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Year 1- Respiratory > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Describe the groups vulnerable to getting TB in the UK.

A

-HIV positive individuals
-Immunosuppressed individuals
-People from high prevalence countries
-Elderly, neonates, diabetics
-Homeless
-Alcoholics
-Prison

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2
Q

What proportional of all TB cases in the UK are alcoholics/homeless/in prison?

A

1 in 10

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3
Q

TB kills more than which two diseases together?

A

Malaria and HIV

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4
Q

What ranking is TB on deaths of commuincable diseases?

A

2
after Covid-19

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5
Q

How many people worldwide are estimated to have TB?

A

2 billion

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6
Q

List some countries where TB is more prevalent.

A

Nigeria, Pakistan, China, Philippines, Bangladesh, India, Indonesia

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7
Q

Where are mycobacteria found?

A

Soil and water

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8
Q

Name some species of mycobacteria responsible for TB.

A

M. tuberculosis, M.africanum, M. bovis

M= mycobacteria

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9
Q

What mycobacteria causes leprosy?

A

M.leprae

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10
Q

Describe mycobacteria.

A

Non-motile bacillus, very slowly growing, aerobic

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11
Q

What can be frustrating about diagnosing/treating TB?

A

Disease is slow and long to treat

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12
Q

Which part of the lungs does TB affect?

A

Upper part of the lungs- aerobic

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13
Q

Describe the cell wall of mycobacteria.

A

Thick and fatty cell wall

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14
Q

Due to the thick and fatty cell wall, what are mycobacteria resistant to?

A

Acids, alkalis, detergents
Neutrophil and macrophage detruction

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15
Q

What is the route of transmission for TB?

A

Airbourne

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16
Q

What is the one exception to the transmission of TB being airborne?

A

thanksjacquelinewilsonforwritingqueenie

Cows milk- unpasteurised and infected by Mycobacterium bovi

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17
Q

List some ways TB is NOT spread.

A
  • Shaking hands
  • Sharing food
  • Touching surfaces
  • Sharing toothbrushes
  • Kissing
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18
Q

How can someone get TB via the air?

A

TB bacteria attached to aerosol droplets which can remain suspended in air for many
hours, especially if there is poor air circulation
Someone else breathes these bacteria in

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19
Q

What is usually required for someone to develop TB?

A

Prolonged contact

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20
Q

How is mycobacteria eliminated outdoors?

A

UV radiation and dilution

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21
Q

What % of all TB cases are in the lungs?

A

50%

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22
Q

What is the second most likely part of the body to get infected by TB after the lungs?

A

Lymph nodes

23
Q

Does post-primary TB occur in humans or animals?

A

Only in humans

24
Q

What is DOT?D

A

Directly observed therapy

Nurse goes into the home of individual infected w TB to watch them take their medication to reduce likelihood of spreading it to others.
Often happens with people who may struggle to remember to take medication.

25
Q

What happens to TB bacteria in alveoli?

A

Macrophages recognize it and ingest the bacteria
T helper cells are activated and come from the lymph nodes.
Lymph nodes secrete various cytokines
Macrophages become activated

26
Q

What do activated macrophages turn into?

A

Langhan’s giant cells

27
Q

What forms when there is an accumulation of Langhan’s giant cells, macrophages and epithelioid?

A

Granuloma

28
Q

What can the granuloma lead to?

A

Necrotic tissue, which may calcify later and tissue damage

29
Q

Why are there pros and cons to Th1 cell mediated immunological responses?

A

Eliminates / Reduces number of invading mycobacteria
Tissue destruction is a consequence of activation of macrophages

30
Q

What does the outcome of a TB infection depend on?

A

Infection and Susceptibility

31
Q

What is meant by infection in terms of the outcome?

A

Virulence of infection
Number of infections

32
Q

What is meant by susceptibility in terms of the outcome?

A

Genetics
Nutrition
Age
Immunosuppression

33
Q

What are the three paths that a primary infection of TB could go down?

A

Progressive disease
Contained/ latent
Cleared/cured

34
Q

What can primary infection lead to?

A

Tuberculous bronchopneumonia
Miliary TB

35
Q

What is Bronchopneumonia?

A

Bronchopneumonia is a type of pneumonia that causes inflammation in the alveoli.

36
Q

What can happen in Tuberculous bronchopneumonia?

A

Enlargement of hilar lymph compresses bronchi which can lead to lobar collapse.
Enlargement of lymph node can discharge into the bronchus

37
Q

What happens in miliary TB?

A

Hematogenous spread of bacteria to multiple organs
Looks like millet seeds on autopsy

38
Q

What are the two hypotheses for why humans develop post-primary TB while animals do not?

A
  1. TB bacteria entering a dormant stage with low or no replication over prolonged
    periods of time
  2. Balanced state of replication and destruction by immune mechanisms
39
Q

How long can Miliary, Meningeal, Pleural TB last?

A

6-12 months

40
Q

How long can post primary TB last?

A

1-5 years
But could be 30-40

41
Q

How long can Genitourinary, Cutaneous TB last?

A

10-15 years
But could be 30-40

42
Q

What is the clinical presentation for someone w TB?

A
  • Cough
  • Fever
  • Sweats (mainly at night)
  • Weight loss
43
Q

What is important to note about the presenting symptoms?

A

A lot of people don’t have all of them and some don’t have any.

44
Q

What may a chest xray look like in someone w TB?

A

Apices, soft ‘fluffy/nodular upper zone- like cotton wool
Cavitation in 10-30%

45
Q

When might you consider CT for a patient with suspected/confirmed TB?

A

*Normal CXR but clinical suspicion
* Miliary TB
* Cavitation & other differential
* Lymphadenopathy, alternative diagnosis
* targets for BAL

46
Q

Are mediastinal lymphadenopathy usually bilateral or unilater?

A

Unilateral

47
Q

List some of the investigations used to diagnose TB

A
  • Sputum; 3 samples, 8-24hrs gap, at least 1 early morning sample
  • Induced sputum
  • Bronchoscopy with BAL
  • Endobronchial ultrasound (EBUS) with biopsy
  • Lumbar puncture in CNS TB
  • Urine in urogenital TB
  • Aspirate/biopsy from tissue ( lymph-node, bone, joint, brain, abscess …)
48
Q

Multi drug treatment is used when treating TB.
Why?

A

Single agent treatment leads to drug resistant organisms within 14 days

49
Q

In terms of treatment for TB, how can you remember number and types of treatment?

A

4/2:2/4

50
Q

Describe 4/2:2/4

A

Four drugs for two months
Two drugs for four months

51
Q

Which two drugs do you have for the whole six months of treatment?

A

Rifampicin and isoniazid,

52
Q

Which two drugs do you add in, alongside Rifampicin and isoniazid,, for the first two months of treatment?

A

Pyrazinamide and ethambutol

53
Q

What can be given to reduce risks of isoniazid induced poly neuropathies?

A

Vitamin B6

54
Q

Which vaccine is given to selected groups to help reduce risks of TB?

A

BCG vaccine

Year 1- Respiratory (36 decks)

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