Tuberculosis and Sarcoidosis Flashcards Preview

Year 3 - CR > Tuberculosis and Sarcoidosis > Flashcards

Flashcards in Tuberculosis and Sarcoidosis Deck (47)
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1

How do you diagnose Active tuberculosis

- CXR
- sputum smear
- Sputum culture - Gold standard
- NAAT - more specific than a sputum smear

2

How do you treat tuberculosis for active TB and for latent TB

Active TB
- Rifampicin - full 6 months (if they have TB of the CNS then 10 months)
- Isoniazid - full 6 months (if they have TB of the CNS then 10 months)
- Pyrazinamide - first 2 months
- Ethambutol - first 2 months

Latent TB
- 3 months of isoniazid and rifampicin or 6 months of isoniazid

3

What would you find in a biopsy of sarcoidosis

- non caseating granuloma

4

What is the treatment for sarcoidosis and what are the indications for these treatments

If symptomatic:
- steroids
- Anti-TNF

Indications
- parenchymal lung disease on CXR
- uveitis
- hypercalcaemia
- neurological ro cardiac involvement

5

What is the prognosis of sarcoidosis

- 80% have no problem
- 20% lung, eye - steroid treatment
- 2% - brain and lung transplant

6

What causes TB

- mycobacterium tuberculosis
- M. bovis
- Mycobacterium africanum

7

What stain is used to diagnose TB in a sputum smear

Zihel nelson stain

8

What is a microscopic feature of TB

Chording - when the M Tuberculosis bacteria stick together

9

What does a CXR look like of tuberculosis

- Upper Lobe cavitation
- Bilateral hilar lymphadenopathy (BHL)

10

How many people worldwide are affected by TB

- 3 billion infected (latent TB)
- 12 million cases at any one time
- 10.4 million new cases each year
- 2.6 million infectious diagnosed cases

11

What are the risk factors for developing TB

- recent contacts
- migrants from high incidence areas
- people who work or reside in homeless shelters and prison

12

What is the risk factor for developing serious problems from TB

Immunosuppression
- HIV
- Substance abuse
- silicosis
- kidney disease
- Diabetes
- low body weight
- transplant
- head and neck cancer

13

what are the social risk factors for TB

- alcohol misuse (5%)
- homelessness (5%)
- drug use (4.3%)
- imprisonment (3.5%)

14

how does TB affect the most deprived versus the least deprived

56% TB cases in the most deprived versus 7.4% in the least deprived

15

how much of TB does multi resistant TB make up

3.5% of all TB

16

What is multi resistant TB (MDRTB)

TB that is resistant to
- isoniazid
- rifampicin

17

what is XDRTB (extremely drug resistant TB)

cases where people are resistant to isoniazid, rifampicin as well as the 2nd line drugs such as
- amikacin
- fluroquinolones

- cure rate is 35%
- historical cure rate without treatment is 33%

18

What is the DOTS strategy (directly observed treatment) and what criteria is needed in order for DOTs to take place

- This is whereby a nurse comes every morning to make sure that the person is taking the medication and watches them take it to prevent the development of multi resistant TB

Conditions:
- those who have previously been treated for TB
- history of homelessness, drug or alcohol Misuse,
- in prison
- major psychiatric, memory or cognitive disorder
- in denial of TB diagnosi s
- have multi drug resistant TB
- are too ill to administer medication themselves

19

What TB symptoms do you need to know

- cough
- fever
- night sweats
- weight loss

20

What are the common and uncommon symptoms of TB

Common
- cough
- sputum
- fever
- malaise
- loss of appetite

Uncommon
- haemoptysis
- night sweats
- weight loss
- lymphadenopathy

21

What do you ask when someone coughs up blood

- when did it start
- what time of day
- how much
- bright or dark red
- streak or blob

22

what can cause you to cough up blood

- pulmonary embolism
- tuberculosis
- lung cancer
- bronchiectasis
- aspergilloma
- anticoagulation

23

What are the ways in which the body can react to TB

- immediate clearance
- latent infection
- primary disease
- reactivation disease

24

describe primary TB

- TB with no pre-exsiting immunity
- non infectious
- high mortality in immunocompromised
- often outside the lung
- children and elderly
- HIV co-infection

25

Describe post-primary TB

- TB with pre-existing immunity
- infection
- cavities with TB biofilm
- well tolerated
- young adults
- immunocompetent - CD4, CD8

26

How do you diagnosis of TB

Sputum
- PCR: Mtb and drug resistant
- culture and drug sensitivity testing

CXR
Inflammatory markers
Histology

27

Name ways to diagnosing TB

- CXR
- microscopy ziehl nelson stain - Sputum smear
- sputum culture - GOLD STANDARD
- interferon gamma release assay
- manntoux test
- gene Xpert MTB/RIF
- genotype MDRTBPlus

28

Isoniazid
- action
- site of action
- adverse effects

Action
- Bactericidal

Site of action
- cell wall - Inhibits mycolic acid synthesis

Adverse effects
- Liver damage
- peripheral neuropathy
- nausea
- tiredness

29

Rifampicin
- action
- site of action
- adverse effects

Action
- Bacteriostatic

Site of action
- Ribosome - inhibits bacterial DNA dependent RNA polymerase preventing the transcription of DNA into mRNA

Adverse effects
- liver damage
- flu like symptoms
- low platelets
- makes urine go orange

30

Pyrazinamide
- action
- site of action
- adverse effects

Action
- Bacteriostatic

Site of action
- converts into pryazinamic acid which makes the pH of the bacteria acidic and inhibits fatty acid synthase


Adverse effects
- flushing
- arthritis
- liver damage
- gout