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WINTER 2018-PATH0 > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

TB Rates

A

Overall rates are low, however it is high in the following populations:aboriginal population, people born in countries where TB is high,

May be common in certain pockets in Canada

People with HIV are more sucseptible to TB and they also have an increased risk for it to go from blanatent to active

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2
Q

TB Pathology

A

First you need to be exposure to the bacteria that causes TB

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3
Q

Positive Man Two Test

A

A positive Man two test can be blantent or active

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4
Q

Postprimary Tuberculosis Also Called:

A

Reactivation TB

Reinfection TB

Secondary TB

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5
Q

Primary Tuberculosis Also Called:

A

Primary infection stage

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6
Q

Disseminated Tuberculosis Also Called

A

Extrapulmonary TB

Miliary TB

Tuberculosis-disseminated

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7
Q

Anatomical Alterations in the Lungs

A

(Mainly Postprimary TB)

  • Alveolar consolidation
  • Alveolar-capillary destruction
  • Caseous tubercles or granulomas
  • Cavity formation
  • Fibrosis and secondary calcification of the lung parenchyma
  • Distortion and dilation of the bronchi
  • Increased bronchial airway secretions
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8
Q

Caseous

A

Caseous: Describing necrotic tissue — cottage cheese like mixture of fat and protien often yellowish/white

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9
Q

What is the primary bacteria that causes TB

A

In humans, TB is primarily caused by Mycobacterium Tuberculosis

Highly aerobic organisms

Considered acid-fast bacilli due to the staining procedure used to ID them in vitro.

Part of the diagnostic process is looking at what type of micro bacterium

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10
Q

Test to Diagnosis TB

A

All can diagnose TB but not all can differeniate between the active and latent

  • Mantoux tuberculin skin test
  • Acid-fast Staining
  • Sputum Culture
  • QuantiFERON®-TB Gold Test-New test that is quickly becoming the gold standard
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11
Q

Mantoux Tuberculin Skin Test

A
  • Injection of purified protein derivative (PPD)
  • Wheal less than 5 mm: negative
  • Wheal 5 mm to 9 mm: considered suspicious in non high risk categories
  • But in high risk categories (Recent exposure, Ghon lesions, HIV, under age of five it is considered to be a Positive resulst
  • Wheal 10 mm or greater: positive
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12
Q

Acid-Fast Stain and Sputum Culture

A
  • Ziehl-Neelsen stain-Reveals bright red acid-fast bacilli against a blue background
  • Fluorescent acid-fast stain-Reveals luminescent yellow-green bacilli against a dark brown background

AFB smear is not a culture and sensitivity-Does not take long but lot of false negatives

Microbacterium TB takes a long time to culture but the culture is more specific and will tell us if it more resistant to antibiotics, which is a big problem in TB.

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13
Q

TB and Antibotics

A

A problem is people not taking the full course of antibotics which will make them more resistance to antibotics

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14
Q

Sputum Culture

A

Because a variety of non-tuberculous strains of Mycobacterium can show up on an AFB smear, a sputum culture is often necessary to differentiate M. tuberculosis from other acid-fast organisms.

Can also identify drug-resistant bacilli and their sensitivity to antibiotic therapy.

M. tuberculosis grows very slowly. It takes up to 6 weeks for colonies to appear in culture.

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15
Q

Sputum Culture Procedure

A

We are often the ones taking the sputum culture

Normally done in the morning because then they have had all night to let it collect

Have to do three sample (three consecutive days)

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16
Q

QuantiFERON-TB Gold Test

A

The QFT-G is a whole-blood test used for diagnosing Mycobacterium tuberculosis infection

Results are available after 24 hours

Cannot distinguish active vs latent infections

Useful in that BCG vaccinations will not mask results

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17
Q

Overview of the Cardiopulmonary Clinical Manifestations Associated with Tuberculosis

A
  • Alveolar Consolidation
  • Increased Alveolar-Capillary Membrane Thickness
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18
Q

Vital Signs

A

Increased:

  • Respiratory rate (tachypnea)
  • Heart rate (tachycardia)
  • Blood pressure
  • Generally no fever unless a concomitant bacterial infection is present.
    • This is the big difference between TB and pneumonia
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19
Q

Chest Assessment Findings

A
  • Increased tactile and vocal fremitus
    • Due to consolidation
  • Dull percussion note
    • Due to consolidation
  • Bronchial breath sounds
  • Crackles, rhonchi, and wheezing
  • Pleural friction rub if process extends to pleural surface
  • Whispered pectoriloquy
20
Q

Pulmonary Function Tests

A

Restrictive Process

21
Q

Arterial Blood Gases in Extensive Tuberculosis with Pulmonary Fibrosis

A

Chronic Ventilatory Failure with Hypoxemia

(Compensated Respiratory Acidosis)

22
Q

Arterial Blood Gases in Moderate Tuberculosis

A

Acute Alveolar Hyperventilation with Hypoxemia

(Acute Respiratory Alkalosis)

Chronic ventilatory failure with hypoxemia (like in COPD)

23
Q

Acute Ventilatory Changes Superimposed on Chronic Ventilatory Failure

A

˜Because acute ventilatory changes are frequently seen in patients with chronic ventilatory failure, the respiratory care practitioner must be familiar with and alert for the following:

Acute alveolar hyperventilation superimposed on chronic ventilatory failure

Acute ventilatory failure (acute hypoventilation) superimposed on chronic ventilatory failure.

24
Q

Oxygenation Indices in Moderate to Severe Stages

A

Interpulmonary shunt like pneumonia

Increased QS/QT

Decreased D02

Normal V02

Normal C(a-v)02

Increased O2ER

Decreased Sv02

­

25
Q

Hemodynamic Indices

Severe Stage

A

Pulmonary hypertension and right heart failure

Incresed CVP

Increased RAP

Increased PA

Normal PCWP

Normal CO

Normal SV

Normal SVI

Normal CI

Increased RVSWI

Normal LVSWI

Increased PVR

Normal SVR

26
Q

Abnormal Laboratory Tests and Procedures

A
  • Positive tuberculosis skin test (PPD)
  • Positive sputum acid-fast bacillus (AFB) stain test
  • Positive sputum culture
27
Q

Chest Radiograph

A

Increased opacity

Ghon nodule

Ghon complex

Cavity formation

Cavity lesion containing an air-fluid level

Pleural effusion

Calcification and fibrosis

Retraction of lung segments or lobe

Right ventricular enlargement

Pulmonary hypertension and right sided heart failure

28
Q

What is the two main things that differentiate between latent and active TB

A

The two big things that differentiate between active and latent TB is your chest Xray and whether or not there is active symptons

29
Q

Isoniazid and Rifampin

A
  • Isoniazid is considered to be the most effective first-line antituberculosis agent.
  • Rifampin is bactericidal and is most commonly used with Isoniazid.
30
Q

Ghon Lesion and Latent TB

A

Ghon Lesion is the only thing abnormal you would see in latent TB and may not always be there

31
Q

General Management of Tuberculosis-Pharmacologic Agents

6 Month Treatment Protocol

A

For the first 2 months (called the induction phase), the patient takes a daily dose of isoniazid (INH), rifampin, pyrazinamide, and either ethambutol or streptomycin.

For the next 4 months, the patient takes isoniazid and rifampin daily or twice weekly.

This is why ppl tend to not follow through all the way because it is a lot to take

32
Q

Protocols Used

A
  • Oxygen Therapy Protocol
  • Bronchopulmonary Hygiene Therapy Protocol
  • Mechanical Ventilation Protocol
33
Q

Differential Diagnosis

A
  • Acute / chronic COPD
  • Pneumonia
  • Neoplasms

Positive tests for the active disease are conversion of the Mantoux and sputum culture containing M. tuberculosis bacilli

34
Q

Prevention-Bacille Calmett Guerin (BCG)

A
  • A vaccine used as an active immunizing agent against tuberculosis and in cancer immunotherapy.
  • A dried, living, avirulent culture of the Calmette-Guerin strain of M. bovis.
  • The CDC in Atlanta recommends BCG vaccine be reserved for high risk groups. Eg. Infants and children who reside in areas where incidence and transmission is high, and certain healthcare workers where incidence of MDR M. tuberculosis is suspected.
  • Not recommended in pts with HIV.
35
Q

Modes of Treatment

A
  • C&S will reveal which of the common drugs, the organism is susceptible to.
  • Therapy includes at least three (normally four) of the mainline drugs.
    • Isoniazid (INH) (hepatitis may appear in 2.5% of pts over 65),
    • Rifampin (Rifadin®),
    • ethambutol, pyrazinamide, streptomycin.
36
Q

MDR and XDR TB

A

MDR-TB are appearing in specific sites around the world.

XDR-TB = extensively drug resistant

Treatment with the secondary drugs is problematic in that expense is high and side effects are more severe.

37
Q

DOT plus (World Health Organization).

A

Direct observation therapy has a much higher success rate than patient reported compliance.

38
Q

Tuberculosis Definition

A

Tuberculosis is a chronic bacterial infection that primarily affects the lungs but can invade almost any part of the body. (DJ)

Primary refers to the initial infection. It looks like most other pneumonias at first, but some engulfed bacilli survive and are walled off by the immune system. (caseation—Ghon lesions)

Later, these tubercles can reactivate and the bacilli spread to others areas—primarily the apices of the lungs.

39
Q

Structural Changes-Other

A
  • Pleural effusions and inflammation.
  • Destruction, cavitation, fibrosis all lead to ­WOB etc.
40
Q

Structural Changes-Distortion and dilation of bronchi

A

Distortion and dilation of bronchi—-bronchiectasis.

41
Q

Structural Changes-Fibrosis and Calcification

A

Fibrosis and calcification-Decrease Flows & volumes on PFT

42
Q

Structural Changes-Cavitation

A

Cavitation-visible on X-ray.

43
Q

Structural Changes-Caseating Tubercles

A

Caseating Tubercles-Retraction of surrounding tissue.

44
Q

Structural Changes-Alveolar-Capillary Destruction

A

Alveolar-capillary destruction—shunt, Decrease Dlco.

45
Q

Structural Changes-Alveolar Consolidation

A

Alveolar consolidation—pneumonia.

46
Q

Why are TB pt. on airborne precautions

A

The bacilli are almost exclusively transmitted within aerosol droplets produced by coughing, sneezing, or laughing of an individual with active TB.-This is why we isolate ppl suspected of active TB

WINTER 2018-PATH0 (7 decks)

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