W3: COVID & TB

Question 1

pathogenesis and transmission of SARS-CoV-2.

Answer 1

1. BETA CORONAVIRUS, DROPLETS + FOMITES -> ACE2 R CELLS (PREDOM. RESP SYSTEM)
2. CELL DEATH + RELEASE OF MEDIATORS
3. MACROPHAGE + DC RECRUITMENT => CYT T CELLS = > MILD SYMPTOMS
4. HYPERINFLAMM: failure to contain => STORM
5. MULTI ORGAN FAILURE

Question 2

terms epidemic, pandemic, endemic and outbreak.

Answer 2

1. EPIDEMIC rapid increase in cases in area population
2. PANDEMIC epidemic spread over countries/continents, large no. of ppl
3. ENDEMIC constant prevalence in pop in area
4. OUTBREAK epidemic limited highly localised area

Question 3

common clinical presentations of COVID-19 disease and proression + detection

Answer 3

-malaise, cough, flu-like, sore throat, fever
⇣
MYOCARDITIS, CLOT DYREG, CONFUSION, EPILEPSY

-CXR: pneumonia, ARDS: white patchy lungs d/t alveolar fluid

Question 4

clinical management of COVID-19 including general supportive measures.

Answer 4

1. ANTI-PYRETIC
2. STEROIDS: 6mg of DEXAMETHASONE/day/10d
3. FLUIDS, O2 THERAPY NC.

Question 5

role of infection control practitioners in the management of COVID-19

Answer 5

Identifying incubation period, R number. Public health. Infection control in 2ºcare, isolation, PPE

Question 6

Understand the concept of herd immunity in relation to population vaccination.

Answer 6

Containing spread/outbreak by protecting large majority + protecting most vulnerable. ↓transmission ↓mortality

Question 7

global distribution of tuberculosis and its impact on tuberculosis in the UK.

Answer 7

High TB Burden countries, developing

UK: major city clusters + immigrant communities. deprivation: vulnerable groups

Question 8

Granuloma formation in TB

Answer 8

1. macrophage ingest pathogen via TH1 activation and IFN-g recruitment => EPITHELOID CELL
2. EPITHELOID CELL => LANGERHAN’S GIANT CELLS
3. Accum => Granuloma
4. CENTRAL CASEATING NECROSIS: granuloma centre necrosis d/t insufficient support

Question 9

TB Pres and. diagnostics

Answer 9

▲ FEVER NIGHT SWEAT WT LOSS
-sputum
- bronchoscopy BAL
lumbar puncture
-urine
- culture => sensitivity

Question 10

PRIMARY TB

Answer 10

usually asymptomatic,
no preceding exposure = RESULT IN IMMUNITY
hilar lymph, lymphadeenopathy, pleural effusion

initial lesion => 1º COMPLEX @ LYMPH NODE => GHON FOCUS (calcification) + COMPLEX

• GHON calcification is rare (15%)

Question 11

POST-PRIMARY TB

Answer 11

most common, if not cleared.
=LATENT, balance

• XR: apex, fluffy
• lymphadenopathy, cavitation RARE

Question 12

PROGRESSIVE TB

Answer 12

TB BRONCHOPNEUMONIA
- cavitation
- lobar collapse d/t enlarged lymph
- discharge to bronchus
= POOR PROG

MILIARY TB

• haematogenous spread
• XR: fine mottling, widespread small granulomas

Question 13

TB MGMT

Answer 13

H - IONIAZID (hepatitis)
Z - PYRANIZAMIDE (gout)
R - RIFAMPICIN (hepatitis)
E - ETHAMBUTOL (optic neuropathy)
(at least 6mos)

4:2m or 2:4m (R/H)
12 tablets/day
+Vit B6 (neuropathy), Steroids

LEGAL NOTIFICATION

Question 14

AAFB smear

Answer 14

+ve: pulmonary TB or Laryngeal TB

False -ves!

Question 15

Oxygen Therapy Masks & Flows

Answer 15

NC, 1-6L

Simple face mask 5-10L

Resevoir 15L

Nasal high Flow O2 70L (severe, overwhelm hospital supply)

CPAP, 15L (severe, tolerance?)