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Finals - CardioResp > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What is meant by the ‘acid fast’ property of mycobacterium tuberculosis?

A

Its waxy coating is resistant to the acids used in the staining procedure

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2
Q

What stain is used to identify TB?

A

Zeihl-Neelsen stain

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3
Q

What type of granuloma is formed in TB?

A

Caseous

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4
Q

What happens in primary TB

A
  1. Exposure to M. tuberculosis
  2. Small lung lesion known as ‘Ghon focus’ develops in the lungs
  3. Ghon focus + hilar lymph nodes is known as a Ghon complex
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5
Q

What is active TB?

A

Active infection in various areas within the body

In the majority of cases the immune system is able to kill and clear the infection

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6
Q

What is latent TB

A

Immune system encapsulates sites of infection and stop the progression of the disease

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7
Q

What is secondary TB?

A

When latent TB reactivates

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8
Q

What happens if the immune system is unable to control the TB?

A

Causes a disseminated, severe disease

Referred to as miliary TB

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9
Q

List 4 Extra-pulmonary TB infections

A
  • CNS (tuberculous meningitis - most serious complication)
  • vertebral bodies (Pott’s disease)
  • cervical lymph nodes (scrofuloderma)
  • renal
  • GI tract
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10
Q

What is a “cold abscess”?

A

A firm painless abscess caused by TB, usually in the neck

NO inflammation, redness or pain as expected

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11
Q

List 4 risk factors for TB

A
  1. Contact with active TB
  2. Immigrants from areas of high TB
  3. Immunosuppression ie. HIV
  4. Homeless people or IVDU
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12
Q

What type of vaccine is the BCG?

A

live attenuated

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13
Q

What 2 things must be checked/assessed prior to the BCG

A
  1. Mantoux test
  2. Immunosuppression and HIV
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14
Q

List 2 groups of people which the BGC is routinely offered too

A
  1. Neonates who are born in areas in UK with high rates of TB
  2. Healthcare workers
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15
Q

Presentation of TB?

A
  1. Lethargy
  2. Fever or night sweats
  3. Weight loss
  4. Cough +/- haemoptysis
  5. Lymphadenopathy
  6. Erythema nodosum
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16
Q

What is Pott’s disease?

A

Form of osteoarticular TB which affects the spine, also known as Tuberculous spondylitis?

17
Q

How does Pott’s disease present?

A

Typical TB features + Spinal pain

18
Q

Describe the typical disease pattern of Pott’s disease

A
  • Starts in subchondral bone
  • Follows longitudinal ligaments
  • Mainly lower thoracic and upper lumbar spine
  • Insidious onset over months → may progress to paralysis
19
Q

List 2 tests to check for Latent TB

A
  1. Mantoux test (screening)
  2. Interferon‑gamma release assay

IGRA is used if there are NO features of active TB but a positive Mantoux test to confirm a diagnosis of latent TB

20
Q

Explain the Mantoux test

A
  1. Tuberculin (TB protein) injected into forearm
  2. Injecting creates a bleb under the skin
  3. After 72 hours the induration of the skin at the site of the injection is measured
  4. Induration of ≥ 5mm is positive
21
Q

Explain the Interferon-Gamma Release Assays (IGRAs)

A

Sample of blood mixed with antigens from the TB bacteria

If patient has had previous contact with TB, interferon-gamma is released from WBC

22
Q

Investigations if active TB is suspected

Highlight gold standard

A
  1. Chest xray
  2. Sputum smear (3 specimens needed)
  3. Sputum culture (GOLD standard)
  4. NAAT (diagnosis within 24-48 hours)
23
Q

When is NAAT used over sputum cultures?

A
  1. If having the information would affect treatment OR
  2. They are at higher risk of developing complications (ie. in HIV)
24
Q

List 3 ways to collect cultures for suspected TB

A
  1. Sputum
  2. Mycobacterium blood cultures
  3. Lymph node aspiration or biopsy
25
Q

List 3 chest X-ray findings of primary TB

A
  1. Patchy consolidation
  2. Pleural effusions
  3. Hilar lymphadenopathy
26
Q

Typical chest X-ray finding of reactivated TB

A

Upper lobe cavitation

27
Q

What typical chest x-ray finding is seen in Miliary TB?

A

“Millet seeds” uniformly distributed throughout the lung fields

28
Q

Management of Latent TB?

A
  1. 3 months Isoniazid (with pyridoxine) and rifampicin OR
  2. 6 months of isoniazid (with pyridoxine)
29
Q

Management of Acute Pulmonary TB (RIPE)

A
  • Rifampicin for 6 months
  • Isoniazid for 6 months
  • Pyrazinamide for 2 months
  • Ethambutol for 2 months
30
Q

A patient is started on RIPE, what must be co-prescribed and why?

A

Pyridoxine

Isoniazid causes peripheral neuropathy, pyridoxine (B6) should be co-prescribed prophylactically

31
Q

Is TB a notifiable disease?

A

YES - must inform PHE

32
Q

If a patient is identified to have active TB, what steps must be taken to prevent airborne spread?

A

Should be isolated until they are established on treatment (usually 2 weeks)

In hospital negative pressure rooms are used to prevent airborne spread

33
Q

Treatment of meningeal TB?

A

Treated for at least 12 months with the addition of steroids

34
Q

What is Multi drug resistant TB?

A

TB resistant to isoniazid and rifampicin

35
Q

S/E of Rifampicin

A
  1. Red/orange urine and tears
  2. Potent inducer of CYP P450 enzymes (important for medications such as the COCP)
36
Q

S/E of Isoniazid

A

Peripheral neuropathy

Pyridoxine (B6) usually co-prescribed prophylactically

37
Q

S/E of Pyrazinamide

A

Hyperuricaemia resulting in gout

38
Q

S/E of Ethambutol

A

Colour blindness and reduced visual acuity

39
Q

Which TB drugs are associated with hepatotoxicity?

A

Rifampicin, isoniazid and pyrazinamide

Finals - CardioResp (18 decks)

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