Chronic Lung Disease

Question 1

What is the incubation period of TB

Answer 1

3-12 w

Question 2

How to Diagnose TB?

Answer 2

Laboratory nonspecific:
• CBC > lymphocytosis, ESR > 100
• Tuberculin skin test (TST); Mantoux test:
• 0.1 ml PPD in forearm - read after 48 - 72 h
• measure INDURATION: cut-off 5 mm / 10 mm (country)
• Can be +ve after BCG vaccination
• Interferon-gamma release assays (IGRAs) : QuantiFERON TB
• Blood test for MTB only (not BCG)
• TB infection (cannot differentiate active disease)

Question 3

Treatment of TB

Answer 3

• Combination therapy (3-4 drugs) X 2 months
• Rifampicin, isoniazid, pyrazinamide, ethambutol
• Continue INH/RIF
• Duration 6 m or longer
• Drug sensitivity for MDR-TB
• Pyridoxine added to prevent peripheral neuropathy in adolescents
• Corticosteroids added to prevent fibrosis e.g., meningitis & miliary TB
• Latent TB ttt: 3m INH/RIF or 6m INH

Question 4

What is the prophylaxis of TB?

Answer 4

• BCG vaccination :
• Incomplete prophylaxis (attenuated bovine strain)
• Egyptian NIP : first month of life
• 0.1 ml intradermal in left deltoid region > reaction after 3-6 weeks :
• erythema, papule & occasional ulceration/ subsides within 2-6 m + small scar
• A booster dose is administered at 6 years.
• Chemoprophylaxis for close contact : Isoniazid

Question 5

What is the prophylaxis for close contacts of TB?

Answer 5

Isoniazid

Question 6

What is the most common non tuberculous mycobacteria?

Answer 6

Mycobacterium avium complex(MAC)

Question 7

What is the mode of inheritance of Cystic Fibrosis?

Answer 7

Autosomal recessive

Question 8

Interpretation of a positive tuberculin skin test

Answer 8

Previous BCG vaccination

TB infection

Question 9

How to Diagnose Cystic Fibrosis?

Answer 9

Sweat chloride test : chloride>60 mmol/L
Gene testing: CFTR F508
Fecal elastase: +++ in Pancreatic insufficiency
Newborn screening

Question 10

What is kartagener syndrome?

Answer 10

Situs inversus & dextrocardia

Question 11

What is the newborn screening teat of Cystic Fibrosis?

Answer 11

Immunoreactive trypsin

Question 12

Treatment of GORD?

Answer 12

Posture/positioning
• Diet (thickening, early solids)
• Medications:
• Ranitidine/PPI
• Gaviscon? Domperidone?

Question 13

What does auscultation of velcro crackles denote on chest examination?

Answer 13

Interstitial lung disease

Question 14

What is the most common cause of obstructive sleep apnea?

Answer 14

Adenotonsillar hypertrophy