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SPM- Respiratory > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What is the causative organism of TB?

A

Mycobacterium TB

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2
Q

What are the options that can occur on TB exposure?

A

Immediate clearance
Primary disease: Onset of active disease
Latent infection- Infection is contained and suppressed by the immune system. This can then re-activate to cause secondary infection

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3
Q

What are some symptoms of primary TB infection?

A 
Haemoptysis
Night sweats
Fever
Weightloss
Fatigue
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4
Q

What might cause reactivation of latent TB?

A

Immunosupression
Anti TNF therapy
HIV

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5
Q

What investigation is done for TB?

A

Sputum culture- ZN/AFB staining, TB culture
Tuberculin Skin Test- Shows exposure to BCG or TB (therefore indicates latent TB too)
Interferon gamma release assay- more specific to TB
CXR- Apical cavitating nodules, effusions, hilar lymphadenopathy
If no sputum- may induce sputum or BAL

Biopsy of extrapulmonary sites- Caseating granulomas

ALWAYS DO A HIV TEST (REACTIVATION OCCURS WITH IMMUNOSUPPRESSION)

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6
Q

What might be seen on CXR for TB?

A

Upper lobe cavitating masses
Hilar lymphadenopathy
Pleural effusion

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7
Q

What are the majority of cases of active TB due to?

A

Reactivation in a patient with latent TB

This can occur with immunosuppression, HIV, anti TNF therapy

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8
Q

What is miliary TB?

A

Widespread TB that has spread via haematogenous spread. Causes milliarly seeded appearance on a CXR

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9
Q

What type of granuloma is seen in TB?

A

Caseating granuloma

Note non-caseating granulomas are seen in sarcoidosis.

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10
Q

Outside of the lungs where the other two most common places for TB to infect?

A

Lymph nodes
Gastrointestinal system

CNS and bone infection also common.

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11
Q

What is the treatment for active pulmonary TB?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

6 months of top two
2 months at start with all four

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12
Q

What is a Ghon focus?

A

This is where the caesiating granuloma is

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13
Q

What is a Ghon complex?

A

Ghon focus and the lymph node involved with caseating granuloma

Undergo fibrosis and calcification making them visible on the CXR

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14
Q

What does TB cause with renal involvement?

A

Sterile pyuria

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15
Q

What does TB cause with adrenal gland involvement?

A

Addisons

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16
Q

What does the tuberculin skin test show?

A

It shows prior exposure to TB therefore may indicate active or latent TB
Immune reaction occurs within 48-72 hours

17
Q

What test can be done to test for exposure to TB?

A

Tuberculin skin test

Interferon Gamma Release Assays (Blood test)

18
Q

How long is rifampicin and isoniazid give for?

A

6 months

19
Q

How long are ethambutol and pyrazinamide given for?

A

2 months

20
Q

How might samples be obtained for AFB/ZN staining or TB culture?

A

Sputum
BAL
Induced sputum- nebulised salbutamol

Biopsy

21
Q

What should you also test for in patients with TB?

A

HIV

22
Q

What are some side effects of rifampicin?

A

Liver toxicity
Renal failure
Thrombocytopenia

23
Q

What are some side effects of isoniazid?

A

Peripheral neuropathy

Liver toxicity

24
Q

What are some side effects of pyrazinamide?

A

Liver toxicity

25
Q

What are some side effects of ethambutol?

A

Rarely causes optic toxicity so baseline visual acuity should be checked.

26
Q

Why is BCG vaccination contraindicated in HIV positive patients?

A

It is a live vaccine

27
Q

If a patient is diagnosed with active TB what needs to be done?

A

Contact tracing

Test all family members, colleagues, classmates

28
Q

Where should patients with suspected TB be kept in a hospital?

A

In side rooms

FFP3 face masks must be used when seeing them as well as standard PPE.

29
Q

How can you test for latent TB?

A

Tuberculin skin test

Interferon gamma release assay

30
Q

Why does latent TB occur?

A

Immune system prevents primary infection but this is done through granuloma formation where the mycobacterium are walled off to prevent spread. Granulomas are maintained with TNF alpha.

31
Q

Who should be tested for latent TB?

A

Contacts of people with active TB
New healthcare workers
Immunocompromised patients
New entrants from high incidence countries

32
Q

How is latent TB treated?

A

Isoniazid and rifampicin daily for 3 months

This reduces risk of reactivation later on

SPM- Respiratory (17 decks)

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