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Respiratory > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Definition

A

Chronic granulomatous disease caused by mycobacterium tuberculosis affecting lungs

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2
Q

Features of mycobacterium tuberculosis

A

slow growing
rods (bacillus)
high contents of lipids - Ziehl Neeson stain

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3
Q

Transmission of TB

A

Airbourne

Coughing and sneezing- respiratoyr droplets- droplets evaporate- suspended in air and circulated

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4
Q

Pattern of infection in TB

A

Primary TB
Secondayr TB
Miliary TB

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5
Q

Primary TB

A
  • initial infection
  • usually children
  • May be entirely asymptomatic
  • Bacilli are transported through lymphatics
  • granulomatous hilar lymph node infection in lung,known as Ghon focus
  • infection is then arrested
  • Tuberclin tests become positive after this
  • may cause mild cough, wheeze, erthema nodosum
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6
Q

Difference between ghon focus and ghon complex

A

Ghon focus- subplerual granuloma

Ghon complex- granuloma with associate lymph node

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7
Q

Secondary TB

A

Reactivation of disseminated dormant organisms

  • particullarly in the immunocompromised
  • florid and widespread
  • upper lung lobes and cavitation
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8
Q

miliary TB

A

Widespread haematological spread of small milet seed sized granulomas

Failure of Primary/secondary can gain entry throughout the body and set up many foci

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9
Q

Symptoms of TB

A

Pulmonary tB (90%)

  • cough, haemoptysis, shortness of breath
  • constitutional symptoms (fever, night sweats, fatigue, loss of apetits, lymphadenopathy)

10% extrapulmonary features

  • CNS (meningitis)
  • Eyes (blurred vision)
  • CVS (constritive perocarditis)
  • Renal (dysuria, haematuria)
  • GI (abdnominal pain, ascities)
  • Skeletal(arthritis, osteomyelitis)
  • skin (LUPUS)
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10
Q

Diagnosis of TB

A

Active TB:

Chest xray

Samples

  • sputum (patients who are not expectorating can induce with hypotonic saline, 3 separate samples including one early morning , collected and examined for TB bacillus Ziehl neison stain)
  • CT- differnetiates active TB
  • Bronchoscopy - intra-airway neoplasm
  • pleural effusion - tapped and examined for TB

latent TB
- Manteoux tuberculin skin test (used to screen peope at high risk for TB)

others
T-spot test
Lymph node biopsy

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11
Q

What does the Ziehl Neelsen stain test for

A

rapid direct mircoscopy for acid-alcohol-fast bacili (AAFBs)

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12
Q

How long does the culture take?

A

at least 6 weeks

therefore treatment started before culture results are back and continued even if cultures are negative

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13
Q

Mantoux test

A

Artificially injected material into skin
Harness immune response
Infiltration of lymphocytes

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14
Q

T-spot test

A 
Blood take 
RBCs and nuclear cells removed 
Immunologically competent cells left 
Purified TB added 
T cells release interferon y 
Antibody for interferony captured at the bottom
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15
Q

Spread of infection

A

Renal

  • aggresive destruction of parenchyma
  • WBCs in urine, negative culture

CNS

  • Cranial nerve palsies
  • meningeal pattern of spread
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16
Q

ABx treatment regimen

A

Should only be administered by doctors familiar with manageent

  1. 6 months therapy for pumonary TB
  2. Inital phase- 2 months on four drugs
    - Rifampicin, isoniazid, pyrazinamide (dropped after 2 months no effect on slow growing TB), ethambutol (once sensitivityes known)
  3. continuation phase - 4 months on 2 drugs
    - rifampicin
    - isoniazid
17
Q

Mnemonic for TB drugs

A 
PRIEST 
Pyrazinamide 
Rifampicin
Isoniazid 
Ethambutol 
STreptomycin
18
Q

Rifampicin side effects

A

red/orange pee
hepatitis
enzyme inducer

19
Q

Isoniazid side effects

A 
hepatitis 
peripheral neuropahty (cover with pyridoxine)
20
Q

Pyrazinamide side effects

A

hepatitis
rash
gout
little effect against slow growing bacteria

21
Q

Ethambutol side effects

A

optic neuritis

renal dysfunction

22
Q

Prevention

A

Vaccination (BCG)
Public health measures: treatmen/prophylaxis of contacts
Notifiable disease in UK

23
Q

Risk factors

A 
HIV 
Alcoholics 
Immigrants from endemic areas 
Homelss 
IV drug sers
24
Q

granuloma draw

A

Langhan cells -fusion of epithelial cells
Epitheloid cells- macrophages
Lymphocytes- T cells
central caseating necrosis

Respiratory (18 decks)

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