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Year 4: Infectious Disease > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

what bacterium causes TB

A

mycobacterium tuberculosis

- rod shaped bacilli

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2
Q

what stain is used to detect TB

A

Zeihl-Neelson stain

- waxy coat of mycobacterium tuberculosis prevents use of gram stain – known as “acid fast bacilli”

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3
Q

what colour does mycobacterium tuberculosis stain on a Zeihl-Neelson stain

A

red

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4
Q

how is TB spread

A

respiratory transmission

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5
Q

what are the stages of TB

A

primary infection
latent disease
secondary infection
miliary TB

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6
Q

what happens in primary TB infection

A

primary infection enters the lungs – formation of Gohn focus + spread to lymph nodes

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7
Q

what is a Gohn focus

A

lung lesion composed of tubercle- laden macrophages seen in primary TB

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8
Q

what kind of necrosis is there in TB

A

caseous necrosis

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9
Q

what is latent TB

A

immune system encapsulates sites of infection and stops progression of the disease

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10
Q

what is secondary TB

A

latent TB becomes reactivated due to the host becoming immunocompromised

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11
Q

where does secondary TB most commonly occur

A

apex of the lungs

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12
Q

what things can trigger secondary TB

A

immunosuppressive drugs e.g. steroids
HIV infection
malnutrition

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13
Q

what is miliary TB

A

Infection has disseminated in blood/lymphatics to cause multi organ disease

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14
Q

where does TB most commonly affect

A

the lungs

- 60% of TB cases

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15
Q

how does pulmonary TB present

A 
chronic productive cough (+/- haemoptysis)
systemic symptoms: 
- fever / night sweats
- weight loss
- malaise
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16
Q

what is the second most common presentation of TB

what are the symptoms?

A

genitourinary TB

- dysuria, loin/back pain, haematuria

17
Q

what is Potts disease

A

TB affecting the spine

18
Q

features of cutaneous TB

A

lupus vulgaris
erythema nodosum
erythema multiforme

19
Q

what is the most serious complication of TB

A

TB meningitis

20
Q

first line investigation for TB

A

chest XRAY

21
Q

signs of primary TB on CXR

A

Ghon focus with ipsilateral hilarious lymphadenopathy

pleural effusion

22
Q

signs of secondary TB on CXR

A

Cavitating lesion in apices

23
Q

signs of miliary TB on CXR

A

diffuse 1-10mm shadows throughout lung fields

24
Q

how many sputum samples are needed for microbiology

A

3

25
Q

what tests are done on the sputum samples

A

microscopy, culture, sensitivities

  • Zeihl-Neelson stain
  • Nucleic acid amplification test (NAAT) can replace standard culture for earlier result if patient at high risk complications
  • PCR for rifampicin resistance
26
Q

what is a Mantoux test

A

tuberculin skin test

  • indicates active/latent TB or previous BCG vaccination
  • induration of 5mm or more = +Ve and patient should be assessed for active disease
27
Q

what is an interferon-Gamma release assays

A

measures T cell response to TB antigens

- if person has had previous contact with TB then WBCs will release interferon gamma = positive result

28
Q

what is the treatment for active TB

A 
RIPE:
Rifampicin (6 months)
Isoniazid (6 months)
Pyrazinamide (2 months)
Ethamnutol (2 months)
29
Q

what drug should also be co-prescribed in active TB treatment

A

pyridoxine (vit B6) to prevent peripheral neuropathy caused by isoniazid

30
Q

how are patients with meningeal TB treated

A

further 6 months of rifampicin + isoniazid plus steroids

31
Q

treatment of latent TB

A

3 months of rifampicin + isoniazid
or 6 months isoniazid
(+ pyridoxine)

32
Q

what drug can cause red/orange discolouration of urine/tears

A

rifampicin

33
Q

what drug can cause optic neuritis / colourblindness

A

ethambutol

34
Q

what drug induces P450 system and so decreases effectiveness of oral contraceptive pill and warfarin

A

rifampicin

35
Q

what drug can cause peripheral neuropathy

A

isoniazid

36
Q

what drag can cause high uric acid levels and precipitate gout

A

Pyrazinamide

37
Q

what drug can cause agranulocytosis

A

isoniazid

38
Q

what drugs cause hepatitis

A

rifampicin
isoniazid
Pyrazinamide

Year 4: Infectious Disease (17 decks)

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