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Z Year3 Resp Conditions > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What is the epid of TB?

A
  1. 9.6million cases per year
  2. Co infection with HIV in 12% cases
  3. Leading cause of death worldwide
  4. 5million deaths/yr
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2
Q

What are RF for TB?

A
  1. HIV
  2. Immunosuppressive medication i..e. RA, IBD
  3. Overcrowding more likely relatives>strangers + homeless people
  4. Travel: sub Saharan Africa Indica/bangledesh
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3
Q

What is the cause of TB?

A

infection by mycobacterium tuberculosis affecting multiple organs

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4
Q

What lobes are usually affected in TB?

A

upper lobes as ventilated better as bacteria need oxygen

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5
Q

When does active TB infection happen?

A
  • active infection happens when containment by immune system (T cells. macrophages) is inadequate
  • Can arise by primary infection or reactivation of previous latent disease
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6
Q

How common is latent disease changing?

A

Latent disease and lifetime risk of reactivation is 5-10% - if immunosuppressed or aging

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7
Q

What are the 3 things possible after initial infection?

A
  1. Successful clearance
  2. Active TB
  3. Latent TB
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8
Q

What are key points of active TB?

A

transmissible and pt requires treatment

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9
Q

What are key points of latent TB?

A

> 90%, not transmissible and TB contained in “caseating granulomas”

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10
Q

What are the systemic features of TB?

A
  1. Low grade fever
  2. Anorexia
    Weight loss
  3. Malaise
  4. Night sweats
  5. Clubbing
  6. Erythema nodusm
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11
Q

What are pulmonary features of TB?

A
  1. Cough: dry then productive
  2. Pleurisy
  3. Haemoptysis (late)
  4. Dyspnoea/SOB
  5. Pleural effusion
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12
Q

What is TB lymphadenitis and how is it investigated?

A
  1. Usually painless enlargement of cervical or supraclavicular lymph nodes
  2. Firm to touch and not acutely inflammaed
  3. Investigate with FNA and AFB staining and culture
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13
Q

How does GI TB manifest?

A
  1. Ileocaecal
  2. Colicky abdominal pain and vomiting
  3. Peritonitis
  4. Ascites
  5. BO can occur from bowel wall thickening
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14
Q

How can you diagnose GI TB?

A
  1. Biopsy for diagnosis

2. Caseation necrosis and absence of transmural cracks/fissures distinguish from Crohns

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15
Q

How does Spinal TB manifest?

A
  1. Local pain and bony tenderness for weeks-months
  2. Slow insidious progressive
  3. Pott’s disease – TB spinal effect
  4. Spinal cord compression
  5. Osteomyelitis
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16
Q

What is Miliary TB?

A
  1. Haematogenous dissemination leads to formation of discrete foci (around 2cm) of granulomatous tissue throughout lung
  2. Sputum may be negative for AFB
  3. Untreated moratlity 100%
17
Q

How does CNS TB manifest?

A
  1. Haematogenous spread lead to foci of infection in brain and spinal cord
  2. Foci can enlarge to form tuberculomas
  3. Foci rupture lead to meningitis
  4. Headache, meningism, seizure, confusion, focal neurological deficient
  5. meningitis
18
Q

What do you look for in LP and examination of CSF for CNS TB?

A
  • leucocytosis
  • Raised protein
  • CSF plasma glucose <50%, AFP stain,
  • PCR and culture
19
Q

What are symptoms and result of genitourinary TB?

A
  1. Dysuria
  2. Frequency
  3. Loin pain
  4. Haematuria
  5. Can cause infertility
  6. Renal failure
  7. Sterile pyuria
  8. Epidiymo-orchtiis
20
Q

What does cardiac TB result in?

A
  1. Pericarditis
  2. Pericardial effusion
  3. Constrictive pericarditis
  4. Normocytic anemia
21
Q

What are the skin manifestations in TB?

A
  1. Lupus vulgaris
  2. Addison’s disease
  3. Scrofuloderma
  4. Erythema nodosum
  5. Clubbing
22
Q

What is Lupus vulgaris?

A

persistent progressive cutaneous TBL red brown apple jelly nodules

23
Q

What basic obs are done in active TB/symptomatic?

A

HR, RR, BP, O2 Sats, Temp

24
Q

What bedside tests are done for active TB/symptomatic?

A

sputum MCS (x3 samples, one in early morning)

25
Q

What Microscopy and culture is done for TB?

A
  • Microscopy: AFB stain – Ziehl-Neelsen (cultured in Lowenstein jensen medium)
  • Culture takes 6-8 weeks (most sensitive/sepcific)
26
Q

What bloods are done for active TB/symptomatic?

A
  1. FBC: high WCC, anaemia
  2. CRP: high CRP
  3. ABG: dyspnoea
  4. HIV
27
Q

What other tests are done for TB active?

A
  1. CXR

2. Lymph node biopsy

28
Q

What would CXR for TB show?

A
  1. Consolidation: patchy/heterogenous
  2. Bi-hilar lymphadenopathy
  3. Upper lobe scarring
  4. Cavitating lesions
  5. Pleural effusions
29
Q

What would lymph node biopsy for TB show?

A

caseating granuloma

30
Q

What tests are done for latent TB?

A
  1. Tuberculin skin test (Mantoux test) >15 mm – affected by BCG vaccine
  2. Interferon Gamma release Assay (>99% specific)
31
Q

What is good/bad about latent TB tests?

A
  • if either is +ve (exposed to TB) get chest CXR
  • also used to screen close contacts
  • can’t tell if TB is active or latent
32
Q

What does miliary TB show on CXR?

A
  1. nodular shadowing

2. lymphohematogenous dissemination of TB throughout the body – BAD SIGN

33
Q

What antibiotics are used to treat TB?

A
  1. Rifampicin
  2. Isoniazid
  3. Pyrazinamide
  4. Ethambutol
34
Q

What are SE of rifampicin?

A

Red/orange secretions

35
Q

What are SE of isoniazid?

A

peripheral neuropathy + Vit B6 deficiency so give pyridozine

36
Q

What are SE of pyrazinamide?

A

Hyperuricaemia (gout)

37
Q

What are SE of ethambutol?

A

eye – optic neuritis (reversible red-green colour blindness)

38
Q

What acronym is used for treatment of TB?

A

RIPE

Z Year3 Resp Conditions (20 decks)

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