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ZA - Respiratory Diseases > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

How many people are affected by TB worldwide?

A

2 billion

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2
Q

Why is TB becoming more of a problem in the UK?

A

Immigration from high risk countries

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3
Q

What bacteria is the cause of TB?

A

Mycobacteria

M.tuburculosis
M. Bovis

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4
Q

What sort of bacteria is mycobacteria? What stain is used?

A

Acid-Alcohol Fast Bacilli - AAFB

Doesn’t decolourise in acid, alcohol staining techniques so ZN stain used

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5
Q

Why can our bodies not fight off TB? Why does TB prefer apicies of lungs? Why is disease usually long and drawn out?

A

Resistant to macrophages and n.phils
Aerobic - so prefers apicies
Slow growing - long disease

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6
Q

How is M.Tuburculosis spread?

A

Coughing
Sneezing
Resp - droplets

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7
Q

How is M.Bovis TB spread?

A

Drinking infected cow’s milk - bacteria placed in cervical and intestinal lymph nodes

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8
Q

Pathology of TB, what happens in body as bacteria invades?

A

Invading mycobacteria triggers Th1 cells which activate macrophages, epitheliod cells and langhan’s giant cells that all accumulate around the infection and form granulomas

Causing central caseous necrosis

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9
Q

Why is the Th1 response a “two edged sword”?

A

As the response does get rid of infection - but the accumulation of stuff and subsequent necrosis causes problems

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10
Q

How would TB affect a malnourished/elderly patient?

A

Lots of tissue destruction
Organism proliferates and spreads
Ongoing disease

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11
Q

How would TB affect a healthy young patient?

A

May or may not have tissue destruction
Organism is contained
Disease is contained or can continue

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12
Q

When does primary disease occur? In who does it occur? Where is the infection focused?

A

Occurs in those with no immunity
Mainly children
Infection focused in alveoli

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13
Q

Where can the infection spread from alveoli to?

A

Lymphatics to other organs

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14
Q

Symptoms of primary TB are usually asymptomatic - what may appear?

A

Erythema nodosum

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15
Q

What are the effects of primary disease progression?

A

Cavitation

Hilar lymph nodes can enlarge and compress bronchi - causes lobar collapse and discharge of infection into bronchus. This causes TB bronchopneumonia - poor prognosis

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16
Q

What can occur 6-12 months after a primary infection?

A

Miliary TB
meningeal TB
TB pleural effusion

17
Q

How does miliary TB show on a CxR?

A

Fine motting

Widespread small granuloma

18
Q

How can meningeal TB be detected. Is it severe?

A

Very severe

CSF has high protein and lymphocyte readings

19
Q

How can TB reinfection take place?

A

Reactivation of latent TB or re-infection from an outside source

20
Q

In re-infection - is the host response similar?

A

It will be different - but if insufficient immunity the re-infection will cause tissue damage and progression

21
Q

Risk factors of TB reinfection

A 
Diabetes
Immunosuppresed
Previous TB
Alcohol abuse
IVDA
Poor standards or living
Immigration from high risk area
22
Q

Symptoms of reinfected TB?

A

Cough with sputum and haemoptysis
Pleuritic chest pain
Malaise and weight loss
Fever and night sweats

23
Q

What are the primary and secondary TB investigation steps?

A

Sputum samples
CxR

If sputum negative:

CT scan
Bronchoscopy with bronchoalveolar lavage (washing and collecting of washed sample) or biopsy
Pleural aspiration and biopsy if pleural effusion present

24
Q

What is seen on a CxR?

A

Patchy shadowing on apices/upper zones OR apex of lower lobes
Often bilateral

Cavitation if advanced disease

Calcification in chronic/healed TB

25
Q

Treatment - what NEVER to do?

A

Single drug treatment - creates a resistant organism

26
Q

Treatment plan?

A 
First 2 months:
Rifampicin
Isoniazid
Ethambutol
Pyrazinamide

For next 4 months (2-6 months):
Rifampicin
Isoniazid

27
Q

When is TB declared non infectious in a patient?

A

2 weeks after treatment begins

28
Q

Side effects of rifampicin?

A

Orange urine/tears

Makes oral contraceptive pill ineffective

29
Q

Side effects of isoniazid?

A

Hepatitis

Peripheral neuropathy

30
Q

Side effects of ethambutol?

A

Optic neuropathy

31
Q

Side effects of pyrazinamide?

A

Gout

32
Q

What are the 2 TB tests?

A

Test immunity to tuberculopritein

Mantoux
Heaf

33
Q

How is mantoux measured?

A

Injected intradermally

Induration read at 48-72 hours - if over 10mm positive

34
Q

How is heaf measured?

A

Multiple punctures

Read after 4-7 days

ZA - Respiratory Diseases (30 decks)

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