Brainscape's Knowledge GenomeTM

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


See full index

RESP (Respiratory Medicine) > Tuberculosis (TB) > Flashcards

Tuberculosis (TB) Flashcards

1
Q

What is TB?

A

A chronic granulomatous infectious disease caused by the bacteria : Mycobacterium tuberculosis.

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

Epidemiology (& Risk Factors) of TB (3).

A

More prevalent in :-
1. Non-UK Born Patients (South Asia).
2. Immunocompromised e.g. HIV.
3. Close Contacts with TB.

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

What is Multi-Drug Resistant TB?

A

Strain resistant to more than one TB drug, making it difficult to treat - use amikacin, macrlides, quinolones and capreomycin.

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

Nature of Mycobacterium tuberculosis (3).

A
  1. Small Rod-Shaped Bacillus.
  2. Waxy Coating (makes Gram-Staining Ineffective).
  3. Acid-Fast (Resistant to the acids used in the staining procedure).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Staining of Mycobacterium tuberculosis.

A

Ziehl Neelsen Stain : Bright Red against Blue Background.

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

What property of Mycobacterium tuberculosis makes it difficult to culture?

A

Very slow dividing with high Oxygen demands.

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

Transmission of TB.

A

Inhalation of saliva droplets from infected people, spreading through lymphatics and blood.

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

What is a Granuloma?

A

An aggregate of activated epithelioid macrophages - walling off viable organisms in anoxic and acidic environment.

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

Pathophysiology of Pulmonary TB (5).

A
  1. Lung Lesion - Ghon Focus develops (tubercle-laden macrophages).
  2. Ghon Complex = Ghon Focus + Hilar Lymph Nodes.
  3. Granuloma Formation with Caseous Necrosis in Centre.
  4. Inflammatory Response : Type 4 Hypersensitivity Reaction.
  5. Th2 Driven (usually Th1 Driven in good health to form granulomas).
  6. Immunocompetent = Healing by Fibrosis. Immunocompromised = Disseminated Disease.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Active TB?

A

Active infection in various areas within the body.

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

What is Latent TB?

A

When the immune system encapsulates sites of infection to stop the progression of the disease.

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

What is Secondary TB?

A

Reactivation of Latent TB.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Military TB?

A

When the immune system is unable to control the disease, this causes a disseminated severe disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sites of TB Infection (2H).

A
  1. Pulmonary : Lungs (Oxygen Supply).
  2. Extrapulmonary :
    2A. Lymph Nodes (Cervical - Scrofuloderma).
    2B. Pleura.
    2C. CNS (Tuberculous Meningitis).
    2D. Pericardium.
    2E. GI System.
    2F. GU System (commonest).
    2G. Bones and Joints.
    2H. Cutaneous TB (Skin).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does TB in the Lymph Nodes cause?

A

A ‘cold abscess’ - firm painless abscess in the neck with no inflammation, redness and pain (unlike an acutely infected abscess).

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

What is Spinal TB known as?

A

Pott’s Disease of the Spine.

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

Clinical Presentation of TB (2).

A
  1. Chronic Gradually Worsening Symptoms.
  2. 70% Pulmonary TB (but with Systemic Symptoms).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Clinical Features of TB (5).

A
  1. Constitutional Symptoms.
  2. Cough +/- Haemoptysis.
  3. Lymphadenopathy.
  4. Erythema Nodosum.
  5. Spinal Pain (Spinal TB).
19
Q

Investigations of TB (2B).

A
  1. Ziehl-Neelsen Stain.
  2. Immune Response to TB Tests :
    2A. Mantoux Test.
    2B. IGRA Test.
20
Q

Indication of Mantoux Test (3).

A
  1. Previous Vaccination to TB.
  2. Latent TB.
  3. Active TB.
21
Q

Method of Mantoux Test (2).

A
  1. Inject tuberculin into the intradermal forearm to create a bleb under the skin.
  2. After 72 hours, measure the induration of the skin at the site of injection.
22
Q

What is Tuberculin?

A

A collection of tuberculosis proteins that have been isolated from the bacteria - the infection does not contain any live bacteria.

23
Q

Mantoux Test Results (3).

A
  1. Negative : Induration < 6mm (no significant hypersensitivity to tuberculin protein - can give BCG if unvaccinated).
  2. Positive : Induration of 6-15 mm (hypersensitive - previous TB infection or BCG - don’t give BCG).
  3. Strongly Positive : Induration > 15mm (hypersensitive - TB infection).
24
Q

Give 5 false negative causes of the Mantoux test.

A
  1. Military TB.
  2. Sarcoidosis.
  3. HIV.
  4. Lymphoma.
  5. Very Young (< 6 Months).
25
Q

Method of IGRA Test (2).

A
  1. Mix TB antigens with a sample of blood.
  2. WBCs that are already sensitised will release Interferon-Gamma as part of the immune response.
26
Q

Indication of IGRA Test.

A

Positive Mantoux test but no features of Active TB in order to confirm a diagnosis of Latent TB.

27
Q

What would a CXR show in TB (3)?

A
  1. Primary : Patchy Consolidation, Pleural Effusions and Bilateral Hilar Lymphadenopathy.
  2. Reactivated : Patchy/Nodular Consolidation with Cavitation (Gas Spaces in Lungs) in Upper Zones.
  3. Military : ‘Millet Seeds’ uniformly distributed throughout the lung fields.
28
Q

Cultures in TB (3).

A
  1. Sputum - 3 Samples Collected and Tested (Hypertonic Saline to induce Sputum / Bronchoscopy with Lavage to collect Sputum Samples).
  2. Mycobacterium Blood Cultures.
  3. Lymph Node Aspiration or Biopsy.
29
Q

When would a NAAT be useful?

A

Only if the information would affect treatment or the patient is at a higher risk of developing complications e.g. HIV.

30
Q

What can decrease the sensitivity of a sputum smear?

A

HIV.

31
Q

Management of Latent TB (2B).

A
  1. No Treatment - Healthy.
  2. Risk of Reactivation :
    2A. Isoniazid and Rifampicin - 3 Months.
    2B. Isoniazid - 6 Months.
32
Q

Why are there 2 options in Latent TB management?

A

A : People Younger than 35 if Hepatotoxicity is a concern.
B : Interactions with Rifamycins are a concern e.g. HIV, Transplant.

33
Q

Management of Acute TB (2D).

A
  1. MDT.
  2. RIPE Combination :
    2A. Rifampicin - 6 Months.
    2B. Isoniazid - 6 Months.
    2C. Pyrazinamide - 2 Months.
    2D. Ethambutol - 2 Months.
34
Q

What is given with Isoniazid Prophylactically?

A

Pyridoxine (Vitamin B6) - Isoniazid causes peripheral neuropathy.

35
Q

Important Management Considerations of TB (4).

A
  1. Test for Infectious Diseases e.g. HIV.
  2. Contact Testing.
  3. Public Health England.
  4. Isolation until Established on Treatment (2 Weeks).
36
Q

How are patients with Active TB isolated in hospital?

A

Negative pressure rooms have ventilation systems that actively remove air to prevent it spreading out on to the ward to prevent airborne spread.

37
Q

Management of Meningeal Tuberculosis.

A

Prolonged period - at least 12 months - with addition of steroids.

38
Q

What is Direct Observed Therapy (DOT) (3)?

A

3x a weekly dosing regimen indicated in certain groups e.g. :-
1. Homeless People.
2. Poor Concordance.
3. Prisoners.

39
Q

Medication Information for Patient.

A

Take RIPE all together on empty stomach 1 hour before breakfast.

40
Q

What is the BCG Vaccine?

A

An intradermal infection of live attenuated TB.

41
Q

What is the BCG Vaccine useful for and not useful for?

A

Useful : Severe and Complicated TB.
Not Useful For : Pulmonary TB (Less Effective).

42
Q

Conditions for the BCG Vaccine (2).

A
  1. Mantoux Test Negative.
  2. Immunosuppression and HIV Negative (Live Vaccine).
43
Q

Relationship between HIV and TB (3).

A
  1. Depletion of M. tuberculosis-specific CD4 T Lymphocytes and Type I Cytokine Production.
  2. Dysfunction of the CD4 T Lymphocyte-Macrophage Immune Axis.
  3. Impairs Host’s Ability to Form Granulomas.

RESP (Respiratory Medicine) (35 decks)

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