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Respiratory system > TB - clinical presentation and management*** > Flashcards

TB - clinical presentation and management*** Flashcards

1
Q

What are the risk factors of getting a TB infection?

A

Non-UK born - Asia, africa

HIV

Immunosuppressed

Young-middle aged adults

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2
Q

What are the symptoms of TB?

A

Fever

Night sweats

Weight loss, anorexia

Tiredness

Cough

Haemoptysis

Breathlessness, pleural effusion

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3
Q

What investigations are done for a patient with TB?

A

Chest X ray

Sputum samples

Culture

Biopsy, histopathology

Tuberculin sensitivity test

Interferon gamma test

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4
Q

What is seen on a chest X-ray of a patient with TB?

A

Consolidation in upper parts of lungs

Cavitation within consolidation

Pleural effusion

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5
Q

What does consolidation on a chest X-ray look like?

A

White areas

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6
Q

What does cavitation on a chest X-ray look like?

A

Dark areas within white areas of consolidation

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7
Q

Why is consolidation seen on a chest X-ray of a patient with TB?

A

Fibrosis of lungs

takes over air spaces of lungs

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8
Q

Why is cavitation seen on a chest X-ray of a patient with TB?

A

Empty areas within lung

due to destruction of lung tissue

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9
Q

What part of the lung is most commonly affected by TB?

A

Upper parts of lungs

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10
Q

Why are the upper parts of the lungs most commonly affected by TB?

A

Because mycobacterium TB needs high levels of oxygen to grow and replicate
and the upper parts of the lungs are most oxygenated

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11
Q

What does pleural effusion on a chest X-ray look like?

A

White areas

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12
Q

What is done to sputum samples of a patient with TB?

A

Auramine staining, look at using a fluorescent microscope

Ziehl Neelsen stain, look at under microscope

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13
Q

What does TB look like with a Ziehl Neelsen stain under a microscope?

A

Pink elongated structures

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14
Q

If a patient with TB isn’t coughing up sputum, how is sputum obtained?

A

Induce sputum via exercise

Bronchoscopy

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15
Q

How is a sputum sample obtained from children with TB?

A

Children swallow sputum

so do gastric aspirate

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16
Q

What is seen in a sample of lung tissue under a microscope of a patient with TB?

A

Caseating granuloma
caseous necrosis in centre
surrounded by macrophages, Langhans giant cells, T cells

17
Q

What is tuberculin?

A

Mycobacterium TB antigen

18
Q

What is the tuberculin senstivity test?

A

Prick person’s skin with tuberculin
wait 2-3 days
measure induration, that’s the clear skin between the redness

19
Q

What happens when tuberculin is injected into a person’s skin?

A

Inflammatory cells and immune cells accumulate there

skin becomes red

20
Q

What are the disadvantages of using the tuberculin sensitivity test?

A

False positives

False negatives

Does not differetiate between primary infection, latent infection, post primary disease

21
Q

What are the advantages of using the tuberculin sensitivity test?

A

Cheap

22
Q

When might the tuberculin sensitivity test give a false positive? Why?

A

BCG vaccine

because T cells have seen antigen before
react to it

23
Q

When might the tuberculin sensitivity test give a false negative? Why?

A

HIV

Immunosuppressed

insufficient T cells and other immune cells to mount a response

24
Q

How is the interferon gamma test carried out?

A

Take blood from patient
add mycobacterium TB antigens to it
measure interferon gamma levels produced by T cells

25
Q

What is the advantage of using the interferon gamma test?

A

Doesn’t cross react with BCG vaccine

26
Q

What is the disadvantage of using the interferon gamma test?

A

Doesn’t differentiate between primary infection, latent infection and post-primary disease of TB

27
Q

How is a patient with TB treated?

A

First line drugs

Second line drugs

28
Q

What are the first line drugs?

A

Rifampicin

Isoniazid

Pyrazinamide

Ethambutol

29
Q

When are the second line drugs used to treat TB?

A

If the mycobacterium TB is resistant to first line drugs

30
Q

What are the second drugs used to treat TB?

A

Quinolones

31
Q

What are the conditions of treating TB?

A

Early treatment

Long duration of treatment

Adherence to treatment

Multiple drugs used at once

32
Q

Why is it important that TB has a long duration of treatment?

A

Because mycobacterium TB takes a long time to replicate

longer duration of treatment ensures all mycobacterium TB has been killed

33
Q

Why si it important that patients with TB adhere to their treatment?

A

To prevent TB from becoming drug resistant

34
Q

Why is it important that multiple drugs are given at one time to patient with TB?

A

Kill mutant strains of mycobacterium TB

that may be resistance to drugs

35
Q

What are the side effects of rifampicin?

A

Makes body secretions an orange colour

Respiratory system (32 decks)

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