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Flashcards in deck_1502503 Deck (56):
1

What was the biggest advance in TB treatment in the 1900's?

• Development of the BCG vaccine

2

Where is TB most prevalent?

• India and China

3

What area has the highest incidence of TB?

Subsahran Africa

4

Outline two usual treatments of TB

• Thoracoplasty (crushing of the chest, reduces area for TB to thrive)• ExercisePhrenic nerve crush - Paralyzed diaphragm, reduces ability of lung to expand

5

What does the BCG vaccine prevent?

• Childhood TB

6

Why are Mycobacteria hard to stain?

• Lipid-rich cell wall that retains some dyes, and resists decolourisation with acid

7

What is TB latency?

• First encounter may not cause disease• Mycobacterium lives in system, can be reactivated spontaneously or as a result of a new encounter

8

When is risk of developing TB greatest after initial infection?

• First 2 years - 5% • Rest of lifetime - 5%

9

What are the two main stages of tuberculosis infection?

• Primary complex• Post-primary infection

10

What is the primary complex in TB?

• Infection begins with local scarring

11

What is post primary infection of TB?

• Refers to development of TB beyond the first few weeks• Infection may spread throughout the body via blood (miliary spread) or develop into localised infection (meningitis)

12

Outline the pathology of TB infection

• Mycobacterium Tuberculosis phagocytosed • Escapes from phagolysosome to multiply in the cytoplasm• Causes intense immune response, which damages lung

13

How does intense immune response damage the body?

• Local tissue destruction - Cavitation in the lung• Cytokine mediated systemic effects - Fever and weight loss

14

Why are the symptoms of late stage TB so varied?

Can effect every organ in the body, mimicking inflammatory and malignant disease

15

Give five main structures which can be affected by TB

• Pulmonary tuberculosis • Tuberculous meningitis • Lymph node tuberculosis (Often painless, most commonly in non-asians) • Kidney infection • Lumbosacral spine• Inflammation of large joints

16

Give some symptoms of pulmonary tuberculosis

• Chronic cough• Haemoptysis• Fever• Weight loss• Recurrent bacterial pneumonia

17

What does tuberculous menigitis present with?

• Fever • Slowly detriorating level of conciousness

18

What are the symptoms of kidney infection with TB?

• Signs of local infection• Fever• Weight loss• Ureteric fibrosis• Hydronephropathy

19

What are the two main symptoms of lumbosacral spine infection with TB?

• Vertebral collapse• Nerve compression

20

What can inflammation of the large joints due to TB cause?

• Destructive arthritis

21

Outline what occurs after mycobacterium tuberculosis enters lung tissue in terms of immune response

• Ingested by macrophages, escapes from paholysosome to multiply in cytoplasm• Immune response provoked via IL-12• IL2 drives the release of IFN-y and TNF-a from Natural Killer and CD4+ T helper cells• Cytokines activate and recruit more macrophages from the site of infection, resulting in formation of Granulomas

22

Give some primary changes in TB

• Few symptoms• Lymph nodes often enlarge

23

Outline some post-primary changes in TB

• Cough (not always productive)• Fever (towards the end of the day or at night)Weight loss and general debility

24

What does chest x-ray of post primary TB cause?

• Patchy solid lesions• Cativated solid lesions• Streaky fibrosis Flecks of calcification

25

Give six signs of respiratory TB

• Non-specific • Pallor• Fever• Weight loss• Clubbing• Palpable lymph nodes

26

Give seven symptoms of respiratory TB

• Primary usually asymptomatic• Post Primary ○ Tiredness and malaise ○ Weigth loss and anorexia ○ Fever ○ Cough ○ BreathlessnessHaemoptysis

27

Give six x-ray changes in Respiratory TB

• Shadowing• Cavities• Consolidation• Calcification• Cardiomegaly• Miliary seeds

28

Who is pleural TB more common in?

Males

29

Give two mechanisms by which pleural TB occurs?

• Hypersensitivity response in primary infection• Tuberculosis epyema with ruptured cavited ○ Burrows through chest wall

30

What is lymph node tuberculosis?

• More common in children, women and Asians. Painless, occurs most commonly in the neck

31

What are two types of osteo-articular TB?

• Tuberculous Spondylitis• Poncet's disease

32

What is tuberculosis spondylitis?

• Most common form of osteoarticular TB• Starts in sub-chondral bone and spread to vertebral bodies and join space, before following the longitudinal ligaments anterior and psoterior to the spine• Mainly occurs in the lower thoracic and lumbar spine and can be very high

33

What is poncet's disease?

• Aseptic polyarthritis Knees, ankles and elbows

34

What is miliary tuberculosis?

• Bacili spread through blood stream during primary infection of reactivation• Lungs are always involved ○ Spread throughout both lungs, as it is in the blood ○ Many visible through the lungs on an x-ray

35

Give four symptoms of miliary tuberculosis

• Headaches which suggest meningeal involvement• Few respiratory symptoms• Ascites may be present• Retinal involvement in children

36

What are the three factors which need to be investigated to give a TB diagnosis?

• Clinical features • Radiological features• Microbiology

37

Give three of the main clinical features of TB

• Cough• Night fever • Weight loss

38

What are five main radiological features of TB?

• Shadowing• Cavities• Consolidation• Cardiomegaly• Miliary seeds

39

What does microbiology need to achieve in order to diagnose TB?

• Identification of bacillus • Direct smear and subsequent culture of the appropriate body fluid • Important to isolate organism and determine it susceptibility to drugs

40

Outline treatment of patients with TB

• Initially treated with four drugs for 2 months• 2 drugs are then dropped, and the other two continue to be used to treat

41

Why are multiple drugs used in TB?

• To combat resistance (5-10% patients TB resistant to isoniazid)

42

Why are there problems with compliance, and what can be done to solve these problems?

• Long drug regime with several different pills to take Patients instead put on directly observed therapy

43

What does directly observed therapy do?

• Increases adherence to antibiotic treatment

44

What are four drugs given in the initial phase of TB treatment?

• Riampicin• Isoniazid• Pyrazinamide• Ethambutol

45

What are the two drugs given in the continuation phase of TB treatment?

• Rifampicin• Isoniazid

46

Give six side effects of rifampicin

• Hepatitis• Rash• Flu-like symptoms• Shock• Acute Renal Failure• Thrombocytopenic purpura

47

What three side effects of pyrazinamide

• Rash, hepatitis, athralgia

48

Give a side effect of ethambutol

• Optic neuritis

49

Describe the mechanism of multidrug-resistant TB

• Caused by incompleted treatment• Residence in a country with a high incidence of MDRTB• Failure to response clinically to an adequate regimen

50

How is multidrug resistant TB treated?

• A grueling regimen of several drugs at once

51

What is the BCG vaccine?

• Attenuated Live Bovine Tuberculosis Bacillus• Bacteria retain a strong enough antigenicity to act as a vaccine for human TB

52

What are two issues with BCG?

• Has variable efficacy depending on genetic variation of population and BCG strain• Efficacy lasts 15 years at most

53

What were UK regulations on vaccination up to 2005?

• All children ages 13 were immunised along with all neonates born into high risk groups• Now only high risk groups given, as cost effectiveness has fallen due to falling incidence rates of TB

54

Give five groups which are at risk of TB

• HIV patients• Those suffering from malnutrition• People living in overcrowded accommodation• IV drug abusers• Smokers• Diabetics• Asians

55

What is the link between HIV and TB?

• Much more likely to develop TB if already have HIV • Risk estimated to be 20-37 times greater in HIV infected people than uninfected people• Leading cause of morbidity and mortality among HIV patients

56

Describe what occurs when a case of TB is suspected

• Contact is immediately made with TB radiology• Patient goes straight to TB clinic and given a questionnaire and asked to give sputum samples• Treatment within 7 days