Extrapulmonary TB

Question 1

ecg and 2decho findings in pericardial tb

Answer 1

ecg: st elevation, no reciprocaal st depression

2d echo: black space between myocardium and pericardium (cardiac tamponade)

Question 2

most common cause of pericardial disease in hiv infected patients

Answer 2

tb pericarditis

Question 3

clinical features of pericardial tb

Answer 3

dyspnea, ankle edema, paradoxical pulse, distant heart sounds, pleural effusion

Question 4

definitive diagnosis for pericardial tb

Answer 4

isolating organism from fluid

Question 5

management of pericardial tb

Answer 5

• tamponade: emergency pericardiocentesis
• surgical: pericardial window
• multidrug antimycobacterial treatment

Question 6

clinical manifestations of tb meningitis

Answer 6

• weeks of low grade fever, malaise, anorexia, irritability
• tolerable headache and slight mental changes
• evolves over 1-2 weeks

Question 7

diagnosis of tb meningitis

Answer 7

• neuroimaging
• csf studies
• afb smear, afb culture, gene xpert

Question 8

typical findings in tb meningitis

Answer 8

• elevated opening pressure (>20 mmh2o)
• pleocytosis with lymphocytic predominance
• decreased glucose, elevated protein

Question 9

t/f ct scan for suspect meningitis doesnt need contrast

Answer 9

false

Question 10

complications of tb meningitis

Answer 10

• obstructive hydrocephalus
• stroke in small arteries in deep territories = motor deficit
• hyponatremia (cerebral salt wasting, siadh)
• tuberculomas = edema or pressure = deficits
• cn palsies*

hydrocephalus = vasculitis + damage in cortical areas = seizures

Question 11

management of tb meningitis

Answer 11

• hrze
• dexamethasone
• mannitol for hydrocephalus
• shunt for hydrocephalus (temp: ventriculostomy, perm: ventricular peritoneal shut)
• seizures dont require prophylaxis, treat as they come

Question 12

prognostic factors for tb meningitis

Answer 12

• advanced age
• late diagnosis
• hydrocephalus (independent risk factor)
• tb at other sites

Question 13

indications for surgery in pott’s disease

Answer 13

• progressive neurologic deficit (back pain only = conservative treatment)
• progressive increase in spinal deformity (coronal or sagittal)
• failed conservative treatment
• uncertain diagnosis

Question 14

t/f baseline labs should be done before surgery in pott’s disease

Answer 14

true

Question 15

other types of eptb

Answer 15

• ileocecal tb
• gu tb: dilated calyces and dystrophic calcification, beaded appearance of right ureter
• thimble bladder: irregular margin, contracted
• cervical lymph nodes: enlarged heterogenous hypoechoic structures

Question 16

cpg diagnosis of eptb

Answer 16

Xpert MTB/Rif
appropriate specimens for sites
microscopy and culture

Question 17

management of eptb

Answer 17

longer duration: cns, bone, joints (2HRZE/10HR)

others: 2HRZE/4HR

Question 18

retreatment of rif susceptible ptb and eptb

Answer 18

2hrzes/1hrze/5hre

Question 19

retreatment of rif susceptible cns, bones, joints

Answer 19

2hrzes/1hrze/9hre

Question 20

corticosteroid use

Answer 20

tb meningitis: dexamethasone 0.4 mg/kg/d

tb pericarditis: prednisolone