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Medicine - Year 1 - Term 2 > W5 - TB > Flashcards

W5 - TB Flashcards

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1
Q

Name 7 groups vulnerable to TB in the UK

A

Those from high prevalence countries
HIV positive, immunosuppressed
Elderly, neonates
Diabetics, kidney disease
Homeless, alcoholics, IDUs
Mental health problems
Prisons

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2
Q

In 2021, 68% of global cases of TB were in how many countries?

A

8

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3
Q

What % of UK TB cases are in London? Why?

A

39%
Immigration from high incidence areas

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4
Q

How is TB incidence changing each year? TB is what # killer of communicable diseases? How many people are infected worldwide?

A

2% fall per year

2nd largest killer, after Covid

2 billion people infected worldwide

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5
Q

What infective agent causes TB?

A

Mycobacterium tuburculosis

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6
Q

What 3 diseases can mycobacterium cause?

A

TB
Atypical mycobacteria
Leprosy

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7
Q

Mycobacteria has what 3 characteristics?

A

Non-motile bacillus = very slow growing
Aerobic = likes apices of lungs
Very thick fatty cell wall

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8
Q

A very thick fatty cell wall makes mycobacteria resistant to what 6 things?

A

Acid
Alkali
Detergent
Neutrophil destruction
Macrophage destruction
Ziehl Neilson Stain (AAFB)

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9
Q

In what 2 ways can mycobacteria be eliminated?

A

UV radiation
Dilution

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10
Q

How is TB spread and what is the exception?

A

Airborne (pulmonary & laryngeal TB)

Exception: M. bovis which is spread through consumption of unpasturised infected cow milk

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11
Q

Outline the immunopathology of TB - when we breathe in mycobacterium, what happens?

A
  1. Breathe in mycobacterium
    1. Mycobacterium ends up in alveoli
    2. Macrophages react in a TH1 Immune Mediated Response
    3. TH1 cells in LNs activate macrophages
    4. They turn to epitheloid cells which accumulate into Langerhans giant cells
    5. They form granulomas (to encapsulate infection)
      This can lead to central caseating necrosis and potential calcification
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12
Q

Explain why the Th1 cell mediated immunological response is a double-edged sword

A

It eliminates/reduces the number of invading mycobacterium

But

Tissue destruction is a consequence of activation of macrophages

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13
Q

What 2 factors influence the outcome of infection?

A

Virulence and number of pathogens

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14
Q

What 4 factors determine a patient’s suceptibility to an infection?

A

Genetics
Nutrition
Age
Immunosuppression

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15
Q

Explain how mycobacterium spreads in a primary infection

A

Via lymphatics to draining hilar LNs

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16
Q

Outline the 5 symptoms of primary infection of TB

A

Asymtomatic (most common)
Fever
Malaise
Erythema nodosum
Rarely chest signs

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17
Q

Primary infection can result in immunity to what?

A

Tuberculoprotein

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18
Q

What are the 3 potential outcomes of TB primary infection?

A

Progressive disease
Contained latent
Cleared cured

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19
Q

What is TB bronchopneumonia and its 3 features? What’s the prognosis?

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A

Progression of primary infection.

Enlargement of primary focus (cavitation)
Enlarged hilar LN compress bronchi, lobar collapse
Enlarged LN discharges from bronchus

Poor prognosis

20
Q

What does Miliary TB affect and what does it look like on CXR?

Study These Flashcards
A

Affects multiple organs

CXR
Fine mottling
Widespread small granulomata

21
Q

What are the 2 main hypotheses around post-primary TB?

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A
  1. TB bacteria enter dormant stage with no/low replication
  2. Balanced state of replication and destruction by immune mechanisms
22
Q

Miliary, meningeal and pleural TB take how long to develop symptoms?

23
Q

Post primary disease, pulmonary and skeletal TB take how long to develop symptoms

Study These Flashcards
A

Typically 1-5 years. Maybe 30-40

24
Q

Genitourinary and cutaneous TB take how long to develop symptoms?

Study These Flashcards
A

Typically 10-15 years. Maybe 30-40

25
What are the 5 symptoms of TB?
Cough Fever Sweats (mainly at night) Weight loss Some/all above symptoms missing
26
What does post-primary TB look like on CXR?
Apices with soft fluffy or nodular upper zone Cavitation in 10-30%
27
Following CXR, what 5 things may make you consider CT?
Normal CXR but clinical suspicion Miliary TB Cavitation and other differential Lymphadenopathy, alternative diagnosis Targets for BAL
28
What 4 things does primary TB look like on CXR?
Mediastinal lymphadenopathy Pleural effusion Miliary Pneumonic lesion with enlarged hilar nodes
29
Aside from scans, what 5 tests can we do for TB?
Sputum (3 samples; 8-24h gap, 1+ early morning) Induced sputum Broncoscopy with BAL EBUS with biopsy Aspirate/biopsy from tissue
30
What test can we do for CNS TB?
Lumbar puncture
31
What test can we do for urogenital TB?
Urine test
32
What 3 tests are useless for active TB?
Mantoux IGRA Blood tests
33
How do we treat TB?
Multidrug therapy, either 4:2 or 2:4 for 6+ months
34
Describe the public health duties of doctors managing cases of Tuberculosis
We have a legal requirement to notify all cases
35
Name 5 drugs for treating TB
Rifampicin Isoniazid Pyrazinamide Ethambutol Steroids
36
What are the 5 side effects of rifampicin?
Irn Bru urine/tears/lenses Induces liver enzymes (so use prednisolone and anticonvulsants) Hormonal contraceptive ineffective Hepatitis Rash
37
What are the 3 side effects of isoniazid?
Hepatitis Peripheral neuropathy (manage with pyridoxine - vit B6) Rash
38
What are the 3 side effects of pyrazinamide
Hepatitis Gout Rash
39
What are the 2 side effects of ethambutol?
Optic neuropathy Rash
40
To what 3 at-risk groups is the BCG vaccination given to?
Unvaccinated kids under 5 with parents/grandparents from high-incidence countries Contacts of cases High risk employees
41
Describe the effectiveness of the BCG vaccination
Reduces risk of severe forms of TB, mainly in kids but doesn't stop you from getting it
42
What 3 groups are screened for latent TB?
Contacts of people with active TB over 65 years New entrants to area with high incidence Pre-biologics (TNF-alpha inhibitors)
43
What 2 tests are used to screen for latent TB?
Mantoux skin test Interferon Gamma Release Assay (IGRA) blood test
44
A latent TB (LTBI) diagnosis is made if what 4 conditions are met?
Asymptomatic Normal CXR Normal exam Positive Mantoux/IGRA
45
In what 3 potential ways is latent TB treated
Rifampicin+isoniazid for 3 months Isoniazid or rifampicin for 6 months Rifapentine+isoniazid once weekly for 12 weeks

Medicine - Year 1 - Term 2 (13 decks)

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