Tuberculosis *

Question 1

What is tuberculosis

Answer 1

Chronic granulomatous caseating disease caused by Mycobacterium Tuberculosis

Question 2

How is TB transmitted

Answer 2

Airborne
-By inhaling droplets of M.TB
(Last long in the environment)

Question 3

What are the risk factors for TB

Answer 3

Age
Ethnic minority
Homeless/ Crowded living
IVDU/Alcohol abuse
Immunosupressed
Travel from India

Question 4

How does Microbacterium cause TB

Answer 4

Primary (dormant)
-Macrophages engulf TB in Hilar lymph where they are destroyed or trapped by granulomatous tissue
Secondary (Active)
-TB becomes active esp. in immunocompromised @ lung apex were it spreads

Question 5

What is Milliary TB

Answer 5

TB travels via the blood stream

-Millet seeds visible on x-ray

Question 6

What is the general and resp presentation of a TB patient

Answer 6

Night sweat and weight loss
Fever
Chronic cough w/ purulent sputum
Haemoptysis
(Can get bronchiectasis, pneumonia and pleural effusion)

Question 7

What are some extrapulmonary signs of TB

Answer 7

Meningitis
Skin change
Pericarditis
Joint pain

Question 8

What are the investigations of TB

Answer 8

CXR
3x Sputum sample w/ Ziehl Neelsen = Bright red
Biopsy and needle aspiration
Mantoux - for latent with BCG vaccine

Question 9

What are the RIPE drugs for TB

Answer 9

R- Rifampicin
I - Isoniazid
P - Pyramidine
E - Ethambutol

Question 10

How long should you give the drugs for active and latent TB

Answer 10

ACTIVE
-RIPE = 2 months -RI = 4 months
LATENT
-RI = 6 months -I = 3 months

Question 11

What are the SE for Rifampicin

Answer 11

Body fluid = red

Question 12

What are the SE for Isoniazid

Answer 12

Peripheral neuropathy ( Give Pyrodixin in adjunct)

Question 13

What are the SE for Pyrazinamide

Answer 13

Hepatitis

Question 14

What are the SE for Ethambutol (Avoid in CKD)

Answer 14

Eye Problem(Optic Neuritis)

Question 15

What are the 4 microbacteriums part of the Microbacterium Tuberculosis complex (Cause TB)

Answer 15

M Tuberculosis
M Africarium
M Microtis
M Bovis

Question 16

Where in the world is TB commonly found

Answer 16

South Asia and Subsahran Africa

Question 17

What is the pathology of TB

Answer 17

TB resists phagocytosis and form caseous granulomata
T cells cause central caseating necrosis = Ghon Focus in Lung upper lobe
Ghon focus spreads to lymph nodes = Ghon Complex
Systemic TB = Milliary TB
Remains in Granulomata = Latent TB (Can reactivate in Immunosupressed)

Question 18

Describe the features of the MTC

Answer 18

Non motile and non spore forming
Mycolic acid capsule
-fast acid staining w/ ZN = Bright red
Phagocytosis resistant
Slow growing organisms

Question 19

How do Ghon focus form in TB

Answer 19

T cells cause central granuloma to undergo caseating necrosis of upper lung

Question 20

How does a Ghon Complex form

Answer 20

Ghon focus spreads to lymph nodes
Forms latent TB (Bad for IC Patients)

Question 21

What is millairy TB

Answer 21

When the ghon complex spreads sytematically

Question 22

What investigation can differentiate between latent and active TB

Answer 22

Monteaux skin test

Question 23

What is the Gold investigation used in TB

Answer 23

3 sputume cultures
Positive acid fast bacilli on ZN stain
Bright red

Question 24

Which TB drug is avoided in Liver fail

Answer 24

Pyramidine
-SE is hepatitis