Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Why are children less likely to spread TB?

A
  • Because they rarely develop lung cavities or sputum meat positive TB
  • but children above 10 years usually develop adult TB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the primary peripheral lesion that occurs as a result of the exudation of polymorphonuclear leucocytes followed by monocytes?

A

A ghon focus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a ghon complex/ ranke’s complex?

A

It is the ghon focus and the involvement of regional lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are Simon’s foci?

A

They are small metastatic foci which contain low numbers of mycobacterium and may calcify and are also seen on chest X-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In children when is the most risk of developing TB?

A

-First year after infection especially if with impaired immunity and between <2-3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What usually happens aa couple of weeks after the initial infection?

A

Fever may occur
Enlargement of regional lymph nodes
Hypersensitivity phenomena like erythema nodosum
The TST> 15mm
The disease process goes no further than this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What usually tends to occur in the first 3-9 months following infection?

A

If they have miliary(disseminated TB) they present with TB-meningitis, lymphobronchial TB and pleural effusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What age is the safest at getting TB?

A

5-10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do >10 years usually present with?

A

TB cavitation in the upper apices similar to adults and pleural effusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is IRIS?

A

TB associated with immune reconstitution inflammatory syndrome which usually occurs with HIV positive children in the first few weeks/months after ARV treatment has been initiated
-accompanied by viral suppression and increase in CD4 count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does Tuberculosis associated with immune reconstitution inflammatory syndrome present?

A

It commonly occurs as right sided axillary adenitis due to BCG vaccination given at birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is infection without disease?

A
  • incubation phase
  • positive TST
  • usually a symptomatic children with a normal chest x-ray but at a risk of developing the active disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is intrathoracic lymphadenopathy?

A

It usually occurs after recent infection with Tb

  • most children do not have constitutional symptoms but may present with hilar or paratracheal lymphadenopathy and so must be treated with TB drugs to prevent possible further progression of the disease
  • we should also always think of a lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When does a ghon focus show up on chest X-ray?

A

When it has calcified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is lymphobronchil Tb?

A

TB that involves the intrathoracic lymph nodes close the large airways
-this can cause collapse of the airway due to obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If a lymph node ulcerated and the contents are released into the bronchus what can we expect to happen?

A

Hypersensitivity reaction in the s affected lobe or segment

-usually seen as collapse or consolidation on X-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How long does it take for lymphobronchial TB to be treated and for it to resolve?

A

2-3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What kind of pleural effusion can we expect to see in young children? <5 years

A

Small effusion or thickening of the pleura is seen with the primary focus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What kind of pleural effusion can we expect in older children?

A

Straw colored, large exudative and lymphocytic effusions are more common and represent pleural hyper-reactivity response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Who is most affected by miliary(disseminated) TB?

A
  • Very young
  • malnourished kids
  • HIV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do children with miliary usually present with?

A
  1. Wasting
  2. Hepatosplenomegaly
  3. Generalised lymphadenopathy
  4. On auscultation-fine crepitations may be heard
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What symptoms in children would suggest miliary TB?

A
  1. Fever
  2. Poor feeding
  3. Lethargy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What do we see on chest X-ray in miliary TB?

A

-snowstorm appearance of the diffuse reticulonodular (miliary) pattern throughout the lung fields is highly suggestive of miliary TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What else presents similarly to the snow storm appearance of miliary TB on X-ray?

A

Lymphocytic interstitial pneumonitis which occurs in HIV, histoplasmosis, sarcoidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the rich focus?

A

It is a foci that allows entry into the blood brain barrier and the CSF that has TB bacilli
-these will undergo cassation and release their contents into the CSF and takes up to 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How long does TBM usually take to show up after primary infection?

A

3-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why is the CSF thick and proteinaceous?

A

-the bacilli and antigen inflammatory response can cause the thick exudate covering the base of the brain and enveloping the cranial nerves and blood vessels and obstructs the CSF flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What do 80% of children with TBM usually present with?

A

Obstructive hydrocephalus (communicating or non communicating)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What does the obstructive hydrocephalus cause?

A

Increased intracranial pressure and may cause cranial nerve palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What should we worry about if the child also has vasculitis of the cerebral blood vessels?

A

Strokes(brain infarcts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does TBM initially present with?

A
  1. Irritability
  2. Headache
  3. Vomiting
32
Q

How can we stage TBM?

A

Refined British MRC staging

33
Q

What is stage 1 oft TBM?

A
  • GCS: 15/15
  • No focal neurological fallout
  • alert and awake
34
Q

What is stage 2a?

A

-GCS: 15/15 with focal neurological deficit

Or GCS: 13-14/15 without focal neurological deficit

35
Q

What is stage 2b?

A

-GCS 10-12/15 with or without focal neurological deficit

36
Q

What is stage 3?

A

-GCS: less than 10/15 with or without focal neurological deficit

37
Q

When should we start TBM treatment?

A

IMMEDIATELY

DO NOT WAIT FOR SPECIAL INVESTIGATIONS

38
Q

What do we see on chest X-ray of children with TBM?

A

70-80 have features of primary TB

39
Q

What would see in CT or MRI scan of the child?

A
  • infractions particularly of the middle cerebral artery
  • hydrocephalus
  • tuberculoma
40
Q

What do we usually see on CSF in TBM?

A
  • We usually see a cell count that is low (500x10 to the power of 6/l) with a predominance of lymphocytes
  • glucose is low(<2,2mmol/l)
  • protein: > 1,2g/l
41
Q

What is the clinical feature of TBM that we observe on CSF compared to other causes of meningitis?

A

The CSF values remain abnormal for a long time (for a couple weeks) meaning we should complete TBM treatment

42
Q

Which lymph nodes are usually involved in children?

A
  1. Cervical lymph nodes mostly

2. Inguinal and axillary occassionally

43
Q

How do the diseased lymph nodes usually feel?

A

-painless
-matted
-firm
Due to significant periadenitis and fibrosis

44
Q

How can we diagnose superficial lymphadenitis in TB in children?

A

We can take a fine needle aspiration biopsy

45
Q

What would be on our differential diagnosis for superficial lymphadenitis?

A
  • malignancies especially lymphoma
  • acute pyogenic infections
  • chronic fungal infection
46
Q

How does abdominal usually occur?

A

From haematogenous and lymphogenic spread

47
Q

What are the 4 clinical forms of abdominal TB?

A
  1. Intestinal TB-mostly terminal ileum and caecum but any part of the gastrointestinal-intestinal tract may be involved
  2. Abdominal lymphadenopathy
  3. Peritoneal disease
  4. Solid organ TB(liver, spleen)
48
Q

What are the most common symptoms of abdominal TB?

A
  1. Abdominal distension
  2. Fever
  3. Loss of weight
  4. Diarrhea
  5. Abdominal pain
49
Q

What do you usually feel on deep palpating in abdominal TB?

A
  1. Acute abdomen due to perforation
  2. Masses-enlarged lymph nodes, matted mesenteric and mental clumping in the RIF, centrally or along both sides of the spine
  3. Massive ascites
50
Q

What does compression of the inferior vena cava cause?

A

Oedema of the lower limbs

51
Q

What is the differential diagnosis for abdominal TB?

A
  1. Lymphoma for abdominal masses
  2. Malabsorption
  3. Ascites
  4. Blood in stools
  5. Protein losing enteropathy(PLE)
52
Q

What diagnostic tests can we do to do to diagnose TB of the abdomen?

A
  1. Abdominal ultrasound and CT

2. Laparoscopic biopsy might be needed for definitive diagnosis

53
Q

How does TB usually present in the liver?

A

Either as a isolated tuberculoma on the liver (hepatic nodule)

54
Q

How does tuberculous pericarditis present in these children?

A
  1. Pericardial friction rub
  2. Increased cardiac dullness
  3. Impalpable apex beat
  4. Muffled heart sounds
55
Q

How does tuberculous pericarditis occur?

A
  • usually from haematogenous and lymphatic spread
  • this then leads to pericarditis with effusion and long term constriction of the heart due to the calcification of the pericardium
56
Q

What can we do to diagnose TB pericarditis?

A
  • pericardiocentesis-may help with a definitive diagnosis and cans be therapeutic
  • we can also do a chest X-ray and echocardiograph
57
Q

What upper respiratory tract involvement can we expect to see?

A
  1. Tonsils asymmetrically enlarged and red and with small yellow nodules and shallow grey ulcers
  2. Submandibular lymph node swelling may also be seen
58
Q

What involvement of the eyes would we be able to see in TB in children?

A
  • the everted eyelid reveals thickened granulation with yellow areas
  • pre-auricular and tonsillar nodes are enlarged
59
Q

What is the presentation we can expect in TB of the ear?

A
  • ottorhea (chronic painless discharge)
  • facial nerve palsy
  • conductive hearing loss
60
Q

What is the skin involvement in TB?

A
  • Tuberculous wart or chancre

- haematogenous spread may lead to modular lesions, papulonerctotic tubercuilids

61
Q

What is the bone and joint involvement of TB in children?

A
  1. Vertebral involvement(Pott’s disease) is the most common

2. Disease of weight bearing joints(hips and knees)

62
Q

What is the differential diagnosis for bone and joint involvement in TB?

A
  1. Sickle cell anaemia
  2. Syphillis
  3. Salmonella
63
Q

What are the blood abnormalities we can see in TB?

A
  1. Normocytic, normochromic anaemia
  2. Aplastic anaemia
  3. Pancytopenia
  4. Neutrophil leucocytosis
    Similar to the picture of leukemia
64
Q

What does TB look like when involving the urogenital system?

A
  1. Sterile pyuria should point to TB immediately
65
Q

How do neonates presenting with TB from the mother present?

A
  1. They usually have intra-uterine growth retardation
  2. Prematurity
  3. Respiratory disease
66
Q

What are the three definitive clinical signs that lead to the diagnosis of TB?

A
  1. Failure to thrive or weight loss
  2. Persistent cough or wheeze >2 weeks
  3. Unusual fatigue(reduced playfulness)
  4. Prolonged unexplained fever
  5. Organomegaly or lymphadenopathy
  6. Lethargic or altered level of conscious
67
Q

What would indicate a positive turberculin/mantoux test?

A
  1. > 10mm
68
Q

In HIV positive children what would point to a positive TST/Mantoux test?

A

> 5mm

69
Q

How long should we wait before we check the result of Mantoux test?

A

48-72 hours

70
Q

What are the possible causes of a false positive Mantoux test?

A
  1. Incorrect technique
  2. Immune compromised of any origin
    - HIV
    - measles
    - steroid use
71
Q

What is the IGRA test?

A
  • used to diagnose TB
  • however just shows infection and not disease
  • interferon gamma release assays
72
Q

Where can we get the M.tb organism?

A

Pus, CSF, bone marrow, pleural and ascetic fluids

73
Q

Why is difficult for us to get sputum from children?

A

They swallow sputum and so early morning gastric aspirated or induced sputum collections may be necessary

74
Q

Why is difficult to do a culture in children?

A

They are paucibacillary which means that they are often negative

75
Q

How does the BCG vaccine work?

A

It prevents disseminated TB in 60-70% early in childhood

Paediatrics (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions