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201 International Health: What were the 5 leading causes of death in the world in 2011?

1) Ischaemic heart disease - 7m
2) Stroke - 6.2m
3) Lower respiratory infections - 3.2m
4) COPD - 3m
5) Diarrhoeal disease - 2m


201 International Health: Which percentage of deaths due to NCDs occurred in low+middle income countries?



201 International Health: What are the leading causes of death in countries with a high-income?

Chronic diseases.
- Cardiovascular disease
- Cancers
- Diabetes
- Dementia

Lung infection is the only leading cause of infectious disease.


201 International Health: What are the leading causes of death in countries with a low-income?

Infectious diseases.
- Acute respiratory infections
- Diarrhoeal diseases
- HIV/AIDS, TB, Malaria
- Complications of childbirth and pregnancy.


201 International Health: There are 68 countries that lie near the equator that are responsible for how many (%) of the child and maternal deaths?



201 International Health: What are DALYs, and how can they be calculated?

These are disability-adjusted life years, they tell us the morbidity and burden of disease.

It is calculated by adding years lost of life and years of disability together. (Years of disability are calculated by the length of time multiplied by a standardised number for the severity of the disability.)


201 International Health: What is the current treatment regime for TB?

• 1st 2 months - Rifater® and Ethambutol
• For following 4 months - Rifanah®


201 International Health: Rifater® and Rifanah®, are combination drugs used for the treatment of which condition? What drugs do they contain.

Used for the treatment of TB (Rifater® for 1st two months, Rifanah® for the four months after that)

• Rifater - Rifampicin, Isoniazid, Pyrazinamide.
• Rifanah - Rifampicin, Isoniazid.


201 International Health: Rifampicin, Isoniazid, Pyrazinamide and Ethambutol are treatment agents for which disease? How do they work, why are they used in combination, what are the side-effects?

They are used for TB.

They act on the processes/structure of the mycobacterium.

Used in a combination to reduce resistance.

Side-effects include liver toxicity and visual disturbance.


201 International Health: How is the treatment regime for TB monitored?

• Regular liver function tests (Due to toxicity of drugs)
• Inform patients of signs of liver disease.
• Sight - Snellen charts, fields and colour vision.


201 International Health: What is the purpose of contact tracing?

• To detect associated cases.
• To detect latent cases.
• To identify non-infected susceptible individuals for vaccination.


201 International Health: What is the typical picture of the bacteria that cause TB?

• Aerobes
• Infective dose is 24 bacilli
• Resists de-staining with alcohol acid - 'Acid fast bacilli'.
• Capable of intracellular survival.


201 International Health: What is the course of the pathology of a primary infection of TB?

1) Sub-pleural/upper-middle zone.
2) Proliferate inside macrophages.
3) Presentation to Th1 cells.
4) Type IV hypersensitivity reaction.
3) Necrotising granulomas.
4) Ghon complex.


201 International Health: What is a Ghon complex?

It is a lesion in the lung that is caused by TB.
- It is a calcified focus of infection and an associated lymph node.


201 International Health: What is a type IV hypersensitivity reaction?

It is often called delayed type hypersensitivity.
It takes 2-3 days and is mediated by cells not antibodies..
CD4+ cells recognise the antigen on the class 2 MHC, which cause the release of Il-2, causing the recruitment of more CD4+ cells.


201 International Health: What family does the TB causing bacteria belong to? Which two are commonly found and which one causes TB?

Mycobacterium TB complex - TB.
Atypical Mycobacterium.


201 International Health: If you find a patient has Atypical Mycobacterium what should you do?

Nothing - It is non-infectious and non-notifiable.


201 International Health: Can you differentiate between Atypical mycobacterium and mycobacterium tuberculosis with acid-alcohol?

No, both are acid-fast bacilli.


201 International Health: In the TB cycle, if some one is exposed to TB what are the chances (%) of being infected?



201 International Health: Of those that get infected with TB, they will have a Th1 response, leading to what?

They will get asymptomatic TB, which in 5% of people will develop active TB, whilst the other 95% will develop latent TB.


201 International Health: Of those people with latent TB, what is their lifetime risk of it developing into active TB?



201 International Health: What are the symptoms of TB?

• TB may be asymptomatic.
- Fever,Sweats (70%)
- Chest pain (25%)
- Cough,fatigue,rash


201 International Health: What are the signs of TB?

-Erythema nodosum
- Pleural Effusion
- Phlyctenular conjuctivitis


201 International Health: What would you expect to see on a CXR of a patient with TB?

• 1/3 have pleural effusion.
• Pleural infiltrates.
• Hilar lymphadenopathy.
• Right Middle lobe collapse- Brock's Syndrome


201 International Health: What is Brock's Syndrome? What is the cause of it?

• Right Middle Lobe Collapse.
• Secondary to lymphadenopathy, due to a large number of lymph nodes around the orifice of the RML.


201 International Health: What are the risk factors for reactivation of TB?

Age, Malignancy, HIV, Drugs, CRF, DM, Alcoholism, Malnutrition.


201 International Health: How does Post-primary TB differ from primary TB?

• Fever/Night Sweats (50%)
• Cough - 50%
• Weight loss - 50%
• Haemoptysis - 25%
• Chest Pain - 33%


201 International Health: What are the biochemical tests for TB?

• Acid Fast Bacilli - Does not distinguish between tuberculosis and non-tuburculosis mycobacterium.
• Liquid culture - Takes 3-15 days.
• Traditional culture - Takes 4-6 weeks.


201 International Health: Whilst waiting for test results from TB investigations, what determines whether you should treat or not?

• Well patient - Wait
• Unwell patient - Treat


201 International Health: Who should people with TB be advised to avoid any contact with?

Those that are immunocompromised and <4 years.


201 International Health: What test is performed for the diagnosis of latent TB? How do you interpret the results?

Mantoux test
- Looked at after 72hrs.
- a positive result is >6mm
- a strong-positive result in >15mm
A positive result could indicate a TB vaccination.


201 International Health: What is miliary TB?

This is where the organisms are disseminated throughout the blood-stream, may present acutely unwell with shock and ARDS. Often associated with miliary shadowing on CXR.


201 International Health: Which screening test should be performed on those with TB?