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Respiratory > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What are the risk factors for tuberculosis?

A

Diabetes

Immunosuppressed

Alcohol

Poor social circumstances/malnourished

Immigrant/overseas travel

HIV

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2
Q

What organisms cause TB?

A

Mycobacterium tuberculosis

Mycobacterium bovis

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3
Q

How is mycobacterium tuberculosis spread?

A

Air-borne transmission

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4
Q

How is mycobacterium bovis spread?

A

Un-pastered milk

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5
Q

How is miliary tuberculosis spread?

A

Haematogenous spread of tubercle bacilli through the pulmonary venous system

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6
Q

Describe the presentation of TB

A

Haemoptysis

Persistent cough with grey sputum production

Weight loss

Dyspnoea

Lethargy

Night sweats

Fever

Erythema nodosum

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7
Q

What area of the lung does TB favour?

A

Upper lobes

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8
Q

What investigations are used in TB diagnosis?

A

CXR

Sputum culture with Zeil Neilson stain

  • 3+ on successive days

Bronchoscopy and biopsy for histology with Zeil Neilson stain

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9
Q

What investigations are used in TB monitoring?

A

Visual acuity: Optic neuritis due to Ethambutol

LFT: Liver failure

U&E: Renal failure

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10
Q

What CXR findings are present in TB?

A

Bilateral hilar lymphadenopathy

Upper lobe cavitation

Millet seeds in miliary TB

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11
Q

What is the management of TB?

A

RIPE

Rifampicin

Isoniazid

Pyrazinamide

Ethambutol

All for 2 months, then first 2 for 4 more months

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12
Q

What are the side effects of Rifampicin?

A

Orange urine

Hepatitis

It is a potent inducer of cytochrome P450 enzymes therefore reduces the effect of drugs metabolised by this system, such as COCP

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13
Q

What are the side effects of Isoniazid?

A

Peripheral neuropathy

Hepatitis

Agranulocytosis

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14
Q

What are the side effects of Pyrazinamide?

A

Gout

Hepatitis, most commonly

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15
Q

What are the side effects of Ethambutol?

A

Optic neuritis

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16
Q

What is given to prevent peripheral neuropathy caused by Isoniazid?

A

Pyridoxine

17
Q

What is multi-drug-resistant TB (MDR-TB)?

A

Resistance to rifampicin and isoniazid

Teatment is complicated and must be done under specialist centres, usually involving five or more drugs to which the bacteria is susceptible for a minimum of 9 months

18
Q

What investigation should be offered to all TB patients?

A

HIV testing

19
Q

Why are LFTs measured prior to and during TB therapy?

A

Rifampicin, Isoniazid and Pyrazinamide can call cause hepatitis

20
Q

What drug is given to prevent Ethambutol associated optic neuritis?

A

Pyridoxine

21
Q

What is the mechanism of action of Rifampicin?

A

Inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA

22
Q

What is the mechanism of action of Isoniazid?

A

Inhibits mycolic acid synthesis

23
Q

What is the mechanism of action of Pyrazinadmide?

A

Converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I

24
Q

What is the mechanism of action of Ethambutol?

A

Inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan

25
Q

What causes peripheral neuropathy with Isoniazid?

A

B6 deficiency

26
Q

What type of bacteria is mycobacterium tuberculosis?

A

acid-fast bacilli

Meaning they are rod shaped and resistant to the acids used in staining procedures, so require ZN stain

27
Q

What colour does mycobacterium tuberculosis turn with ZN stain?

A

Red against blue background

28
Q

What are the classifications of TB?

A

Active, where infection is active in various areas of body

Latent, in which immune system encapsulates site of infection and stops disease progression

Secondary, when latent TB reactivates

Disseminated/Miliary, in which immune system is unable to control disease

Extrapulmonary, in which TB affects other areas

29
Q

What can cause a false negative Mantoux test?

A

Immunosuppression/steroids

Sarcoidosis

Lymphoma

Extremes of age

Fever

Hypoalbuminaemia

Anaemia

30
Q

What investigation is used to identify latent TB?

A

Interferon gamma release assay (IGRA)

31
Q

Give features of aspergilloma

A

Fungus arising secondary to TB, lung cancer, CF

Cough

Haemoptysis

Rounded opacity with crescent sign on xray

Respiratory (14 decks)

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