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2a Resp > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Tuberculosis as a g_____ c______ disease, caused by m_____

A

granulomatous caseating
mycobacteria

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2
Q

What are the 4 species known as mycobacterium tuberculosis complex? (MTC that cause TB)

A

M. tuberculosis
M africanum
M microti
M bovis

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3
Q

Where does M bovis come from?

A

Unpasteurised milk

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4
Q

Where is TB most common?

A

South Asia (China, India, Pakistan)
Subsaharan Africa

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5
Q

Approximately how many people worldwide have TB? (mostly latent)

A

1.7 billion

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6
Q

How is TB spread?

A

Airborne

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7
Q

What are risk factors for TB?

A

Country and travel eg to India
Immunocompromised eg HIV
Homeless/crowded housing
IVDU
Smoking
Alcohol
Age

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8
Q

Are mycobacteria tuberculosis complexes (MTC) motile?

A

No, non-motile

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9
Q

Are mycobacteria tuberculosis complexes (MTC) spore forming?

A

No, non-spore forming

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10
Q

Are mycobacteria tuberculosis complexes (MTC) slow growing?

A

Yes, 15-20 hours

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11
Q

Are mycobacteria tuberculosis complexes (MTC) susceptible to phagolysosome killing?

A

No, they are resistant due to mycotic acid capsule

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12
Q

Mycobacteria tuberculosis complexes (MTC) are acid-____ bacteria that have a thick, waxy wall that is resistant to most staining methods.

A

acid-fast

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13
Q

What stain turns mycobacterium tuberculosis bright red?

A

Ziehl-Neelsen stain

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14
Q

The waxy cell wall of mycobacterium tuberculosis also makes it resistant to weak d_____

A

disinfectants

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15
Q

True or false: Mycobacterium tuberculosis needs oxygen to survive

A

True, strict aerobe

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16
Q

What happens when an alveolar macrophage engulfs m. tuberculosis?

A

Bacteria produces a protein preventing the lysosome fusing to the vesicle containing the bacteria, so it can’t break it down. Proliferates causing a localised infection = primary tuberculosis

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17
Q

What are symptoms of primary tuberculosis

A

Most asymptomatic
Some have flu-like symptoms

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18
Q

How long after initial infection of m tuberculosis for cell-mediated immunity to kick in?

A

around 3 weeks

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19
Q

What is the cell-mediated immune response to primary tuberculosis?

A

Immune cells surround TB infection, forming granuloma to wall off and prevent it spreading

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20
Q

What does caseous necrosis refer to in TB?

A

The tissue in the middle of the granuloma dying

caseous = cheese-like as dead tissue looks soft and white like cheese

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21
Q

What is the primary lesion in response to TB infection called?

A

Ghon focus (pulmonary caseating granuloma)
In upper parts of lung

22
Q

Ghon ____ spreads to nearby lymph nodes, creating Ghon c_____

A

focus
complexes

23
Q

Where do Ghon complexes normally occur?

A

Usually subpleural and occur in the lower lobes

24
Q

What happens to the tissue encapsulated by the granuloma?

A

Undergoes fibrosis and often calcification producing scar tissue

25
What is a calcified Ghon complex called?
Ranke complex
26
Sometimes, the TB is killed of, leaving some scar tissue. In other cases, the TB is walled off but lies dormant. What factors may lead to the TB reactivating?
When the immune system is compromised eg AIDs or aging
27
Where does TB spread to after being reactivated?
One or both of the upper lobes of the lungs due to best oxygenation.
28
What happens when TB is reactivated and it spreads to the upper lobes?
Memory T cells recognise it and release cytokines This causes more areas of caseous necrosis to form
29
The reactivation of TB and areas of caseous necrosis can form cavities, allowing the bacteria to spread through a____ and l_____ channels to other parts of the lungs
airways and lymphatic channels
30
What is TB in the airways called?
bronchopneumonia
31
What is it called when TB spreads through the vascular system to other parts of the body?
Systemic miliary TB
32
Where does TB commonly spread to in systemic miliary TB?
kidneys Meninges Lumbar vertebrae Adrenal glands Liver Cervical lymph nodes (K, My Love, A Lager, Cheers Love)
33
What does TB in the kidneys cause?
Sterile pyuria (WBCs in urine)
34
What does TB in meninges cause?
Meningitis
35
What does TB in the lumbar vertebrae cause?
Pott disease (causes bone destruction, deformity and paraplegia)
36
what does TB in the adrenal glands cause?
Addison's disease
37
What does TB in the liver cause?
Hepatitis
38
What does TB in the cervical lymph nodes cause?
Lymphadenitis in neck (scrofula)
39
What are symptoms of TB?
Characteristic night sweats and weight loss Pyrexia (fever) Chest pain Patient looks unwell Skin changes Joint pain
40
How is TB diagnosed?
Mantoux skin test Interferon gamma release assay (IGRA) Sputum or bronchoalveolar lavage, and culture (positive will show bright red when stained with Ziehl Neelsen) Chest XR Biopsy
41
What is the Mantoux skin test?
Tuberculin (component of TB) is injected between layers of the dermis T cells recognise tuberculin and produces small, localised reaction with 48-72 hours showing large area of induration
42
What does a positive Mantoux test mean?
Tee patient has been exposed to TB at some point
43
Interferon Gamma Release Assay (IGRA) is more s____ to TB than a Mantoux test and is unlikely to be positive from the BCG vaccine
specific
44
What happens after a positive sign of Mantoux or IGRA?
Chest XR to see whether TB is active
45
What mnemonic is used to describe how TB is treated?
RI2PE6
46
What does RI2PE6 stand for (treatment of TB)?
Rifampicin (2 months) Isoniazid (2 months) Pyramidine (6 months) Ethanbutamol (6 months)
47
What is a side effect of Refampin?
Haematuria
48
What is a side effect of Isoniazid?
Peripheral neuropathy (tingling hands and feet)
49
What is a side effect of Pyrazinamide?
hepatitis
50
What is a side effect of Ethambutol?
Eye problems (optic neuritis)
51
True or false: adults with reactivated TB are most infectious
True
52
Adults with reactivated TB are typically kept in n_____ p_____ rooms with visitor wearing specific protective masks
negative pressure

2a Resp (15 decks)

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