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YR3: RESPIRATORY LO's > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What happens in primary TB?

A

1st encounter
Host macrophages in the lung engulf the organisms + carry them to hilar lymph nodes in an attempt to control infection.
Small granulomas (tubercles) are formed around the body to contain the mycobacteria

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2
Q

What is the outcome of primary TB?

A

80% heal spontaneously + bacteria are eliminated
20%: bacteria encapsulated in a defensive barrier but persist in an otherwise healthy individual where disease is dormant

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3
Q

What is secondary TB? What is it usually precipitated by? Where does it usually occur?

A

Reactivation of semi-dormant TB
Precipitated by impaired immune function: malnutrition, AIDS or immunosuppressive therapy.
Occurs in lung apices

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4
Q

List 7 risk factors for TB

A

Close contact with TB patient
Ethnic minority groups (sub-saharan Africa + S. Asia)
Homeless, alcohol dependent, drug misusers
HIV+, immunosuppressed
Elderly
Co-morbidities
Children

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5
Q

How do primary and secondary tuberculosis patients present?

A

1: usually asymptomatic.
2: variable + nonspecific

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6
Q

List 8 general symptoms a patient with TB may complain of

A 
Fatigue
Malaise
Fever
Weight loss
Anorexia
Night sweats
Clubbing
Erythema nodosum
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7
Q

What pulmonary symptoms occur in TB?

A

Chronic, productive cough/ Haemoptysis

Purulent ± bloodstained sputum

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8
Q

What genitourinary, musculoskeletal, CNS, and GI symptoms may arise from caseous tubercles spreading in miliary TB?

A

GU: Sterile pyuria, Infertility
MSK: pain, arthritis, osteomyelitis, Pott’s disease, spinal cord comp. + abscess formation
CNS: meningitis + tuberculomas: headaches, vomiting
GI: Subacute obstruction, COBH, Weight loss, Peritonitis, Ascites

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9
Q

What is TB?

A

Granulomatous disease caused by Mycobacterium tuberculosis

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10
Q

What are the 3 subtypes of TB?

A

Primary: initial infection; pulmonary or GI (rare)
Post-primary: Reinfection/ reactvation
Miliary: Haematogenous dissemination

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11
Q

Give 4 features of Mycobacterium Tuberculosis

A

Intracellular organism
Acid fast bacilli
Survives after being phagocytosed by macrophages
Aerobe: prefers upper lung lobes

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12
Q

Describe the epidemiology of TB

A

Annual mortality = 1.5 million (95% in developing countries)
Annual UK incidence = 8000
Asian immigrants = highest risk group in UK

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13
Q

List 6 signs and symptoms in primary TB

A 
Mostly ASYMPTOMATIC
Fever  
Malaise  
Cough  
Wheeze  
Erythema nodosum 
Phlyctenular conjunctivitis
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14
Q

List 7 symptoms in post-primary TB

A 
Fever/ night sweats  
Malaise  
Weight loss  
SOB 
Cough with purulent, blood streaked sputum  
Pleuritic chest pain  
Clubbing
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15
Q

List 6 signs and symptoms in miliary TB

A 
Fever  
Weight loss  
Cough
SOB
Meningitis
Yellow caseous tubercles spread to other organs
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16
Q

What investigations should be performed for TB?

A 
Sputum/ Pleural Fluid MC+S 
CXR
Raised WCC + Anaemia
HIV Testing 
CT, lymph nodes, pleural biopsy, sampling of other affected systems
17
Q

What is seen on CXR in primary TB?

A

Peripheral consolidation

Hilar lymphadenopathy

18
Q

What is seen on CXR in post-primary TB?

A 
Upper lobe shadowing  
Streaky fibrosis + cavitation  
Calcification  
Pleural effusion 
Hilar lymphadenopathy
19
Q

What is seen on CXR in miliary TB?

A

Fine shadowing

Nodular

20
Q

What group of antibiotics are used to treat TB?

A

Rifampicin (6months)
Isoniside (6months)
Pyrazinamide (2months)
Ethambutol (2months)

21
Q

What is extra pulmonary TB? In which patients does this most commonly occur?

A

TB involving organs other than the lungs

Immunocomprimised

22
Q

What lymph, dermatological, CVS and adrenal signs and symptoms may arise from caseous tubercles spreading in miliary TB?

A

Lymphadenopathy
Skin: lupus vulgaris
Heart: pericardial effusion, constrictive pericarditis
Adrenals: Addisons

23
Q

How does primary TB present?

A

Mostly asymptomatic

May have vague flu like symptoms

24
Q

What is the gold standard investigation for TB? What is the issue of relying on this?

A

Sputum culture + Ziehl-Nielsen staining

Culturing TB takes a long time (~ 6 weeks)

25
Q

When are IGRAs useful? What occurs?

A

Useful in latent TB (high specificity)
Negative in BCG vaccine
Exposure of host T cells to TB antigens leads to release of interferon

26
Q

Why is IGRA testing preferred to TSTs?

A

Single patient visit

BCG does NOT give false positive

27
Q

What are the 2 forms of testing for TB?

A

Tuberculin Tests: Mantoux test +Heaf Test

Interferon Gamma Tests (IGRA)

28
Q

How should cultures be taken in suspected TB?

A

Sputum acid-fast bacilli smear (3 samples 8 hours apart, with 1 being in early morning)

29
Q

What is shown by tuberculin skin tests?

A

Positive if previous exposure to TB or BCG

Negative TST doesn’t rule out TB

30
Q

What is the Mantoux test? What does it identify?

A

Erythema after 72hrs of PPD injection suggests patient has previously been exposed to TB.
Identifies those exposed to TB
DOES NOT distinguish between active + latent TB.

31
Q

What is the Heaf test? How is it interpreted?

A

PPD on forearm. Graded according to papule size + vesiculation
(ring-shaped induration)

32
Q

What is the limitation of the IGRA test?

A

Does not differentiate between latent + active TB

33
Q

What is a Gohn focus?

A

Granuloma in which central tissue has died due to caseous necrosis
Sequela of primary TB infection

34
Q

What is a Ghon complex comprised of? What may this progress to if calcified?

A

Ghon focus + ipsilateral mediastinal lymphadenopathy

Ranke complex

35
Q

What is a Ranke complex?

A

a Ghon lesion that has undergone calcification
+
an ipsilateral calcified mediastinal node

36
Q

Which anti-TB antibiotic causes optic neuritis? How may this present?

A

Ethambutol

Loss of colour vision + visual acuity

37
Q

Which anti-TB antibiotic is an enzyme inducer? Thus what drugs need to be considered?

A

Rifampicin

OCP

38
Q

Which anti-TB antibiotic causes peripheral neuropathy?

A

Isoniazid

39
Q

Which anti-TB antibiotics are hepatotoxic?

A

Rifampicin
Isoniazid
Pyrazinamide

YR3: RESPIRATORY LO's (16 decks)

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