Station 1 - old TB

Question 1

What signs in the chest are you looking for in old TB?

Answer 1

• Chest deformity, absent ribs, thoracoplasty scar
• Tracheal deviation towards side of fibrosis (traction)
• Reduced expansion
• Dull percussion but present tactile vocal fremitus
• Crackles and bronchial breathing

Question 2

what historical techniques were used to treat TB?

Answer 2

• Plombage: polystyrene balls to thoracic cavity
• Phrenic nerve crush to paralyse diaphragm
• Thoracoplasty: removal of rib only
• Apical lobectomy
• Recurrent medical pneumothoraces
• Streptomycin, 1st beneficial drug in randomised controlled trial in 1950s.

Question 3

TB drugs, which drug?:

-peripheral neuropathy and hepatitis

Answer 3

isoniazid

can treat neuropathy with pyridoxine

Question 4

TB drugs, which drug?

-hepatitis and increased contraceptive pill metabolism

Answer 4

Rifampicin

Also orange secretion

Question 5

TB drugs, which drug?

-retrobulbar neuritis and hepatitis

Answer 5

Ethambutol

Question 6

TB drugs - what does pyrazinamide cause?

Answer 6

hepatitis

Question 7

What is important to do prior to TB treatment?

Answer 7

check baseline liver function tests and visual acuity

Question 8

How to counsel patients before TB treatment?

Answer 8

1: check for jaundice by looking at whites of eyes every morning to check if yellow
2: If red becomes less bright please ring TB nurse
3: You may develop some tingling in the toes, continue taking the tablets but let Dr know at next clinic visit
4: Secretions will turn orange/red due to a dye in one of the tablets, this will stain contact lenses so please don’t use and wear glasses
5: OCP will fail so use barrier contraceptives