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Resp JL > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What virus is contributing to the global rise of TB?

A

HIV

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2
Q

What bacteria causes the tuberculosis disease?

A

Mycobacteria from the M.tuberculosis complex

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3
Q

Name three bacteria in the Mycobacterium tuberculosis complex?

A
  1. M.tuberculosis
  2. M.bovis
  3. M.africanum
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4
Q

What does M.leprae cause?

A

Leprosy

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5
Q

What infects cows and is killed by pasteurisation of milk?

A

M.bovis

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6
Q

What does not cause TB outside of northwest africa?

A

M.africanum

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7
Q

List 5 risk factors for tuberculosis

A
  1. Contacts of patients with tuberculosis (smear positive)
  2. Children with a positive skin test (Heaf) for tuberculosis
  3. Immigrants from Africa and the Indian Subcontinent
  4. Poverty and homelessness
  5. HIV infection
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8
Q

What is the primary test for TB?

A

PCR for MTB

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9
Q

Name two other tests other than PCR for detecting TB

A
  1. Microscopy for AAFB

2. Liquid culture for mycobacteria

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10
Q

In the modern detection of tuberculosis - what is it critically important to get?

A

Tiisue diagnosis

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11
Q

What 4 samples can you get for testing of TB?

A

Sputum
Bronchial washings
Pleural effusion
Cold abscess

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12
Q

What does IGRA stand for?

A

Interferon Gamma Release Testing

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13
Q

What is IGRA testing for TB?

A

Quantification of how much Gamma-interferon is released from circulating T-lymphocytes in response to specific stimuli.

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14
Q

Name two antigens from M.tuberculosis

A

ESAT-6

CFP-10

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15
Q

What only determines if the patient has T-lymphocytes primed to respond to MTB stimulus?

A

IGRA testing for TB

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16
Q

What 3 states of TB will test positive with IGRA testing?

A

Current TB
Previous, treated TB
Latent TB

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17
Q

Name a reportable illness?

A

Tuberculosis

18
Q

Who must be informed of any case of highly suspected TB and confirmed cases of TB?

A

Public health

19
Q

Are patients with ‘open TB’ contagious?

A

Yes - smear positivity

20
Q

Can patients with ‘open TB’ be detained in hospital until they no longer have ‘open TB’?

21
Q

Can you force patients to take TB treatment?

22
Q

What does modern management of tuberculosis start with?

A

4 Antituberculosis drugs

23
Q

What are the 4 antituberculosis drugs?

A

Rifampicin (R)
Isoniazid (H)
Pyrazinamide (Z)
Ethambutol (E) (15mg/kg body weight)

24
Q

For respiratory and non-respiratory TB patients - describe the initial and continuation phase of treatment (including drugs and timeframe)

A

Initial phase: 2 months (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) 2RIPE

Continuation phase: 4 months (Rifampicin and Isoniazid) 4RI

25
Q

For meningitis/CNS TB what is the treatment? (Including initial phase and continuation phase)

A

Initial phase: 2 months (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) 2RIPE

Continuation phase: 10 months (Rifampicin and Isoniazid) 10RI

26
Q

What does modern management of tuberculosis prevent?

A

Multi-drug resistant tuberculosis

27
Q

To preveny multi-drug resistant tuberculosis what 3 steps are taken?

A
  1. In vitro drug susceptibility testing on all isolates
  2. Initial treatment of 4 drugs to cover unsuspected resistance
  3. If compliance is a problem, in underdeveloped contries use Directly Observed Therapy Short-Course (DOTS)
28
Q

What is the term for a responsible observer administering the drugs and observing ingestion of the drugs, ensuring compliance?

A

Directly Observed Therapy Short Course (DOTS)

29
Q

Name three adverse drug reactions of Isoniazid

A
  1. Hepatitis
  2. Cutaneous hypersensitivity
  3. Peripheral neuropathy (Vit B6 co-factor)
30
Q

Give 4 adverse side effects of Rifampicin

A
  1. Hepatitis
  2. Cutaneous reactions
  3. GI upset
  4. Febrile reactions/flu syndrome
31
Q

Give 5 adverse reactions of pyrazinozide

A
  1. Anorexia and vomiting
  2. Flushing
  3. Hepatitis
  4. Hyperuricaemia
  5. Arthralgia
32
Q

Give 2 adverse effects of ethambutol

A
  1. Retrobular neuritis (colour vision at first)

2. Arthralgia

33
Q

In the UK is latent TB treated?

A

No, transmission rates are low

34
Q

What four drugs would you use to treat latent TB prior to immunosuppressive therapy?

A

Infliximab
Etanercept
Adalimumab
Rituximab

35
Q

If treating latent TB, after initial 4 drug treatment what do you give three months of?

A

Isoniazid and Rifampicin

36
Q

Which type of drug resistant TB is resistant to first line therapy?

37
Q

Which type of drug resistant TB is resistant to second line therapy?

38
Q

Name 4 drugs XDR-TB is resistant to?

A

Isoniazid
Rifampicin
Fluoroquinolones
Injectables - amikacin, capreomycin, kanamycin

39
Q

Name two drugs MDR-TB is resistant to?

A

Isoniazid

Rifampicin

40
Q

In what 3 types of patients should you suspect TB?

A
  1. Returning travellers
  2. Immunocompromised patients
  3. Non-resolving pneumonia patients
41
Q

Where are most TB cases?

A

India and China

Resp JL (27 decks)

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