GP ILA 6: TB

Question 1

Risk factors for TB

Answer 1

o Endemic countries (South Asia, Sub-Saharan)
o Neonates and young children
o Drug users
o Ethanol use
o Malnutrition and poverty
o Immunosuppressed (HIV/AIDS, cancer, diabetes)
o Close contacts

Question 2

TB - investigations

a) Pulmonary TB
b) Non-pulmonary TB
c) Screen for what other infections?
d) Other investigations/screening

Answer 2

a) Pulmonary - CXR, THREE sputum samples for Ziehl-Nielsen stain for acid-fast bacilli
b) Non-pulmonary - samples: lymph node biopsies, aspirated pus, urine or other samples
c) Check HIV, hepatitis B and hepatitis C status
d) Mantoux test (or IGRA if positive on Mantoux, or if patient has had bCG) for close contacts

Question 3

Pneumonia risk assessment:

a) Community
b) In hospital

Answer 3

a) CRB-65

b) CURB-65: 1 (community), 2 (inpatient), 3+ (HDU/ICU)

Question 4

Pneumonia management

a) Supportive
b) Low severity
c) Mod-severe
d) Severe legionella treatment

Answer 4

a) Oxygen, fluids, nebulised saline, analgesia
b) Amoxicillin (or macrolide or doxycycline)
c) Amoxicillin AND macrolide (or more severe: co-amoxiclav and a macrolide)
d) Rifampicin, macrolide

Question 5

TB - management

a) General
b) TB meningitis

Answer 5

a) 6 months - rifampicin, isoniazid; 2 months - pyrizinamide, ethambutol
b) 12 months R/I and a course of prednisolone

Question 6

Tetracyclines (e.g. doxycycline)

a) Indications
b) Advise patients when taking…?
c) In STI managment?

Answer 6

a) Pneumonia, malaria prophylaxis
b) Don’t have with dairy, use factor 50 (photosensitivity)
c) Chlamydia: doxycline (1/52) OR azithromycin (stat)
PID: ceftriaxone (stat) AND metronidazole (2/52) AND doxycycline (2/52)

Question 7

TB appearance on CXR

Answer 7

Typical TB appearances include:
Central apical portion with a left lower-lobe infiltrate or pleural effusion
Patchy or nodular shadows in the upper zones, loss of volume, fibrosis ± cavitation

Question 8

Rusty coloured sputum

Answer 8

Strep pneumonia (pneumococcal)

Question 9

Neonatal pneumonia

Answer 9

Group B strep

Gram neg - klebsiella, e. coli

Question 10

Pott’s disease

Answer 10

TB of the spine

Worry if point tenderness, endemic country, HIV or immunosuppressed

Question 11

Whooping cough

• How could you elicit?
• Rx?
• Also, must do what
• How long recovery?

Answer 11

Tongue depressor – impressive cough
Macrolide treatment (if within 3 weeks of onset)
Notify PHE (within 3 days)
Possibly a few months – 100 day cough

Question 12

Acute infective asthma exacerbation:

a) Assessment
b) Management

Answer 12

a) Assessment:
Vitals – RR, HR, BP, SpO2, Temp
Examine chest – any focal signs?
Assess peak flow
Assess need for admission based on the above

b) Management:
Bronchodilator – check technique with spacer use
Oral prednisolone
Antibiotics only if signs of infection
Review in 48 hours – review medication, need for ICS, etc., offer smoking cessation, asthma action plan, asthma review

Question 13

Suspected heart failure

a) Investigations
b) Management (if confirmed)

Answer 13

a) NT-proBNP blood test +/- echo
b) Beta-blocker, loop diuretic, +/- spiro
Lifestyle advice