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Medicine 1 Respiratory > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Is the disease burgen from TB globally falling or rising?

A

Falling

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2
Q

How are worldwide incidences of TB changing each year?

A

Falling by 2%

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3
Q

How have TB deaths changed since 2000?

A

Fallen 29%

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4
Q

What number of killer of communicable disease is TB?

A

Number 1

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5
Q

How does deaths caused by TB compare to HIV and malaria?

A

TB kills more than HIV and malaria combined

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6
Q

Where are 2/3 of TB cases?

A

Across 8 countries

India

China

Indonesia

Philippines

Pakistan

Nigeria

Bangladesh

South Africa

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7
Q

What 3 countries have the most TB deaths?

A

1) India
2) China
3) Indonesia

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8
Q

How many people are infected with TB worldwide?

A

2 billion

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9
Q

How does incidence of TB change within countries?

A

Different regions can have higher incidences, such as London having 39% of all UK cases

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10
Q

Who are vulnerable groups in the UK?

A

People from high prevalence countries

HIV positive, immunocompromised

Elderly, neonates, diabetes

Homeless, alcohol, mental health problems, prison

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11
Q

What percentage of UK TB cases are from non-UK born people?

A

70%

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12
Q

How many cases are from the homeless, alcohols, mental health problems and prisons?

A

1 in 10

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13
Q

What is TB caused by?

A

Mycobacterium

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14
Q

Where is mycobacterium found?

A

Soil and water

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15
Q

What species of mycobacterium are responsible for TB?

A

Tuberculosis

Africanum

Bovis

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16
Q

What species of mycobacterium cause disease other than TB?

A

Leprae (leprosy)

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17
Q

What is mycobacterium that causes disease other than TB called?

A

Atypical

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18
Q

How can the growth of mycobacterium be described?

A

Non-motile bacteria

Very slowly growing

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19
Q

What does non-motile bacteria means?

A

Lacks the ability to propel themselves through the environment

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20
Q

Is mycobacterium anaerobic or aerobic?

A

Aerobic

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21
Q

How would you describe the cell wall of mycobacterium?

A

Very thick fatty cell wall

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22
Q

What are the consequences of mycobacterium having a very thick, fatty cell wall?

A

Resistant to alcohol

Resistant to neutrophil and macrophage destruction

Acid and alcohol fast bacilli (AAFB)

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23
Q

What can be said about acid and alcohol fast bacilli (AAFB) and TB?

A

Not all AAFB cause TB

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24
Q

How is TB spread?

A

Airborne

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25
Q

What is the process of TB spreading airborne?

A

Someone with TB in their lungs coughs

Attaches to aerosol droplets and remain suspended in the air for many hours

Someone else breathes them in

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26
Q

What is an exception to mycobacterium being spread airborne?

A

Mycobacterium bovis

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27
Q

How is mycobacterium bovis spread?

A

Consumption of unpasteurized infected cow milk

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28
Q

What is the immunopathology of TB?

A

1) Activated macrophages
2) Epitheloid cells
3) Langhan’s giant cells
4) Accumulation of the above 3 leads to a granumla

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29
Q

What leads to a granuloma with TB?

A

Activated macrophages

Epitheloid cells

Langhan’s giant cells

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30
Q

What is the immune response of TB mediated by?

A

TH1

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31
Q

What does TH1 do in response to TB?

A

Eliminated invading mycobacterium but also causes tissue destruction due to activation of macrophages

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32
Q

What does the outcome of a TB infection depend on?

A

Infection

Susceptibility

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33
Q

What factors determine the infection ability of TB?

A

Virulence

Number

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34
Q

What factors determine the susceptibility of someone to TB?

A

Genetics

Nutrition

Age

Immunosuppresion

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35
Q

What is virulence?

A

Pathogens ability to infect host

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36
Q

What is a pathogens ability to infect the host called?

A

Virulence

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37
Q

What happens during a primary TB infection?

A

No preceding exposure or immunity

Mycobacterium spreads via lymphatics to draining hilar lymph nodes

Usually no symptoms, can be fever, malaise

38
Q

How does mycobacterium spread in a primary TB infection?

A

Lymphatics to draining hilar lymph nodes

39
Q

What are some possible symptoms of primary TB?

A

Fever

Malaise

40
Q

What is malaise?

A

General feeling of discomfort, illness or unease whose exact cause is difficult to identify

41
Q

What is the general feeling of discomfort, illness or unease whose exact cause is difficult to identify called?

A

Malaise

42
Q

What are the possible outcomes of primary infection?

A

Progressive disease

Contained latent

Cleared (cured)

43
Q

In what percentage of people does the infection progress to tuberculosis bronchopneumonia?

A

1%

44
Q

What does tuberculous pneumonia cause?

A

Primary focus continues to enlarge, leading to cavitation

Enlarged hilar lymph compress bronchi, lobar collapse

Enlarged lymph nodes discharges into bronchus

45
Q

What is the prognosis of tuberculous pneumonia like?

A

Poor

46
Q

What is cavitation?

A

Formation of an empty space within a solid object or body

47
Q

What is formation of an empty space within a solid object or body called?

A

Cavitation

48
Q

In what percentage of people does the primary infection lead to military TB?

A

1-3%

49
Q

What are examples of diseases that primary tuberculosis can progress to?

A

Tuberculous pneumonia

Military TB

50
Q

How does military TB develop?

A

Haematogenous spred of bacteria to multiple organs

51
Q

What does haematogenous mean?

A

Originating or carried by the blood

52
Q

Why are post primary diseases only present in humans?

A

Animals usually succumb to the primary disease

53
Q

What are the 2 possible post primary diseases?

A

TB bacteria entering dormant stage with low or no replication over a prolonged period of time

Balanced state of replication and destruction by immune mechanisms

54
Q

What are the clinical presentations of TB?

A

Cough

Fever

Sweats (mainly at night)

Weight loss

55
Q

What is important to remember about the typical clinical presentations of TB?

A

They are not present in all cases:

Fever absent in 37%

Sweats absent in 39%

Weight loss absent in 38%

All 3 absent in 25%

56
Q

What does diagnosing primary TB use?

A

Chest X-ray

57
Q

What is typically seen in the chest X-ray of primary TB?

A

Mediastinal lymphadenopathy (mainly unilateral, 15% bilateral)

Pleural effusion

58
Q

What is typically seen in the chest X-ray of post primary TB?

A

Apices, soft fluffy/nodular upper zone

Cavitation in 10-30%

Normal chest X-ray in 13%

Lymphadenopathy is rare

59
Q

When should you consider getting a CT?

A

Normal chest X-ray but clinical suspicion

Military TB

Cavitation

Lymphadenopathy

60
Q

What is lymphadenopathy?

A

Abnormal size or number of lymph nodes

61
Q

What is abnormal size of number of lymph nodes called?

A

Lymphadenopathy

62
Q

What does a proper diagnosis require?

A

Sample of the bug

63
Q

How is a sample of the bug obtained?

A

Sputum

Bronchoscopy with BAL

Endobronchial ultrasound (EBUS) with biopsy

Lumbar puncture in CNS TB

Urine in urogenital TB

Aspirate/biopsy from tissue

64
Q

What does EBUS stand up for?

A

Endobronchial ultrasound

65
Q

What was the first TB drug?

A

Streptomycin

66
Q

When was streptomycin discovered?

A

1944

67
Q

What other TB drugs have been discovered since streptomycin?

A

Isoniazid (H)

Pyrazinamide (Z)

Rifampicin (R)

Ethambutol (E)

68
Q

What is the evolution of TB treatment?

A

Monotherapy (streptomycin)

2 drugs in 1950s, duration 18-24 months

3 drugs in 1960s, duration 12-18 months

3 drugs late 1960s, duration 9 months

4 drugs 19702, duration 6 months

69
Q

What are the rules for the treatment of TB?

A

Multiple drug therapy is essential

Single agent treatment leads to increased drug resistance within 14 days

Therapy must continue for at least 6 months

TB is a job for commited specialists only

Legal requirment to notify all cases of TB

Test for HIV, hep B and hep C

70
Q

What is a legal requirment in terms of TB?

A

Notify of all cases

71
Q

When someone has TB, what should you also check for?

A

HIV

Hep B

Hep C

72
Q

How long must therapy for TB continue for?

A

At least 6 months

73
Q

Why is multiple drug therapy essential?

A

Single agent treatment leads to drug resistance within 14 days

74
Q

What is the standard treatment for TB?

A

2 R/H/Z/E + 4R/H per day

6 month duration at least

Pyridoxine (vitamin B6) with isoniazid to reduce risk of neuropathy

Steroids

Vitamin D substitution

75
Q

What is given with TB treatment to reduce the risk of neuropathy?

A

Pyridoxine (vitamine B6) with isoniazid

76
Q

When does treatment last for longer than 6 months?

A

7-9 months if monoresistant

12 months for CNS TB

9-12 months, or 18-20 months if multidrug resistant

77
Q

What percentage of MTB is dead within 2 days when treatment uses isoniazid?

A

90%

78
Q

What percentage of MTB is dead within 14 days when treatment uses isoniazid and rifampicin?

A

99%

79
Q

What is the annotation for the number of drugs and months?

A
80
Q

What are some side effects of rifampicin?

A

Orange urine/tears

Induces liver enzymes

All hormonal contraceptives ineffective

Hepatitis

81
Q

What are side effects of isoniazid?

A

Hepatitis

Peipheral neuropathy

82
Q

What are side effects of pyrazinamide?

A

Hepatitis

Gout

83
Q

What is gout?

A

A form of arthiritis caused by excess uric acid

84
Q

What is a form of arthiritis caused by excess uric acid?

A

Gout

85
Q

What are side effects of ethambutol?

A

Optic neuropathy

86
Q

What vaccine is used to fight TB?

A

BCG

87
Q

Who is the BCG given to?

A

Neonates

Unvaccinated children under 5 whose parents/grandparents were born in a country with an annual incidence of TB of 40/100,000 or greater

Unimmunised contacts of cases

Unimmunised high risk employees

88
Q

What must the incidence of TB be to get the BCG?

A

40/100,000

89
Q

When is screening for TB done?

A

Contacts of people with active pulmonary or laryngeal TB who are aged less than 65 (hepatoxicity increases with age)

New entrants from high endemic areas

Pre biologics

Outbreaks

90
Q

What is the treatment for latent TB?

A

Medicine 1 Respiratory (20 decks)

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