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Respiratory > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What type of disease is Tuberculosis?

A

A chronic recurrent infectious disease

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2
Q

What is the main cause of tuberculosis?

A

Mycobacterium tuberculosis bacteria

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3
Q

What type of bacteria is mycobacterium tuberculosis?

A

Acid-fast bacilli (small rod shaped bacteria)

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4
Q

How is Tuberculosis transmitted?

A

Inhalation of aerosol droplets containing bacterium

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5
Q

How does Tuberculosis typically present?

A
  • Systemic features
  • Low-grade fever
  • Anorexia
  • Weight loss
  • Malaise
  • Night sweats,
  • Clubbing
  • Erythema nodosum
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6
Q

What are the different forms of Tuberculosis

A

Primary
Secondary/reactivation
Miliary

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7
Q

Where in the body can TB affect?

A

Anywhere in the body (most commonly the lungs)

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8
Q

In who are the lungs typically affected in someone with Tuberculosis?

A
  • Elderly
  • Immunosuppressed
  • Malnourished
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9
Q

Which lymph nodes are commonly affected in Tuberculosis?

A

Painless enlargement of Cervical or supraclavicular lymph nodes

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10
Q

What would you see on a chest x-ray in someone with primary tuberculosis?

A

Patchy consolidation
Pleural effusions
Hilar lymphadenopathy

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11
Q

What would you see on a chest x-ray in someone with reactivated tuberculosis?

A

Patchy or nodular consolidation with cavitation (gas filled spaces in the lungs) typically in the upper zones

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12
Q

What would you see on a chest x-ray in someone with Miliary tuberculosis?

A

“Millet seeds” uniformly distributed throughout the lung fields

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13
Q

What are the two tests for an immune response to TB caused by previous, latent or active TB?

A
  • Mantoux Test
  • Interferon-Gamma Release Assays (IGRAs)
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14
Q

What are the main investigations for Tuberculosis?

A
  • Fine-needle aspiration
  • AFB staining,
  • Culture
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15
Q

What is the name of the stain used to test for mycobacterium tuberculosis?

A

Zeihl-Neelsen stain

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16
Q

What is a positive result from the Ziehl-Neelsen stain?

A

The stain turns TB bacteria bright red against a blue background

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17
Q

What is the gold standard investigation for active tuberculosis?

A

Sputum culture

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18
Q

What is the classic x-ray finding of reactivated tuberculosis?

A

Upper lobe cavitation

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19
Q

What is primary tubeculosis?

A

A non-immune host is exposed to M. tuberculosis and develops a small lung lesion called a Ghon focus

20
Q

What happens during primary tuberculosis in someone who is immunocompetent?

A

The initial lesion (gohn focus) usually heals by fibrosis

21
Q

What happens during primary tuberculosis in someone with is immunocompromised?

A

They may develop disseminated disease (miliary tuberculosis).

22
Q

What is secondary (post-primary) tuberculosis?

A

Host becomes immunocompromised the initial infection may become reactivated

23
Q

Where does reactivation usually occcur in someone with secondary tuberculosis?

A

In the apex of the lungs

24
Q

Where can extra-pulmonary infection occur in someone with tuberculosis?

A

Central nervous system
Vertebral bodies
Cervical lymph nodes
Renal
Gastrointestinal tract

25
Q

What is the most serious complication of tuberculosis?

A

Tuberculous meningitis

26
Q

What disease can occur if tuberculosis affects the vertebral bodies?

A

Pott’s disease

27
Q

What is the standard therapy for treating active TB?

A

Initial phase - first 2 months (RIPE)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

28
Q

What is the next phase of medical therapy after the initial phase?

A

Continuation phase- next 4 months
Rifampicin
Isoniazid

29
Q

What is the management of latent TB?

A

3 months of isoniazid (with pyridoxine) and rifampicin
OR
6 months of isoniazid (with pyridoxine)

30
Q

How are patients with meningeal TB treated?

A

They are treated for longer (at least 12 months) with the addition of steroids

31
Q

What is a complication of TB treatment?

A

Immune reconstitution disease

32
Q

When does immune reconstitution disease typically occur after starting treatment for TB?

A

3-6 weeks after starting treatment

33
Q

How does immune reconstitution disease present?

A

Enlarging lymph nodes

34
Q

What are the main side effects of izonisaid?

A

peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
hepatitis, agranulocytosis
liver enzyme inhibitor

35
Q

What are the main side effects of rifampicin?

A

potent liver enzyme inducer
hepatitis
orange secretions
flu-like symptoms

36
Q

What are the mian side effects of pyrazinamide?

A

Hyperuricaemia causing gout
Arthralgia
Myalgia
Hepatitis

37
Q

What are the mian side effects of ethambutol?

A

Optic neuritis: check visual acuity before and during treatment

38
Q

What should you check before and during treatment due to ethambutol?

A

Visual acuity due to optic neuritis

39
Q

What does the Mantoux test involve?

A

Purified protein derivative (PPD) injected intradermally

40
Q

What does a <6mm result from the mantoux test suggest?

A

Negative — give BCG if they are unvaccinated

41
Q

What does a 6-15mm result from the mantoux test suggest?

A

positive -should not be given BCG; may be due to previous TB infection or BCG

42
Q

What does a >15mm result from the mantoux test suggest?

A

strongly positive- suggests tuberculosis infection

43
Q

How does Tb spread throughout the body?

A

Via the lymphatic system

44
Q

What is the inflammatory response in TB?

A

Type 4 hypersensitivity reaction

45
Q

What happens in the body in TB?

A

Granulomas containing the bacteria form around the body

46
Q

What is a gohn focus composed of?

A

Tubercle-laden macrophages

47
Q

What is a gohn complex?

A

Combination of a Ghon focus and hilar lymph nodes

Respiratory (47 decks)

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