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respiratory > tuberculosis > Flashcards

tuberculosis Flashcards

1
Q

where are majority of cases

A

Africa and Asia

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2
Q

what does it co-infect with

A

HIV

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3
Q

what are the 4 main species

A
  • mycobacterium tuberculosis
  • mycobacterium bovis
  • mycobacterium africanum
  • mycobacterium microti
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4
Q

does it stain well

A

no

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5
Q

what are they termed

A

acid fast bacilli

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6
Q

how does TB spread

A

via respiratory droplets

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7
Q

what happens once TB is inhaled into lungs

A
  1. alveolar macrophages ingest bacteria
  2. the bacilli then proliferate inside the macrophage and cause release of neutrophil chemoattractants and cytokines
  3. results in inflammatory cell infiltrate reaching lung and draining hilar lymph nodes
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8
Q

what does macrophage present the antigen to

A

T lymphocytes

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9
Q

what type of hypersensitivity

A

delayed

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10
Q

what does the delayed hypersensitivity result in

A

tissue necrosis and formation of a granuloma

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11
Q

what does granulomatous lesions consist of

A

central area of necrotic material = caseation

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12
Q

what happens to caseated area if they heal

A

become calcified

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13
Q

can it lie dormant

A

yes

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14
Q

what is the focus termed

A

Ghon focus

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15
Q

what does Ghon focus look like on CXR

A

small, calcified nodule in upper parts

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16
Q

what are majority of TB cases primary or reactivated

A

reactivated

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17
Q

what can cause TB to reactivate

A

HIV

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18
Q

what are factors that implicate reactivation of TB

A
  • HIV
  • chemotherapy
  • diabetes
  • chronic kidney disease
  • malnutrition
  • ageing
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19
Q

different sites of TB

A
  • pulmonary
  • miliary
  • central venous
  • lymph nodes
20
Q

what should be done for suspected TB

A

obtain tissue or fluid microscopy

21
Q

what should be done for pulmonary TB

A

serial sputum samples on 3 occasion

22
Q

symptoms of pulmonary TB

A
  • productive cough
  • haemoptysis
  • weight loss
  • fevers
  • sweats (end of day and night)
  • hoarse voice
  • severe cough
  • pleuritic pain
23
Q

what is seen on pulmonary TB CXR

A
  • consolidation with or without cavitation
  • pleural effusion
  • thickening of mediastinum caused by hilar adenopathy
24
Q

what is most common site for TB

A

pulmonary

25
Q

what is second most common site

A

lymph node

26
Q

what does lymph node present with

A

firm, non-tender enlargement

27
Q

what can be seen on CT of lymph node TB

A

central area appears necrotic

28
Q

how does miliary TB occur through

A

haemotgenous spread of the bacilli

29
Q

what does CXR look like in miliary TB

A

multiple nodules that look like millet seeds

30
Q

what stain is used

A

Ziehl-Neelsen

31
Q

what is done to check for rifampicin resistance

A

PCR

32
Q

how long is treatment

A

6 months

33
Q

what drugs are used

A
  • rifampicin
  • isoniazid
  • pyrazinamide
  • ethambutol
34
Q

side effects of rifampicin

A
  • induces liver enzymes
  • stains body secretions pink (urine, tears, sweat)
  • makes oral contraception non effective
35
Q

side effects of isoniazid

A
  • polyneuropathy
  • B6 deficiency
  • allergic reactions (skin rash, fever)
36
Q

side effect of pyrazinamide

A
  • hepatic toxicity

- reduces renal excretion

37
Q

side effect of ethambutol.

A
  • colour blindness (for green)
38
Q

why does drug resistance occur

A

miss-use and not taking drugs for long enough

39
Q

why does mycobacterium bovis occur

A

due to consumption of unpasteurised milk

40
Q

how is m.bovis diagnosed

A

acid-fast staining

- culture of tissues and sputum

41
Q

treatment of m.bovis

A
  • isoniazid
  • rifampicin
  • ethambutol
  • pyranzinamide resistance is common
42
Q

what can it be co-infected with

A

HIV

43
Q

what is the vaccine

A

BCG vaccine

44
Q

what type of hypersensitivity

A

type IV hypersensitivity

45
Q

what type of focus

A

Ghon focus

46
Q

what type of necrosis

A

caseous

47
Q

where is secondary TB usually

A

in lung apices

respiratory (20 decks)

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