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Karteikarten von Andrew Street, aktualisiert more than 1 year ago
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| Frage | Antworten |
| 1519 What causes TB? Outline it's pathogenesis. | Mycobacterium tuberculosis, bovis, africanum, or microti. See note (Pathogenesis of TB) |
| 1520 Describe screening for TB in the UK. | Active case finding (ACF) is a strategy to identify and treat people with TB who would otherwise not seek prompt medical care targeting high-risk groups. Active case finding usually focuses on detecting of pulmonary TB using chest X-rays or performing a symptom enquiry. Further tests can follow, such as the collection of the patients’ sputum. In the UK, ACF is performed among the following groups: * professionals at risk of TB (eg healthcare workers) * close contacts of patients with TB (if active TB is suspected) * people with social risk factors such as homeless people, people with drug and/or, alcohol problems, prisoners * immigrants from countries were TB is common. NICE recommends screening using a tuberculin skin test (TST) or interferon gamma release assays (IGRA) to screen for latent infxn in: * close contacts of patients with TB * Healthcare workers * Immunosuppressed patients (e.g. those with HIV) * Migrants from countries where TB is common (>150/100,000 or Sb-Saharan Africa aged 16-35). See https://www.gov.uk/guidance/tuberculosis-screening |
| 1521 Describe S & Sx of pulmonary TB. | 'May be silent or present with cough, sputum, malaise, weight loss, night sweats, pleurisy, haemoptysis (may be massive), pleural effusion, or superimposed pulmonary infection.' OHOCM p399. |
| 1522 Name non-pulmonary areas affected by TB and give clinical features of each. | Miliary TB (follows haematogenous dissemination): may be non-specific or overwhelming. Genitourinary TB: dysuria, freq, loin/back P, haematuria, sterile pyuria. Bone TB: vertebral collapse and Pott's vertebra. Skin TB (lupus vulgaris): jelly like nodules on face oor neck. Peritoneal TB: abdo P, GI upset. Acute TB pericarditis. TB meningitis (30% mortality): fever, headache, vomiting, abdo P, drowsiness, meningism, delirium, +/- seizures, tremor, papilloedema, cranial nerve palsies. OHOCM p399. |
| 1523 Outline the Ix of a pt with suspected TB. | Dx depends on demonstrating or culturing the organism. Pulmonary TB: Ziehl-Neelson staining of AFB in sputum, culture samples (takes up to 8/52). Extrapulmonary TB: sputum culture may be +ve, try and access suitable sample for culture or histology showing granulomata or AFB. X-ray changes in Pott's may be diagnostic, lumbar puncture for miliary and CNS (high protein & low sugar), NAA & PCR becoming more common. OHOCM p399 & KAC p841. |
| 1525 Outline the Rx for pulmonary TB. | '4 for 2, 2 for 4'. Rifampicin (8/52) Isoniazid (8/52) Pyrazinamide (4/52) Ethambutol (4/52) OHOCM p398. |
| 1527 Which groups should be immunised against TB? | See http://www.nhs.uk/Conditions/vaccinations/Pages/when-is-bcg-tb-vaccine-needed.aspx |
| 1528 What are the CI's to receiving the BCG vaccine? | The BCG vaccine is not recommended for: * people who have already had a BCG vaccination * people with a past history of TB * people with a positive tuberculin skin test * people who have had a previous anaphylactic reaction to any of the substances used in the vaccine * newborn babies in a household where a case of TB is suspected or confirmed * people who have a septic skin condition at the site where the injection will be given * people who have received another live vaccine less than three weeks earlier * people with a weakened immune system, (eg HIV, chemotherapy Rx, steroids) * people who have cancer of the white blood cells, bone marrow or lymph nodes, such as leukaemia or lymphoma * people who are seriously unwell (vaccination should be delayed) * pregnant women BCG vaccinations are not usually offered to people over the age of 16 and never over the age of 35, because the vaccine doesn't work well in adults. See http://www.nhs.uk/Conditions/vaccinations/Pages/when-is-bcg-tb-vaccine-needed.aspx |
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