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2. Respiratory Medicine (Lectures) > Tuberculosis COPY > Flashcards

Tuberculosis COPY Flashcards

1
Q

If you have what then you are more likely to get TB?

A

HIV

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2
Q

Where are the TB incidence rates the highest?

A

Southern africa
Saharan africa
South east asia

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3
Q

Causative organisms of TB

A

Mycobacterium tuberculosis
Mycobacterium bovis (bovine TB)
Mycobacterium avium-intracellulare (HIV)

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4
Q

Transmission of mycobacterium tuberculosis

A

Respiratory droplets - coughing and sneezing

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5
Q

Transmission of mycobacterium bovis

A

Consumption of infected cows milk - deposited in cervical and intestinal lymph nodes

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6
Q

Pathology of TB

A

Infected with TB
Mycobacteria spread by lymphatics to draining hilar lymph nodes
Haematogenous seeding of mycobacteria to all organs of the body

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7
Q

Presentation of TB

A

Usually no symptoms
Fever
Malaise
Erythema nodosum
Rarely chest signs
Initial lesion + local lymph node
Lesion may calcify

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8
Q

Complications of TB

A

Primary focus continues to enlarge - cavitation
Enlarged hilar lymph compresses bronchi, lobar collapse
Enlarged lymph node discharges into bronchus (TB bronchopneumonia)

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9
Q

In a small number (1%) 6 - 12 months after infection, after the infection…….

A

Miliary TB fine mottling on X ray, widespread small granulomata
Meningeal TB, severe, CSF high protein, lymphocytes
TB pleural effusion

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10
Q

Possible causes post primary disease of TB

A

Reactivation of mycobacterium from latent primary infection spread by blood stream around the body
New reinfection from outside source, susceptible previously infected host

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11
Q

What in the body can TB affect?

A

Pulmonary disease
Lymph nodes, usually cervical (scrofuloderma)
Renal
CNS (tuberculous meningitis)
Bone and joint; spine (vertebral bodies - potts disease), hip
GI tract
GU
Infertility
Van deferens and fallopian tube effects
Constrictive pericarditis, pericarditis
Ascites
Ileal TB - obstruction
Addisions disease
Lupus vulgaris

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12
Q

When does post primary disease of TB occur?

A

1 - 5 years

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13
Q

What is post primary TB?

A

Reactivation of latent disease

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14
Q

Features of post primary TB

A

May occur at any age
May be no symptoms for months
Progressive and occur over several months

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15
Q

Presentation of post primary TB

A

Cough
Sputum
Haemoptysis
Pleuritic pain
SOB
Malaise + weight loss + night sweats (systemically unwell)

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16
Q

Who should you have a high index of suspicion of TB in?

A

Immunocompromised (HIV, corticosteroid therapy)
Malnutrition
Alcoholism
Vagrants
Previous gastric surgery
Malignancy
DM
Adolescence
Elderly
Recent immigrants from high prevalent countries

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17
Q

What are the investigations of TB?

A

3 sputum specimens on successive days
- Sputum smear - Ziehl-Neilsen stain (ZN stain)
- Sputum culture
- Sputum PCR
CXR
- patchy (shadowing, often apices/upper zones or apex of lower lobes), often bilateral
- cavitation if advanced
- may calcify if chronic or healed TB
Further investigations if sputum -ve
- CT thorax
- Bronchoscopy with bronchoalveolar lavage
- pleural aspiration and biopsy if pleural effusion

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18
Q

What is cavitation?

A

Formation of an empty space

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19
Q

Different treatment regimes for treating TB

A

A) Rifampicin + Isoniazid + Ethambutol + Pyrazinamide for 2 MONTHS
B) Rifampicin + Isoniazid for 4 MONTHS

20
Q

S/Es of rifampicin

A

Orange irn bru urine + tears
Deranged LFTs / Hepatitis
OCP ineffective

21
Q

S/Es of isoniazid

A

Hepatitis
Peripheral neuropathy

22
Q

S/Es of Ethambutol

A

Optic neuropathy

23
Q

S/Es of pyrazinamide

A

Gout

24
Q

What is the purpose of TB contact tracing?

A

Identify the source and identify transmission

25
Q

What does the likelihood of infection with TB depend on?

A

Duration of contact
Intensity ofinfection

26
Q

Who should have no immunity to tuberculoprotein?

A

< 16 y/o
no BCG

27
Q

What is the vaccination against TB called?

A

BCG

28
Q

What tests are done to screen for TB?

A

Mantoux test
Heaf test
Tuberculin test

29
Q

If heaf +ve, what must be done next?

A

CXR

30
Q

What must be done if heaf -ve?

A

Repeat after 6 weeks
If still -ve, give BCG
If +ve, Tx as recent infection

31
Q

What is the 5 year survival with patients with cavitating disease?

A

25%

32
Q

How long must TB drug treatment continue for?

A

At least 6 months

33
Q

Types of TB disease

A

Primary
Secondary

34
Q

Features of primary TB

A

Non immune host exposed to the mycobacterium may develop primary infection of the lungs

35
Q

What happens in primary TB?

A

Small lung lesion called Ghon focus develops
Immunocompetent - healing by fibrosis
Immunocompromised - may develop disseminated disease (miliary TB)

36
Q

What is a ghon focus made up of?

A

Tubercle-laden macrophages

37
Q

What is a Gohn complex?

A

Ghon focus and hilar lymph nodes

38
Q

Features of secondary (post primary) TB

A

Host becomes immunocompromised the initial infection may be reactivated

39
Q

Where does reactivation generally occur?

A

Apex of the lungs
May spread to local or distant sites

40
Q

Examples of causes of immunocompromise

A

Immunosuppressive drugs
HIV
Malnutrition

41
Q

Where is the most common site for secondary TB?

A

Lungs

42
Q

Main test used to screen for latent TB

A

Mantoux test

43
Q

False negative tests in the Mantoux may occur when?

A

Miliary TB
Sarcoidosis
HIV
Lymphoma
Very young (e.g. < 6 months old)

44
Q

Contraindications to BCG

A

Previous BCG
Past history of TB
HIV
Pregnancy
Positive tuberculin, heaf or mantoux

45
Q

What test is offered to all patients with TB?

A

HIV testing

46
Q

What can cause a reactivation of TB?

A

Immunosuppressant therapy such as chemo or biological treatments

2. Respiratory Medicine (Lectures) (50 decks)

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