THORACIC Section 4: INFECTION - TB

Question 1

In Primary TB

Essentially you inhaled the bug, and it causes necrosis. Your body attacks and forms a granuloma 1. ______? You can end up with nodal expansion (which is bulky in kids, and less common in adults), this can calcify and you get a 2. “ _________”. The bulky nodes can actually cause compression leading to atelectasis (which is often lobar). If the node ruptures you can end up with either (a) _______ or (b) _________ - depending on if the rupture is into the bronchus or a vessel. This hematogenous spread manifests as a ___________.

Answer 1

Essentially you inhaled the bug, and it causes necrosis. Your body attacks and forms a granuloma 1. (Ghon Focus). You can end up with nodal expansion (which is bulky in kids, and less common in adults), this can calcify and you get a 2. “Ranke Complex. ” The bulky nodes can actually cause compression leading to atelectasis (which is often lobar). If the node ruptures you can end up with either (a) endobronchial spread or (b) hematogenous spread - depending on if the rupture is into the bronchus or a vessel. This hematogenous spread manifests as a MILLIARY PATTERN.

Question 2

This term refers to local progression of parenchymal disease with the development of cavitation (at the initial site of infection / or hematogenous spread).

Answer 2

Primary Progressive TB

Question 3

Primary progressive TB is uncommon - with the main risk factor being ____?

Answer 3

HIV

Question 4

This is a positive PPD, with a negative CXR, and no symptoms.

Answer 4

Latent TB

Question 5

describes an endogenous reactivation of a latent infection.

Answer 5

Post Primary (reactivation)

Question 6

Primary lung location of Post Primary (reactivation) TB

Answer 6

apical and posterior upper lobe and superior lower lobe (more oxygen, less lymphatics).

Question 7

What is the thing to look for when you want to call Post Primary (reactivation) TB?

Answer 7

development of a cavity

Question 8

What aneurysm do the arteries near the cavity have in the setting of a TB cavity?

Answer 8

Rasmussen Aneurysm

Question 9

The story will be a patient with TB and AIDS started on highly active anti-retroviral therapy (HAART) and now doing worse. The therapy is steroids.

Answer 9

Immune Reconstitution inflammatory Syndrome:

Question 10

development of a pleural effusion can be seen around 3-6 months after infection - hypersensitivity response

Answer 10

Primary TB

Question 11

Type of TB with no Cavity

Answer 11

Pimarty

Question 12

TB with cavity

Answer 12

Post primary/ Primary progressive

Question 13

Calcified TB Granuloma ; sequela o f primary TB

Answer 13

Ghon lesion

Question 14

Calcified TB Granuloma + Calcified Hilar Node ; Healed primary TB

Answer 14

Ranke Complex

Question 15

Bulky Hilar and Paratracheal Adenopathy is common on Kids or Adults?

Answer 15

Kids

Question 16

Location for Reactivation TB

Answer 16

Posterior / Apical upper lobes, Superior Lower Lobes

Question 17

Miliary Spread when?

Answer 17

Hematogenous dissemination (usually in the setting of reactivation), but can be in primary progressive TB as well

Question 18

Level of CD4 when reactive TB Pattern (Cavitation) seen in patient with HIV?

Answer 18

CD4 > 200

Question 19

CD4 level

Primary Progressive Pattern (Adenopathy, Consolidation, Miliary Spread)

Answer 19

CD4 < 200