22- extrapulmonary TB

Question 1

What is the most common form of extra pulmonary TB

Answer 1

Tuberculous Lymphadenitis
Cervical nodes are most often affected.
Nodes are discrete, firm, non tender (eventually they become visible)
- if untreated nodes become fluctuant and drain spontaneously with sinus tract formation

Question 2

skeletal TB examples

Answer 2

spondylitis Potts dx
arthritis
osteomyelitis

Question 3

Potts dx is?
What does it affect?
What can it lead to?

Answer 3

most common form of skeletal TB

• affects lower thoracic and upper lumbar area
• infection begins with inflammation of intervertebral joints and can spread to involve adjacent vertebral body
• can lead to vertebral collapse, subsequent kyphosis can lead to cord compression and paraplegia

Question 4

Examples of CNS tuberculosis

CSF Lab results

Answer 4

Meningitis, intracranial tuberculomas, spinal tuberculous arachnoiditis

• meningitis is due to intense inflam post rupture of supependymal tubercle
• CSF labs show lymphocytic pleocytosis, neutrophilic predominance, increased protein levels, glucose less than 45

Question 5

abdominal TB can be found

Answer 5

in the GI tract, peritoneum, mesenteric lymph nodes, or genitourinary tract
- intestinal lesions can be ulcerative (most common), hypertrophic, or both

Question 6

isolation standard of tb pts

Answer 6

those who have infectious tb should be placed in an airborne infection isolation room, and should wear a surgical mask. Note that isolation is not needed for extra pulmonary forms

Question 7

tx for tb

Answer 7

6-9 month regimen (2 months isoniazid, rifampin, pyrazinamide, ethambutol, 4-7 months of isoniazide and rifampin)
- for CNS TB; B&J TB; delayed tx response and drug resistance you need at least 9-12 months of tx

Question 8

adjunctive corticosteroids are useful in which pts with TB

Answer 8

TB meningitis, TB pericarditis, or miliary TB with refractory hypoxemia

Question 9

Articular tuberculosis affects how many joints? Is it rapid? Sx

Answer 9

is a slow monoarthritis of the hip or knee; presentation is pain, swelling, decreased range of motion
chronic cases have draining sinuses abscesses
systemic sx are absent

Question 10

T/F extraspinal tuberculous osteomyelitis presents with local pain and can involve any bone

Answer 10

T

Question 11

SX of abdominal TB

Answer 11

pain, diarrhea, weight loss, fever, melena, rectal bleeding

Question 12

What is tuberculous peritonitis, SX?

Answer 12

results from reactivation of latent foci in the peritoneum,

SX: insidious onset of ascites, abdominal pain, fever

Question 13

PX of pts with renal tuberculosis

Answer 13

dysuria, hematuria, flank pain

CT: renal calcifications, calculi, scarring, hydronephrosis

Question 14

T/F Male genital tuberculosis usually is associated with renal tuberculosis.
It involves the prostate, seminal vesicles, epididymis, and testes, in
order of incidence. Patients usually present with a scrotal mass and
diagnosis is made by surgery

Answer 14

T

Question 15

T/F Female genital tuberculosis begins in the endosalpinx and can spread
to the peritoneum, endometrium, ovaries, cervix, and vagina. Patients
present with pelvic pain, infertility, and vaginal bleeding.

Answer 15

T

Question 16

How is tuberculous pericaditis developed?
SX:
DX:

Answer 16

secondary to contiguous spread from mediastinal node,s lungs, spine, sternum or during miliary dissemination
SX: abrupt/insidious, chest pain, dyspnea, ankle edema, cardiomegaly, tachycardia, fever, pericardial rub, pulsus paradoxus, JVD
DX: pericardial biopsy is more definitive than pericardial fluid

Question 17

T/F all pts with TB should have testing for HIV

Answer 17

T