Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Infectious Disease In The Community And Hospital Setting > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What is the function of the encasing waxy coat of TB?

A

Protects bacteria from antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Current TB treatment

A

Isoniazid
Pyrazinamide
Ethambutol
Rifampicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How many people have died of TB so far?

A

100,000,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Old treatment for TB prior to abx

A

People sent to sanitoriums
Sunshine, rest and good food
Lessons outside
Light therapy on spinal TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What year was TB declared a global health emergency?

A

1993

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How many people are infected with TB worldwide?

A

2 billion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How many new cases of TB are there a year?

A

9 million

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How many people die of TB a year?

A

1.7 million

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the cut off for a county to be consider high risk for TB

A

Incidence of 40/100 000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is TB transmitted?

A

Airborne organism - smear +ve TB
Regular contact = 8 hours cumulative contact over 3 months
Immunosuppressed or co-morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the key factors affecting transmission of TB?

A

Infectiousness of person = 4 + AAFB and productive cough
Environment of exposure = park/small enclose space
Duration of exposure = 8 hours
Virulence of organism
Susceptibility of the contact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Related factors of TB

A 
Poor housing 
Over crowding 
Poor nutritional status
Lowered immunity 
Alcohol/HIV +ve/ drug abusers 
Age young and old 
Ethnic background
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does the process of ‘primary complex’ involve?

A

Droplets inhaled, lodge in alveoli > ghon focus develops > bacteria transported to lymph nodes > 6/10 weeks = calcification/scarring of granulomas (prevents further spread of infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is miliary TB ?

A

Primary infection not controlled
Bacteria spread beyond primary complex via lymphatic system and blood stream
Lodge in any or many organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the two eventualities of miliary spread?

A

Resolves spontaneously

Develop into localised infections in about 10% people - meningitis, osteomyelitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How many people infected, actually develop primary TB disease?

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How many people infected develop post primary disease or reactivation ?

A

10-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pathogenesis of post primary disease/TB reactivation

A

Disease emerges if immunity wanes or later in life;
Viable bacilli multiply and cause immune system to become overwhelmed. (Non-Effective t-cell function) >
Lymphocytes produce cytotoxic substances causing caseation >
Cavity formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define infectious TB

A

Pulmonary TB , smear positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define non-infectious TB

A

Any site (including pulmonary) diagnosed by culture result (smear negative)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is environmental TB?

A

Non tuberculosis mycobacterium

Not public health risk as confined to the patient and can’t be transmitted.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Who is affected by environmental TB?

A

Patients with pre-existing lung disease e.g. Cystic fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you treat environmental TB?

A

Longer treatment period

1 yr 18 months as bacteria already resistant to some drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is empirical TB?

A

Patient with all clinical signs of TB but it’d never cultured. Improve on TB treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why and to who would would TB chemoprophylaxis be given to?

A

People infected with TB but no signs of disease i.e. Latent TB
Young children > 35 years
HCWs any age showing signs of latent TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Signs and symptoms of TB

A 
Persistent cough 3/52 or 2-3/12
Poor appetite 
Weight loss (cytokine mediated) 
Chest pain (if pulmonary) 
Enlarged  glands (particularly children and young Asians) 
Night sweats (cytokine mediated)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Investigations performed by GP

A

Sputum x 3 early morning ruined for c&s and AAFB
chest x-Ray
Refer to TB Team or chest clinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Hospital investigations for TB

A 
Tuberculin skin testing 
Bronchial washings
Biopsy 
Early morning urine 
Interferon gamma release test (IGRA) 
CT scan
29
Q

What is tuberculin skin or Mantoux testing

A

Checks for TB immunity

Doesn’t differentiate between BCG and TB disease immunity

30
Q

When are bronchial washings used?

A

If patient not producing sputum

31
Q

What are the requirements for urine testing for TB?

A

1st urination x 3

Culture and sensitivity

32
Q

What does the IGRA test do?

A

Determines immunity by measuring the gamma interferon response to specific antigens
Differentiates between TB and BCG immunity as measures the amount of IFN gamma produced by cells met with mtb antigen.

33
Q

What are the treatment aims for TB?

A

Reduce transmission
Cure (minimum interference/shortest time/quality of life)
Prevent death - rare in the uk due to late presentation, dx missed
Avoid relapse
Prevent emergence of drug resistance

34
Q

What is the cure rate for TB

A

97-98%

35
Q

What is secondary drug resistance

A

If abx taken intermittently and not for the right amount of time - drug resistance can occur

36
Q

What is primary drug resistance

A

If DRTB is caught from someone who has had previous treatment

37
Q

What is the treatment regimen for TB?

A

6 months minimum, site dependant
At least 3 abx for 2 months, then 2 abx for 4 months.
In practice start on 4 abx whilst waiting for c&s, if orgs res patient still on adequate treatment.
Pyrazinamide, isoniazid, rifampicin, ethambutol (2 months) then isoniazid and rif for four.
Used in combination to prevent resistance acquiring.

38
Q

Treatment for meningeal TB.

A

Quadruple therapy for 2 months, isoniazid and rif for remainder of treatment initially 12 months.
Add glucorticoid equivalent to prednisiolone 20-40mg if on rif; or 10-20mg adults or 1-2mg/kg max 40mg children.
Gradual withdrawal of steroids within 2-3 weeks of starting treatment.

39
Q

What is MDRTB?

A

Multi drug resistant TB.

Resistant to isoniazid and Rifampicin at outset of treatment.

40
Q

What is XDRTB?

A

Extensively drug resistant TB
Resistant to isoniazid and Rifampicin plus any fluoroquinolone plus at least one of the 3 Injectable 2nd line TB drugs (Capreomycin, kanamycin or Amikacin)

41
Q

What is TDRTB?

A

Totally drug resistant TB.
resistant to all 14 known TB drugs.
Reported in media and India.

42
Q

MDRTB drug treatment ?

A

At least 5 drugs, one injectable

43
Q

XDRTB treatment?

A

At least 6/7 drugs.
First line TB meds injectable.
Different abx groups
Requires extensive sensitivity and susceptibility testing

44
Q

When should patients with TB/suspected TB b admitted to hospital?

A

Only if clear clinical or socioeconomic need.

If ill or need clinical support or have issues which make them unable/unreliable to take medications

45
Q

How should a patient be dealt with in hospital with suspected pulmonary TB?

A

Isolate in appropriately engineered (airflow/neg pressure) and ventilated room.
If no appropriate room - isolate in side cubicle.
Remain in isolation until 3 early morning sputums = smear negative. (After 2 weeks of treatment pts considered non-Inf)
Inform TB nurses of suspected case.

46
Q

How should a patient be dealt with in hospital with smear positive pulmonary TB?

A

Only admit if clear need
Isolate for first two weeks of treatment, unless risk of MDRTB (previously treated)
Patient should wear a mask whenever they leave their room for the first two weeks of treatment
Inform TB nurses of confirmed case.

47
Q

What actions should be taken for someone with smear negative pulmonary TB/other sites in hospital ?

A

Isolation not necessary

Inform TB nurses of admission

48
Q

Ways in which TB is prevented?

A

Contact tracing
New entrant screening (born in country >40/100000 cases) - poor
Vaccination of high risk groups - parent/parent in HR country, new entrants, contacts, HCWs, vet care, travelling to HR countries
Chemoprophylaxis for TB contacts
Mop up at key stages of development

49
Q

Who is contact traced for a person who is smear negative?

A

Household contacts only i.e. Shares lounge, bedroom, bathroom or kitchen - family, students, some cultures were women have 7/days a week contact

50
Q

Who is contact traced for a person who is smear positive?

A

Anyone who has regular contact I.e. 8 hours cumulative over 3 months with contact.
Work environment, household, schools teachers and pupils.
If people are immunosuppressed then they should be traced if less than 8 hours contact.

51
Q

How is primary school contact tracing performed if someone is smear positive?

A

Screen whole school and close contacts of adults and children

52
Q

How is contact tracing performed in secondary school if someone is smear positive?

A

Look at year only of contact -> if high incidence = screen years above and below.

53
Q

What screening tests are carried out as part of contact tracing?

A

Mantoux, chest x Ray and IGRA testing

54
Q

Screening/treatment process for children aged 4 weeks - 2 years.

A

Contact with smear +ve TB:
-ve mantoux > chemoprophylaxis for 6 weeks
Repeat mantoux:
-ve > given BCG
+ve > assess for disease and either complete chemoprophylaxis or if disease then complete full 6 months of treatment

55
Q

What screening is required if TB diagnosed after a shortfall flight?

A

No action unless immunosuppressed patients on flight

56
Q

What screening is required if TB diagnosed after long hall flight?

A

> 8 hours = screen 2 rows either side of case.

57
Q

Percentage transmission of cattle to human TB?

A

1%

58
Q

What is done to prevent cattle to humanTB transmission?

A

Pasteurisation of milk
Screening cows
Badger culling

59
Q

Hospital contact tracing of patient with TB

A

Inform patients who have shared same bay or close beds

Inform patients GP and consultant

60
Q

Hospital staff member with TB contacting tracing

A

Same as household screening plus anyone in hospital who has had >8 hours contact or who is vulnerable
MDT with HPA, Hhospital ICN,

61
Q

Steps in hospital contact tracing

A

Liase with ICN - list of people who need to be informed
Assess infectivity of case - length of exposure; susceptibility of other patients; proximity of contact (unless sign exp or suscep)
Inform patient
Record in cases notes
Inform GP

62
Q

What is LTBI?

A

Latent TB INFECTION

Infected with m, tb but no active disease

63
Q

How is TB usually diagnosed?

A

Found through screening contact or new arrival screening

64
Q

Who is treated for LTBI and what treatments is given??

A

Individuals under 35 or HCWs of any age

12 weeks of Rifampicin and isoniazid

65
Q

What is DOTS?

A

Directly observed therapy

Package of interventions designed to improve management of TB and adherence with treatment

66
Q

When are DOTS instigated?

A

If unable to complete treatment due to drug/alcohol or abuse, homeless, chaotic lifestyle
Or if not being compliant during treatment / there are concerns about compliance

67
Q

What other actions are taken or services are provided to increase TB treatment compliance?

A

Rehousing
Food vouchers
Travel to hospital
Social issues to help people help themselves

68
Q

How do TB or HC workers self protect?

A

BCG
Awareness if signs and symptoms
Personal screening dependant on contact

Infectious Disease In The Community And Hospital Setting (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions