ICP 2018: TB, IE, Cholecystitis

Question 1

What is the most common cause of TB?

Answer 1

Mycobacterium Tuberculosis

Question 2

What are the presenting symptoms of patients with TB?

Answer 2

Chronic Persistent Cough
Malaise
Haemoptysis
Weight loss
Fever
Night sweats

Question 3

What are the 3 types of conditions that those infected with Mycobacterium Tuberculosis can present with?

Answer 3

Active Pulmonary TB
Active Extra-pulmonary TB
Latent TB

Question 4

What tests are used for active TB and for latent TB?

Answer 4

For Active TB, nuclear amplification tests is done for detection.
For Latent TB, the Mantoux tuberculin test is done.

Question 5

What vaccination can be given to prevent TB?

Answer 5

BCG vaccine

Question 6

What are the common causes of Infective Endocarditis?

Answer 6

Staphylococci and Streptococci

Question 7

Which Streptococci is the most common cause of IE?

Answer 7

Streptococcus Viridans

Question 8

What is the criteria involved in the diagnosis of Infective Endocarditis?

Answer 8

Duke Criteria.

Major criteria: Positive Blood Culture and Endocardium involvement
Minor Criteria: Fever, Predisposition (cardiac lesion, or IV drug abuse), Vascular or immunological sign

Question 9

Which organ can have a complication from Infective Endocarditis?
What test is done to check for this?

Answer 9

Kidneys can be affected.

Urine dipstick is done to check for microscopic haematuria

Question 10

Who are the patients at high risk of developing infective endocarditis?

Answer 10

Patients with
- hypertrophic cardiomyopathy,
- acquired vulvular heart disease with stenosis or regurgitation,
- structural congenital heart disease, including surgically corrected or palliated structural conditions (except for isolated atrial septal defects, fully repaired ventricular septal defects, or fully repaired patent ductus arteriosus)
- previous infective endocarditis,
and patients with valve replacement

Question 11

What is Cholecystitis?

Answer 11

Cholecystitis is an inflammation of the gall bladder

Question 12

What is the most common cause of Cholecystitis?

Answer 12

Gallstones, causing a blockage of the cystic duct.

Question 13

What significant history is gathered from those with Cholecystitis?

Answer 13

A history of Cholelithiasis (gallstones)

Question 14

Which sign can be elicited in Cholecystitis during examination?

Answer 14

Murphy’s sign: Inspiration is inhibited due to pain when the examiner presses onto the right costal margin.

Question 15

Where can pain be experienced in Cholecystitis?

Answer 15

Epigastric, or Right Upper Quadrant pain which can be referred to the shoulder or inter-scapular region.

Question 16

What complications can arise from cholecystitis?

Answer 16

• Gangrenous Cholecystitis (necrosis of the gallbladder wall)
• Perforation of the gallbladder
• Biliary peritonitis
• Peri-cholecystic abscess
• Fistula, between the gallbladder and the duodenum

Question 17

What can a palpable mass on the RUQ indicate?

Answer 17

Distended gallbladder or an inflammatory mass around the inflamed gallbladder

Question 18

What can presence of fever indicate in terms of complications of Cholecystitis?

Answer 18

Persistent fever and pain may suggest complications such as abscess or perforation

Question 19

What can jaundice in Cholecystitis indicate?

Answer 19

Jaundice may be due to biliary tract inflammation and oedema, pressure from a distended gallbladder, a stone in the common bile duct or impacted in the gallbladder neck (Mirizzi syndrome).

Question 20

Who are the target groups for selective immunisation with BCG?

Answer 20

Individuals in areas of the country with TB incidence >/- 40/100,000.
Or individuals with close contacts to someone with TB, or born in a high incidence country (parent, or grandparents)