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Respiratory Exam 2 > TB > Flashcards

TB Flashcards

1
Q

strongest risk factor for TB

A

HIV- more progression from recent infection or latent infection to disease

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2
Q

4 first line TB drugs

A

isoniazid (INH), Rifampicin (RIF), Pyrazinamide (PZA), Ethambutol (ETH)

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3
Q

define MDR TB

A

resistant to INH and RIF

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4
Q

define XDR TB

A

resistant to 2 classes of second line drugs as well

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5
Q

what is DOTS

A

directly observed treatment short course- medical providers observe pts taking meds to improve compliance

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6
Q

what is BCG

A

live attenuated vaccine w/ mycobacterium bovis, variable effeciency and not used in the US

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7
Q

how to prove an organism causes disease?

A

Koch’s postulates:

  1. isolate bacilli
  2. grow in culture
  3. administer isolates into animals
  4. re-isolate bacilli
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8
Q

what type of organism is TB?

A

mycobacterium, facultative intracellular, acid fast

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9
Q

typical cellular location of TB

A

macrophages

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10
Q

2 kinds of acid fast stains

A

zeihl-neelsen, fluorescent auramine-rhodamine

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11
Q

how is myobacteria different

A

mycolic acid in the cell wall, no LPS

cannot be gram stained

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12
Q

transmission of TB

A

via aerosols and airborne droplets, grows in macrophages

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13
Q

list some characteristics of airborne precautions and 2 organisms they are for

A

w/ TB and measles

  • private room w/ neg pressure
  • N95 masks for providers
  • visitors have surgical masks
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14
Q

mechanism for TB resistance to macrophage killing

A

can resist ROI and RNI; arrests phagosome maturation at early endosome stage and binding w/ lysososme

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15
Q

what type of immune response is needed for TB control? How?

A

Th1 response to macrophage (and dendritic cells) MHC molecules, release of IFN-gamma to activate macrophages and help them destroy TB (via radicals and lysosome fusion)

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16
Q

role of antibodies in Mtb control

A

none, control by CD4 and CD8

17
Q

TNF alpa role in TB

A

responsible for disease Sx like weight loss and fever, helps IFN gamma activate macrophages

18
Q

IL 12 role in TB

A

CD4 differentiation into Th1

19
Q

CD4 role in TB

A

make IFN gamma

20
Q

CD8 role in TB

A

can also produce IFN gamma or directly kill infected macrophages, releasing the contents for further phagocytosis by other cells

21
Q

positive PPD

A

certain amount of hardened tissue (induration) indicating the presence of antibodies to TB and at least a latent infection

22
Q

describe a granuloma

A

organized structure w/ central region of macrophages and giant cells, surrounded by lymphoid cells and other new macrophages

-can have necrotic center

23
Q

what is a tubercle

A

a granuloma walled off by a fibrin coat, can calcify and be visible on xray

24
Q

what happens in center of granuloma

A

becomes necrotic and liquid, site for extracellular replication

25
Q

6 Sx of active Tb

A

chronic cough, hemoptysis, chest pain, weight loss, fever, night sweats

26
Q

cause of Tb sx

A

immune response: cytokines like IL1 and TNFalpha, macrophages, cytolytic T cells

27
Q

difference in primary Tb w/ HIV for pathogenesis

A

no containment, allows for dissemination and miliary TB

28
Q

PPD test w/ HIV pts

A

doesnt always work- test depends on functioning lymphocytes

29
Q

PPD test w/ BCG vaccine

A

can cause cross rxn and false positive

30
Q

fn of quantiferon test

A

measures IFN gamma from T cells in response to TB antigens not in BCG, positive depending on the response

31
Q

fn of new Xpert MTB/RIF test

A

PCR test for Mtb, also determine rifampicin resistance, recommended for those who have HIV coinfection

32
Q

differentiate 2 forms of leprosy

A

tubercuoloid: driven by Th1 response, deformities due to nerve damage (able to contain granulomas)

lepromatous leprosy: active, nodulous from Th2 response that does not fully contain bacteria

33
Q

common sites of Non-TB mycobacteria (NTM)

A

southern and midwestern US- but normal inhabitants of soil and water

34
Q

myco avium location and transmission

A

found in water supplies, forms biofilms, transmitted by inhalation/ingestion, more common in HIV

35
Q

myco abscessus location and transmission and infection

A

common in soil and water, common in bronchiectasis/CF pts, forms biofilms

chronic lung infection, skin/soft tissue infections, highly resistant to drugs

36
Q

association w/ myco fortuitum

A

fast growing NTM, found in nail salons

Respiratory Exam 2 (11 decks)

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