Old Tuberculosis

Question 1

Signs of old TB

Answer 1

Chest deformity, absent rib, thoracotomy scar
Tracheal deviation towards side of lesion
Reduced expansion
Dull to percussion but retained vocal fremitus
Crackles/bronchial breathing

Question 2

Historical tx techniques

Answer 2

Plombage (polystyrene balls in thoracic cavity)
Phrenic nerve crush
Thoracoplasty
Apical lobectomy

Question 3

Side effects of isoniazid

Answer 3

Peripheral neuropathy (Rx pyridoxine)
Hepatitis

Question 4

Side effects of rifampicin

Answer 4

Increased metabolism of OCP

Hepatitis

Question 5

Side effects of ethambutol

Answer 5

Retrobulbar neuritis

Hepatitis

Question 6

Side effects of pyrazinamide

Answer 6

Hepatitis

Question 7

Precautions taken around initiating TB treatment

Answer 7

Baseline LFTs and visual acuity
Warn patients:
1. Look in mirror at eyes every morning - if yellow, stop tablets and call in
2. Pay attention to colours - if red less bright, call in
3. Tingling in toes - keep taking tablets but tell doctor
4. Your secretions/urine will become orange. Do not wear contact lenses.
5. OCP may fail, use barrier contraception.

Question 8

Causes of apical fibrosis

Answer 8

TRASHE
TB
Radiation
Ank spond & ABPA
Sarcoidosis
Histoplasmosis/histiocytosis
Extrinsic allergic alveolitis