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Respiratory System > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

By how much is the worldwide TB incidence rate falling by what percentage per year

A

About 2%

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2
Q

TB deaths have fallen by what percentage since 2000

A

29%

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3
Q

How many people are estimated to by infected by TB worldwide

A

2 billion

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4
Q

Examples of countries with high prevalence of TB

A

India, China, Indonesia, Philippines, Pakistan, Nigeria, Bangladesh, South Africa

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5
Q

Number of TB deaths per year

A

Around 1.6 million

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6
Q

Is TB more common in men or women

A

Men by 2x

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7
Q

Vulnerable groups to TB in the UK

A 
People from high prevalence countries
HIV positive
Immunosuppressed
Elderly and neonates
Diabetics 
Those with chaotic lifestyle (1 in 10)
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8
Q

Mycobacteria causing TB present in

A

Soil and water

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9
Q

Examples of bacteria that cause TB

A

M. tuberculosis
M. africanum
M. bovis

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10
Q

Problem with culturing bacteria

A

Very slow growing - long wait to make diagnosis

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11
Q

Features of mycobacteria causing TB

A

Non-motile
Slow growing
Aerobic
Very thick fatty cell wall - causes resistance

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12
Q

Transmission of TB

A

Airborne

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13
Q

Exceptionally, M. Boris can be spread by

A

Consumption of unpasteurised infected cows’ milk

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14
Q

Immunopathology of TB

A

T cell mediated - eliminates mycobacteria but also results in tissue destruction.
Macrophages, epithelioid cells, laghan’s giant cells -> granuloma

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15
Q

3 fates of primary infection

A

Progressive disease
Contained latent
Cleared cured (immune memory)

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16
Q

Mycobacteria is spread via

A

Lymphatic system to draining hilarious lymph nodes

17
Q

Primary TB can progress to

A

Tuberculosis bronchopneumonia

Milliary TB

18
Q

Tuberculosis bronchopneumonia

A

Primary focus enlargement
Enlarged hilar lymph nodes compress bronchi - lobar collapse
Enlarged lymph node discharge into bronchus
Poor prognosis = high mortality

19
Q

Miliary TB

A

Hematogenous spread of bacteria to multiple organs

Widespread small granulomata

20
Q

Post primary disease hypothesis

A

TB bacteria entering a dormant stage

Balanced stage of replication and destruction by immune mechanisms

21
Q

Clinical presentation of TB

A

Cough
Fever
Night sweats
Weight loss

22
Q

Classical post-primary TB x-ray presentation

A

In the apices, fluffy/nodular upper zone, cavitation (10-30%)

23
Q

When to consider CT scan

A 
Normal chest x-ray but clinical suspicion 
Miliary TB
Cavitation and other differential
Lymphadenopathy, alternative diagnosis
Targets for BAL
24
Q

Primary TB x-ray presentation

A

Pneumonic lesion with enlarged hilar nodes - pleural effusion, mediastinal lymphadenopathy, miliary

25
Q

Sampling bacteria methods

A 
Sputum
Induced sputum
Bronchoscopy with BAL
Endobronchial ultrasound with biopsy
Lumbar puncture in CNS TB
Urine in urogenital TB
Aspirate/biopsy from tissue
26
Q

Clinical mamagement - TB drugs

A 
Isoniazid
Pyrazinamide
Rifampicin
Ethambutol
Streptomycin
27
Q

Rules of TB treatment

A

Multiple drug therapy
Single agent treatment leads to resistance
Therapy for 6 months
TB therapy job for committed specialists only
Legal requirement to notify all cases
Test for HIV, Hep B and C

28
Q

Standard treatment for TB

A 
4 drugs for 2 months then 2 drugs for 4 months (4:2/2:4)
Standard 12 tablets per day
Pyridoxine with isoniazid
Steroids
Vitamin D substitution
29
Q

Side effects of rifampicin

A

Orange ‘Irn Bru’ urine/tears/lenses
Hepatitis
Induces liver enzymes
All normal hormonal contraceptive methods ineffective

30
Q

Side effects of isoniazid

A

Hepatitis

Peripheral neuropathy

31
Q

Side effects of pyrazinamide

A

Hepatitis

Gout

32
Q

Side effects of ethambutol

A

Optic neuropathy

33
Q

BCG vaccination is

A

Given selectively to groups

34
Q

Groups that are given BCG vaccination

A

Neonates or unvaccinated children under 5 whose parents/grandparents born in TB prevalent country
Unimmunised contacts of cases
Unimmunised high risk employees

35
Q

BCG vaccination most effective when given to

A

Neonates

36
Q

BCG vaccination is ineffective over the age of

A

16

37
Q

Latent TB screening

A

Contacts of people with active pulmonary or laryngeal TB aged <65
New entrants from high epidemic areas
Outbreaks
Pre-biologics
Asymptomatic, normal chest x-ray and positive tests

38
Q

Treatment of latent TB

A

Rifampicin and isoniazid for 3 month, or one alone for 6 months
Rifapentine and isoniazid once weekly for 13 weeks (chaotic lifestyle)

Respiratory System (20 decks)

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