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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
Q

What is a calcified Ghon complex called?

A

Ranke complex

26
Q

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?

A

When the immune system is compromised eg AIDs or aging

27
Q

Where does TB spread to after being reactivated?

A

One or both of the upper lobes of the lungs due to best oxygenation.

28
Q

What happens when TB is reactivated and it spreads to the upper lobes?

A

Memory T cells recognise it and release cytokines
This causes more areas of caseous necrosis to form

29
Q

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

A

airways and lymphatic channels

30
Q

What is TB in the airways called?

A

bronchopneumonia

31
Q

What is it called when TB spreads through the vascular system to other parts of the body?

A

Systemic miliary TB

32
Q

Where does TB commonly spread to in systemic miliary TB?

A

kidneys
Meninges
Lumbar vertebrae
Adrenal glands
Liver
Cervical lymph nodes

(K, My Love, A Lager, Cheers Love)

33
Q

What does TB in the kidneys cause?

A

Sterile pyuria (WBCs in urine)

34
Q

What does TB in meninges cause?

A

Meningitis

35
Q

What does TB in the lumbar vertebrae cause?

A

Pott disease

(causes bone destruction, deformity and paraplegia)

36
Q

what does TB in the adrenal glands cause?

A

Addison’s disease

37
Q

What does TB in the liver cause?

A

Hepatitis

38
Q

What does TB in the cervical lymph nodes cause?

A

Lymphadenitis in neck (scrofula)

39
Q

What are symptoms of TB?

A

Characteristic night sweats and weight loss
Pyrexia (fever)
Chest pain
Patient looks unwell
Skin changes
Joint pain

40
Q

How is TB diagnosed?

A

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
Q

What is the Mantoux skin test?

A

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
Q

What does a positive Mantoux test mean?

A

Tee patient has been exposed to TB at some point

43
Q

Interferon Gamma Release Assay (IGRA) is more s____ to TB than a Mantoux test and is unlikely to be positive from the BCG vaccine

A

specific

44
Q

What happens after a positive sign of Mantoux or IGRA?

A

Chest XR to see whether TB is active

45
Q

What mnemonic is used to describe how TB is treated?

A

RI2PE6

46
Q

What does RI2PE6 stand for (treatment of TB)?

A

Rifampicin (2 months)
Isoniazid (2 months)
Pyramidine (6 months)
Ethanbutamol (6 months)

47
Q

What is a side effect of Refampin?

A

Haematuria

48
Q

What is a side effect of Isoniazid?

A

Peripheral neuropathy (tingling hands and feet)

49
Q

What is a side effect of Pyrazinamide?

A

hepatitis

50
Q

What is a side effect of Ethambutol?

A

Eye problems (optic neuritis)

51
Q

True or false: adults with reactivated TB are most infectious

A

True

52
Q

Adults with reactivated TB are typically kept in n_____ p_____ rooms with visitor wearing specific protective masks

A

negative pressure

2a Resp (15 decks)

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