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Respiratory system > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

even though treatment was only found in the 50s why was there a decrease in tuberculosis?

A

due to an increase in living conditions, hygiene and diet

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2
Q

what bacteria are responsible for tuberculosis?

A

mycobacterium tuberculosis

mycobacterium bovis

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3
Q

describe mycobacterium

A

> non-motile bacillus
slow growing
thick cell wall composed of lipids, peptidoglycans, arabinomannans
there are aniline based dyes such as carbon fuschin complex in the cell wall

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4
Q

what is mycobacterium resistant to?

A

> it is alkali, alcohol and detergent resistant

>it is resistant to neutrophil and macrophage destruction

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5
Q

how is tuberculosis transmitted?

A

in open pulmonary tuberculosis they cough up the bacterium from a cavity in the apex. these respiratory droplets evaporate and remain airborne for a very long time.

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6
Q

how is mycobacterium bovis transmitted?

A

through the consumption of infected cows milk that is then deposited in the cervical lymph and intestinal nodes.

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7
Q

how does the mycobacterium hide itself form the macrophages?

A

by presenting antigens making them invisible.

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8
Q

how does the body activate the macrophages against mycobacteria?

A

t helper cells attaches to the mycobacteria so the macrophage recognises the combination and becomes activated.

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9
Q

what is the immunopathology of tuberculosis?

A

the activated macrophages combine with the epithelioid cells creating Langham’s giant cells. this accumulation of cells creates a granuloma which can lead to a ceseating necrosis that may later calcify.

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10
Q

In a primary tuberculosis infection how is the mycobacteria spread around the body?

A

via the lymphatic system draining to the hilar lymph nodes.

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11
Q

what are the signs and symptoms in a primary tuberculosis infection?

A 
> usually none
> fever
>erythema nodosum
> malaise
> there are rarely chest signs
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12
Q

in the majority of cases what is the outcome of tuberculosis?

A

the primary complex (initial lesion and local lymph node) heals with/without a scar (becoming latent) and may calcify

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13
Q

in a primary infection what immunity is developed?

A

the immunity to tuberculoprotein

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14
Q

what is a heaf/tuberculin test?

A

intradermal administration of tuberculoprotein results in lymphocytic and macrophage based area of inflammation after 48 hours if the child has already had a primary infection

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15
Q

what happens when a primary tuberculosis infection becomes progressive?

A

the primary focus enlarges (cavitation). the enlarged hilar lymph nodes begin to compress on the bronchi causing lobar collapse, the hilar lymph nodes discharge into the bronchus. tuberculous pneumonia is then produced
or there is wide spread small granulomata and a tuberculosis pleural effusion.

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16
Q

describe a latent tuberculosis infection

A

there is reactivation of mycobacterium from latent primary infection disseminated by the blood around the body.
or there is re-infection from an outside source.
if there is insufficient immunity present there will be persistent tissue damage leading to progressive disease.

17
Q

what are the respiratory signs for post primary disease?

A 
> cough
> sputum
> haemoptysis (where there is a cavity)
> pleuritic chest pain
> breathlessness
18
Q

what are systemic signs for post primary disease?

A

> malaise
fever
weight loss
night sweats

19
Q

what patients should you have a high index of suspicion for?

A 
> immunosuppressed (HIV)
> malnutrition
> alcoholism
>vagrants
>diabetes mellitus
> recent immigrants form high incidence countries
20
Q

what are the essential investigations in tuberculosis?

A

> three sputum specimens on successive days: smear ZN stain, culture, PCR
chest radiograph

21
Q

what should you be looking for on a CXR of a patient with tuberculosis?

A

> patchy shadowing often in the apices, often bilateral
cavitation
calcification

22
Q

if the sputum investigations are negative what other investigations should be carried out?

A

> CT of the thorax
bronchoscopy with BAL and biopsy
pleural aspiration and biopsy if there is an effusion

23
Q

if carrying out an effusion for diagnosing tuberculosis what tests should be performed on the biopsy?

A

> fluid cytology
fluid for AAFB and culture
histology
sent in saline for culture

24
Q

what is the modern treatment for TB?

A

MULTIPLE DRUG THERAPY that is continued for 6 months.

25
Q

what medication are they given for 2 months?

A

> rifampicin
isoniazid
ethambutol
pyrazinamide

26
Q

what medication are they given for 4 months?

A

> rifampicin

> isoniazid

27
Q 
what are the side effects of:
> rifampicin
> isoniazid
> ethambutol 
> pyrazinamide
A

> orange tears, hepatitis, induces liver enzymes
hepatitis, peripheral neuropathy
optic neuropathy
gout

28
Q

what does single drug treatment of TB lead to?

A

a drug resistant organism within 14 days

29
Q

what is the legal requirement when you diagnose TB?

A

you must notify all cases

30
Q

what would you do in the case of an extremely drug resistant TB?

A

resect the lung

31
Q

why is TB contact tracing carried out?

A

to identify the source of transmission

32
Q

what does the likelihood of infection rely on?

A

duration of contact and intensity of infection

33
Q

describe the heaf test

A

it is a multiple puncture of undiluted PPD. it is read after 4-7 days and graded

34
Q

describe the different grades of heaf test results

A

grade 1: 4-6 papules

2: indurated ring
3: disc of induration
4: induration outside of the ring and blistering

35
Q

describe the mantoux test

A

PPD is diluted 1:1000, 0.1ml. it is intradermal and is read after 48-72 hours. any induration > 10mm is positive

36
Q

a patient has a positive heaf test but a chest x-ray is carried out and is normal. what happens next?

A

they are still at risk of disease so are treated with chemoprophylaxis rifampicin and inh for 3 months and inh for 6 months.

37
Q

what happens if the heaf test is negative?

A

repeat after 6 weeks and if it is normal again give the BCG

38
Q

what is the management of a patient who is older than 16, had their BCG and has been exposed to TB?

A

a CXR is carried out. if it is normal they are reassured and discharged.
if it is abnormal they investigation to diagnose TB is carried out

Respiratory system (19 decks)

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