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Systems 1 > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

How many people are effected with Tuberculosis worldwide?

A

2 Billion

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2
Q

What percentage of UK TB sufferers live in London?

A

39%

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3
Q

What percentage of TB patients are HIV+?

A

~10%

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4
Q

What bacteria cause tuberculosis?

A

Mycobacterium tuberculosis/bovis

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5
Q

How do you test for TB pathogens?

A

Acid Alcohol Fast Bacilli

ZN stain

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6
Q

What factors can turn a resistant host into a susceptible host?

A

Malnutrition and Age

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7
Q

What is MOTT?

A

Mycobacteria other then Tuberculosis
Mycobacterium avium-intracellulare
M. kansasii, malmoense, xenophi

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8
Q

What type of bacterium is mycobacteria?

A

Slow growing, aerobic, non-motile bacillus

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9
Q

What is mycobacteria resistant to?

A

Acids, alkali, detergents

Neutrophils/macrophages

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10
Q

What part of the lung is most vulnerable to TB? Why?

A

Apex of lobes

Parts of lungs ventilated but not perfused

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11
Q

M. tuberculosis spreads how?

A

Inhaling droplets containing mycobacteria

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12
Q

M. bovis spreads how?

A

Consumption of infected cows milk

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13
Q

Secondary infection triggers what?

A

Activation of macrophages causes damage, epithelioid cells propagate to repair

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14
Q

Macrophages and epithelioid cells form what?

A

Langhans giant cells

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15
Q

Langhan’s cells, macrophages and epitheloid cells form what?

A

Granuloma

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16
Q

What types of granuloma are common in TB?

A

Central Caseating Granuloma (may later calcify)

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17
Q

What happens on exposure to a resistant host?

A

Rapid immune response causing a small amount of damage

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18
Q

What happens on exposure to a susceptible host?

A

Large amounts of tissue damage with pathogen survival

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19
Q

How does mycobacterium spread systemically?

A

Via Hilar lymph nodes

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20
Q

How does primary TB present in the majority?

A

Initial lesion + local lymph node

Heals with/without scar

21
Q

What is the basis of Heaf/Tuberculin tests?

A

Intradermal administration of tuberculoprotein based on immunity to said protein

22
Q

What are the three outcomes to primary TB infection?

A

Progressive Disease
Contained Latent
Cleared/cured

23
Q

Progression of primary infection presents with what?

A

Primary focus enlargement

Enlargement of hilar lymph nodes compressing bronchi

24
Q

What causes Tuberculous Bronchopneumonia?

A

Discharge of tuberculous lymph node into the bronchi

25
Q

Disseminated infection can appear as what?

A

Miliary TB
Meningeal TB
Tuberculous Pleural Effusion

26
Q

How does Miliary TB present?

A

Small widespread granulomata

27
Q

What is Post primary disease?

A

Reactivation of disseminated latent mycobacterium

New reinfection

28
Q

What is the clinical presentation of Pulmonary Tuberculosis?

A

Progressive cough
Sputum (haemoptysis)
Pleuritic pain
Malaise, fever, weight loss, night sweats

29
Q

Common PMH in post-primary pulmonary TB?

A

Diabetes
Immunosuppression
Previous TB

30
Q

Social history in post-primary TB?

A

Alcohol, IVDA
Poverty
High incidence immigrants

31
Q

In which patients should you be suspicious of TB?

A 
Immunosuppressed
Malnutrition
DM
Young/Old
High prevalence immigrants
32
Q

Which sputum tests should be done and when?

A

3 sputum specimens on successive days:
Sputum smear (ZN stain)
Sputum culture
Sputum PCR

33
Q

What are the essential investigations for TB?

A

Sputum specimens

CXR

34
Q

What might you expect on a TB CXR?

A

Patchy shadowing at apices
Cavitation
Calcification

35
Q

What additional Investigations would you perform if the sputum tests were negative?

A

Thoracic CT
Bronchoscopy with biopsy
Pleural Aspiration (if pleural effusion)

36
Q

What surgery is used for TB?

A

Collapse cavity and resect (sometimes)

37
Q

What are the drugs used for tuberculosis?

A

Isoniazid
Rifampicin
Ethambutol
Pyrazinamide

38
Q

How long after treatment begins is the patient non-infectious?

A

2 Weeks

39
Q

Side effects of Rifampicin

A

Iron Bru tears, urine
Induced Liver enzymes
Hepatitis

40
Q

Side effects of Isoniazid

A

Hepatitis

Peripheral neuropathy

41
Q

Ethambutol

A

Optic neuropathy

42
Q

Pyrazinamide

A

Gout

43
Q

Which drugs does Rifampicin render ineffective?

A

Prednisolone
Anticonvulsants
Oral contraceptive

44
Q

What are the goals of contact tracing in TB?

A

Identify source and possible transmissions

45
Q

When do you screen casual contacts of TB patients?

A

If close contacts infected suggesting high virulence

46
Q

What are the screening tests used for TB?

A

Mantoux

Heaf

47
Q

If younger than 16, no BCG, Heaf test positive, what do you do?

A

CXR

Chemoprophylaxis

48
Q

If younger than 16, no BCG, Heaf test negative. What do you do?

A

Repeat after 6 weeks

Systems 1 (25 decks)

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