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Junior Medicine- Respiratory > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What is Tuberculosis?

A
  • Infection with Mycobacterium tuberculosis
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2
Q

What sort of inflammation occurs in TB?

A

Caseating granulomas

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3
Q

Where in the world is higher risk of TB?

A
  • Asia
  • African
  • Latin America

TRAVEL Hx

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4
Q

What is primary TB?

A

First infection of TB

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5
Q

What does primary TB create in the lung?

A

Gohn’s Focus

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6
Q

What is the name of a Gohn’s Focus in a lymph node?

A

Gohn’s complex

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7
Q

What is secondary TB?

A

Reactivated TB

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8
Q

Where does secondary TB most commonly occur?

A

Lung apex

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9
Q

What type of hypersensitivity is secondary TB?

A

Type 4 (cell-mediated)

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10
Q

What is latent TB?

A

Inactive TB (asymptomatic)

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11
Q

What is miliary TB?

A

TB that is disseminated through the body

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12
Q

How does miliary TB spread?

A

Lymphohaematogenous

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13
Q

Who is at risk of miliary TB?

A
  • IVDUs
  • HIV
  • Malnutrition
  • Steroid users
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14
Q

What symptoms does TB present with?

A
  • Pleuritic chest pain
  • Low-grade fever
  • Cough (dry at first and then productive)
  • Haemoptysis
  • Weight loss
  • Night sweats
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15
Q

What are the red flags of TB?

A
  • Night sweats

- Weight loss

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16
Q

What is cutaneous TB?

A

TB in the skin, most commonly affecting previously sensitised patients who have high immunity

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17
Q

How does cutaneous TB present?

A

Skin erythema, normally well demarcated but non-specific

18
Q

What is erythema nodosum?

A
  • Inflammation of subcutaneous fat

- Causes pre-tibial marking- pale erythema/bruising

19
Q

How would you stain TB?

A
  • Ziehl Nielson (ZN) stain
20
Q

Why can’t TB be stained with H&E?

A

TB is acid fast, and wouldn’t show on a normal stain

21
Q

What other blood test can be used for TB?

A

Interferon gamma release assay

22
Q

What would a CXR show for TB?

A
  • Fibronodular opacities +/- cavitation

- A-E (second card)

23
Q

What is the A-E of a TB CXR?

A 
Alveolar shadowing (batwing)
Kerley B lines
Cardiomegaly
Distribution of vessels to the apices
Effusion
24
Q

What is a Mantoux test?

A

Tuberculin sensitivity to see latent disease

25
Q

How long do you wait for a Mantoux result?

A

2-3 days

26
Q

How will vaccinated person show on Mantoux?

A

6-15mm raised bump

27
Q

How will latent TB show on Mantoux?

A

15mm+

28
Q

What MUST you do on diagnosis?

A

Notify local health team/infectious diseases officer within 3 days

29
Q

What five drugs are used for TB?

A

RIPE

  • Rifampicin
  • Isoniazid and Pyridoxine (B6)
  • Pyrazinamide
  • Ethambutol
30
Q

How long are [R,I+p] used for?

A

6 months

31
Q

How long are [P,E] used for?

A

Three months

32
Q

What are the side effects of R?

A

OI

  • Orange urine and tears
  • Induces Cyp450 enzymes
33
Q

What are the side effects of I?

A

HIPA

  • Hepatitis
  • Inhibits Cyp450 enzymes
  • Peripheral neuropathy (hence given with B6)
  • Agranulocytosis
34
Q

Why give pyridoxine with isoniazid?

A

To prevent peripheral neuropathy

35
Q

What is agranulocytosis?

A

Drop in inflammatory cells, particularly neutrophils

36
Q

What do you do if you suspect INH-induced agranulocytosis?

A
  • Admit

- Stop Isoniazid

37
Q

What are the side effects of pyrazinamide?

A

HMG

  • Hepatitis
  • Muscle/joint pain
  • Gout (hyperuricaemia)
38
Q

What is the side effect of Ethambutol?

A

Optic neuritis

39
Q

What should you do before beginning ethambutol?

A

Visual acuity test (to reference and monitor for optic neuritis)

40
Q

Name three complications of TB.

A
  • Pott’s disease
  • Pneumothorax
  • Bronchiectasis
41
Q

What is Pott’s disease and how does it occur?

A
  • TB of the spine

- Haematogenous spread of TB

Junior Medicine- Respiratory (17 decks)

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