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Respiratory System > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What organism causes tuberculosis

A

Mycobacterium tuberculosis complex bacteria

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2
Q

Risk factors for reactivation of TB

A
  • infection with HIV
  • substance abuse
  • prolonged therapy with corticosteroids
  • organ transplant
  • diabetes mellitus
  • low body weight
  • severe kidney disease
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3
Q

Describe the mycobacterium tuberculosis

A
  • non motile bacilli
  • obligate aerobe
  • long chain fatty acids + glycolipids in cell wall
  • slow growing
  • acid fast bacilli
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4
Q

Why can gram stain not be used for mycobacterium tuberculosis?
What is used instead?

A

Gram satin cant go through thick fatty acid cell wall
ZN staining

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5
Q

What are the three types of TB disease?

A

Pulmonary TB
Extrapulomary TB
Miliary TB

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6
Q

Site of miliary TB

A

Carried to all parts of the body through bloodstream

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7
Q

Who is extrapulmonary TB often found in?

A

HIV infected
Immunosuppressed
Young children

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8
Q

Symptoms of pulmonary TB

A
  • fever
  • night sweats
  • weight loss/anorexia
  • fatigue
  • cough
  • haemoptysis
  • breathlessness if pleural effusion
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9
Q

Signs of pulmonary TB on examination

A
  • often no chest signs despite CXR abnormalities
  • crackles in affected area
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10
Q

Investigation of pulmonary TB

A
  • CXR
  • sputum samples
  • histology
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11
Q

Diagnosing latent TB

A

Tuberculin sensitivity test
- tuberculin injected intradermally
- read 2-3 days later

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12
Q

First line medication for TB
How long must each be taken for?

A

Rifampicin: 6 months
Isoniazid: 6 months
Pyrazinamide: 2 months
Ethambutol: 2 months

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13
Q

Where is TB common?

A

Africa
Asia
Latin America

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14
Q

Side effects of rifampicin

A

Orange urine/secretions
Hepatitis
Thrombocytopaenic rash

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15
Q

How is tuberculosis spread?

A

Droplet inhalation

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16
Q

What organism most commonly causes TB?

A

Mycobacterium tuberculosis

17
Q

Describe the pathogenesis of TB

A
  • aerosols inhaled
  • engulfed by alveolar macrophages
  • at this point most have a spontaneous recovery
  • those who don’t > primary TB (latent or disseminated)
  • if latent, TB can reactive causing post primary TB
18
Q

How does post primary TB arise?

A

Reactivation of latent infection

19
Q

What does primary TB lead to?

A
  • asymptomatic latent TB (more common)
  • primary progressive pulmonary/extrapulmonary TB through dissemination
20
Q

Main sites of extrapulmonary TB

A
  • CNS
  • pleura
  • bones + joints
  • urogenital tract
21
Q

Risk factors of TB

A
  • Close contact with patient infected with pulmonary TB
  • high prevalence in India + sub-Sahara Africa
  • extremes of age
  • homelessness
  • diabetes
  • immunosuprresion e.g. HIV
  • alcohol or drug dependence
  • prolonged steroid use
22
Q

Clinical features of TB

A
  • often asymptomatic
  • fever
  • lethargy
  • anorexia + weight loss
  • loss of appetite
  • enlarged lymph nodes
  • chronic cough
  • sputum production
  • breathlessness
  • pleuritic chest pain
    (+extrapulmonary symptoms)
23
Q

How does a TB infection appear on CXR?

A
  • often at apex
  • ill defined patchy consolidation
  • cavitation within consolidation
  • healing results in fibrosis
24
Q

What is a ghon focus?
How does it form?

A
  • spherical granuloma with central caseation, caused by the macrophages ingesting Mycobacterium tuberculosis
  • three weeks after infection, immune cells surround site of infection > granuloma
  • this isolates bacteria to prevent spreading
  • tissue inside granuloma dies > caseous necrosis
  • the necrotic area is a ghon focus
25
Q

What is a ghon complex?

A
  • to infection spread to hilar lymph nodes
  • the caseating tissue (ghon focus) + associated lymph node is the ghon complex
26
Q

What is miliary TB?

A

Form of TB characterised by widespread dissemination to extrapulmonary organ causing tiny lesions

27
Q

What is suggestive of miliary TB on chest x ray?

A

Many tiny spots throughout lung field

28
Q

Management of TB

A
  • notify public health England
  • screening + tracing of close contacts
  • medications: isoniazid, rifampicin, pyrazinamide + ethambutol
29
Q

What must always be given with isoniazid?
Why?

A

pyridoxine (vit B6)
Avoid damage to peripheral nerves

30
Q

Side effects of TB drugs

A
  • hepatitis: rifampicin, isoniazid, pyrazinamide
  • visual disturbance: ethambutol
  • peripheral neuropathy: isoniazid
  • orange secretions: rifampicin
31
Q

Pulmonary complication for TB

A
  • pleurisy
  • plural effusion
  • empyema
  • pneumothorax
  • bronchiectasis
  • respiratory failure
32
Q

Why must vitamin B6 be given with TB treatment?

A

Prevents peripheral nerve damage by isoniazid

33
Q

What skin findings can arise with TB?

A

Erythema nodosum

Respiratory System (20 decks)

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