Chest infections 2

Question 1

What is the pathological sequence for TB?

Answer 1

4-8 weeks
Febrile illness
Erythema nodosum
Phlyctenular conjunctivitis (allergic)
6-9 months:
Progressive healign of primary complex
Effusion (focus may rupture into pleural space)
Cavitation (focus may rupture into bronchus)
Coin lesion on CXR- focus may enlarge
Regional lymph nodes may obstruct bronchi or erode into bronchus/pericardial sac
Miliary spread

Question 2

What are the signs in asymptomatic TB?

Answer 2

50% of infants, 90% older children
Disease remains latents
Mantoux test may be positive, sufficient to initiate treatment

Question 3

What are the signs in symptomatic TB?

Answer 3

Fever
Anorexia and weight loss
Cough
CXR changes
Primary complex heals and calcifies- local enlargement of peribronchial lymph nodes causign bronchial obstruction with lung consolidation and collapse

Question 4

How does post primary TB present?

Answer 4

Local disease or widely disseminated miliary TB to bones, joints, kidneys, pericardium and CNS- in infants and children seeding in CNS may cause tuberculous meningitis, which is associated with significant morbidity and mortality if treatment is not initiated early

Question 5

What is given after puberty when treating TB?

Answer 5

Pyridoxine to prevent peripheral neuropathy associated with isoniazid (does not occur in younger children)

Question 6

How is TB meningitis treated?

Answer 6

Dexamethasone is given for 1st month to decrease the risk of long-term sequelae

Question 7

How is TB treated in asymptomatic children?

Answer 7

Rifampicin and Isoniazid for 3 months, decreased risk of reactivation in later life

Question 8

What are the features of hypernatraemic dehydration?

Answer 8

jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma