what are the consequences?

A

Resistant to izoniazid and rifampcin

Require injectables and 9-12 months of treatment

37
Q

What is XDR TB and what are the consequences?

A

Resistant to more than izoniazid and rifampcin
Require injectables and quinalone for 9-12 moths
Must be in a side room in infection control until better
Form eastern Europe/ africa

38
Q

What happens if your newly Dx HIV positive and TB positive?

A

Treat viral load first and then TB within 8 weeks

39
Q

TB can be the first presenting symptom of someone with HIV. True or false?

A

True

40
Q

What is defined as latent TB?

A

Culture negative and symptom free

May have calcifications/ granlomas on the CXR

41
Q

What can cause reactivation of latent TB?

A

Steroids and immunosupressive drugs

42
Q

What are the tests for previous TB exposure?

A

Tuberculin skin test/Mantoux test

Interferon gamma release assay (blood test)

43
Q

How does the interferon gamma release assay work?

A

Blood test which looks for the interferon gamma specific antigen only found in mycobacterium TB
It doesn’t react with BCG which is an attenuated strain of M bovis

44
Q

How does the mantoux test work?

A

Intradermal injection of tuberculin- checking for skin reaction.
Delayed type 4 hypersensitivity
Cannot distinguish between latent TB, cured TB, active TB and BCG

45
Q

How is latent TB treated?

A

Can be treated or untreated.
Must be treated if you want to give anti-TNF drugs
Treatment = 6 months izoniazid OR 3 months izoniazid and rifampcin

46
Q

How is TB prevented

A

Contact tracing and screening of high risk sub groups
Isolation of infectious cases
BCG immunisation- most effective in neonates of high risk families
Social measures- housing and nutrition

47
Q

Who might you want to give anti-TNF drugs to and therefore need to treat their latent TB?

A

Anyone with rheumatoid’s, Crohn’s, Psoriasis or ankylosing spondylytis

48
Q

What is in the BCG vaccine?

A

Attenuated strain of M bovis

49
Q

When people are on TB treatment, what should be monitored?

A

Liver function

Kidney function?

Respiratory (26 decks)

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