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Medicine - Year 1 - Term 2 > W5 - TB > Flashcards

W5 - TB Flashcards

1
Q

Name 7 groups vulnerable to TB in the UK

A

Those from high prevalence countries
HIV positive, immunosuppressed
Elderly, neonates
Diabetics, kidney disease
Homeless, alcoholics, IDUs
Mental health problems
Prisons

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2
Q

In 2021, 68% of global cases of TB were in how many countries?

A

8

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3
Q

What % of UK TB cases are in London? Why?

A

39%
Immigration from high incidence areas

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4
Q

How is TB incidence changing each year? TB is what # killer of communicable diseases? How many people are infected worldwide?

A

2% fall per year

2nd largest killer, after Covid

2 billion people infected worldwide

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5
Q

What infective agent causes TB?

A

Mycobacterium tuburculosis

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6
Q

What 3 diseases can mycobacterium cause?

A

TB
Atypical mycobacteria
Leprosy

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7
Q

Mycobacteria has what 3 characteristics?

A

Non-motile bacillus = very slow growing
Aerobic = likes apices of lungs
Very thick fatty cell wall

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8
Q

A very thick fatty cell wall makes mycobacteria resistant to what 6 things?

A

Acid
Alkali
Detergent
Neutrophil destruction
Macrophage destruction
Ziehl Neilson Stain (AAFB)

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9
Q

In what 2 ways can mycobacteria be eliminated?

A

UV radiation
Dilution

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10
Q

How is TB spread and what is the exception?

A

Airborne (pulmonary & laryngeal TB)

Exception: M. bovis which is spread through consumption of unpasturised infected cow milk

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11
Q

Outline the immunopathology of TB - when we breathe in mycobacterium, what happens?

A
  1. Breathe in mycobacterium
    1. Mycobacterium ends up in alveoli
    2. Macrophages react in a TH1 Immune Mediated Response
    3. TH1 cells in LNs activate macrophages
    4. They turn to epitheloid cells which accumulate into Langerhans giant cells
    5. They form granulomas (to encapsulate infection)
      This can lead to central caseating necrosis and potential calcification
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12
Q

Explain why the Th1 cell mediated immunological response is a double-edged sword

A

It eliminates/reduces the number of invading mycobacterium

But

Tissue destruction is a consequence of activation of macrophages

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13
Q

What 2 factors influence the outcome of infection?

A

Virulence and number of pathogens

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14
Q

What 4 factors determine a patient’s suceptibility to an infection?

A

Genetics
Nutrition
Age
Immunosuppression

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15
Q

Explain how mycobacterium spreads in a primary infection

A

Via lymphatics to draining hilar LNs

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16
Q

Outline the 5 symptoms of primary infection of TB

A

Asymtomatic (most common)
Fever
Malaise
Erythema nodosum
Rarely chest signs

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17
Q

Primary infection can result in immunity to what?

A

Tuberculoprotein

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18
Q

What are the 3 potential outcomes of TB primary infection?

A

Progressive disease
Contained latent
Cleared cured

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19
Q

What is TB bronchopneumonia and its 3 features? What’s the prognosis?

A

Progression of primary infection.

Enlargement of primary focus (cavitation)
Enlarged hilar LN compress bronchi, lobar collapse
Enlarged LN discharges from bronchus

Poor prognosis

20
Q

What does Miliary TB affect and what does it look like on CXR?

A

Affects multiple organs

CXR
Fine mottling
Widespread small granulomata

21
Q

What are the 2 main hypotheses around post-primary TB?

A
  1. TB bacteria enter dormant stage with no/low replication
  2. Balanced state of replication and destruction by immune mechanisms
22
Q

Miliary, meningeal and pleural TB take how long to develop symptoms?

A

6-12 months

23
Q

Post primary disease, pulmonary and skeletal TB take how long to develop symptoms

A

Typically 1-5 years. Maybe 30-40

24
Q

Genitourinary and cutaneous TB take how long to develop symptoms?

A

Typically 10-15 years. Maybe 30-40

25
Q

What are the 5 symptoms of TB?

A

Cough
Fever
Sweats (mainly at night)
Weight loss
Some/all above symptoms missing

26
Q

What does post-primary TB look like on CXR?

A

Apices with soft fluffy or nodular upper zone

Cavitation in 10-30%

27
Q

Following CXR, what 5 things may make you consider CT?

A

Normal CXR but clinical suspicion
Miliary TB
Cavitation and other differential
Lymphadenopathy, alternative diagnosis
Targets for BAL

28
Q

What 4 things does primary TB look like on CXR?

A

Mediastinal lymphadenopathy
Pleural effusion
Miliary
Pneumonic lesion with enlarged hilar nodes

29
Q

Aside from scans, what 5 tests can we do for TB?

A

Sputum (3 samples; 8-24h gap, 1+ early morning)
Induced sputum
Broncoscopy with BAL
EBUS with biopsy
Aspirate/biopsy from tissue

30
Q

What test can we do for CNS TB?

A

Lumbar puncture

31
Q

What test can we do for urogenital TB?

A

Urine test

32
Q

What 3 tests are useless for active TB?

A

Mantoux
IGRA
Blood tests

33
Q

How do we treat TB?

A

Multidrug therapy, either 4:2 or 2:4 for 6+ months

34
Q

Describe the public health duties of doctors managing cases of Tuberculosis

A

We have a legal requirement to notify all cases

35
Q

Name 5 drugs for treating TB

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Steroids

36
Q

What are the 5 side effects of rifampicin?

A

Irn Bru urine/tears/lenses
Induces liver enzymes (so use prednisolone and anticonvulsants)
Hormonal contraceptive ineffective
Hepatitis
Rash

37
Q

What are the 3 side effects of isoniazid?

A

Hepatitis
Peripheral neuropathy (manage with pyridoxine - vit B6)
Rash

38
Q

What are the 3 side effects of pyrazinamide

A

Hepatitis
Gout
Rash

39
Q

What are the 2 side effects of ethambutol?

A

Optic neuropathy
Rash

40
Q

To what 3 at-risk groups is the BCG vaccination given to?

A

Unvaccinated kids under 5 with parents/grandparents from high-incidence countries

Contacts of cases

High risk employees

41
Q

Describe the effectiveness of the BCG vaccination

A

Reduces risk of severe forms of TB, mainly in kids but doesn’t stop you from getting it

42
Q

What 3 groups are screened for latent TB?

A

Contacts of people with active TB over 65 years

New entrants to area with high incidence

Pre-biologics (TNF-alpha inhibitors)

43
Q

What 2 tests are used to screen for latent TB?

A

Mantoux skin test
Interferon Gamma Release Assay (IGRA) blood test

44
Q

A latent TB (LTBI) diagnosis is made if what 4 conditions are met?

A

Asymptomatic
Normal CXR
Normal exam
Positive Mantoux/IGRA

45
Q

In what 3 potential ways is latent TB treated

A

Rifampicin+isoniazid for 3 months

Isoniazid or rifampicin for 6 months

Rifapentine+isoniazid once weekly for 12 weeks

Medicine - Year 1 - Term 2 (13 decks)

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