TB

Question 1

Extrapulmonary TB

Answer 1

1. Lymph node TB
   
   • commonest after lung
   • usually extrathoracic
   • firm, non-tender cervical/supraclavicular node enlargement
   • central necrosis (Central Caseating lesion) → fluctuant
     ± sinus tract w purulent discharge
   • cold abscess (X erythema)
   • Caseation and calcification of cervical lymphadenopathy may be highly suggestive but is not pathognomonic of TB.
2. CNS TB
   
   • TB meningitis — Hydrocephalus is a common finding, may be associated with Cranial nerve Palsy
3. Abdominal TB
   
   • Features suggestive of abdominal TB are ascites (79%), enlarged LN (35%) omental thickening (29%) and bowel wall thickening (25%).
4. Genitourinarry TB
   
   • IVU can demonstrate the ‘moth-eaten’ calyx which may be the earliest evidence of renal TB.
5. TB of bone & spine
   
   • Pott’s Disease
6. Miliary TB
   
   • dt haematogenous spread to other sites
   • systemic disturbance
   • look for other organ involvement esp CNS
7. Pericardial TB
8. Skin

Question 2

CXR TB

Answer 2

• consolidation ± CAVITATION/ Calcification of Upper lobes (more common in adolescents)
• pleural effusion
• widened mediastinum (hilar, paratracheal lymphadenopathy)

Question 3

CXR TB

Answer 3

• consolidation ± CAVITATION/ Calcification of Upper lobes (more common in adolescents)
• pleural effusion
• widened mediastinum (hilar, paratracheal lymphadenopathy)

Question 4

SE rifampicin

Question 5

SE isoniazid

Answer 5

rash
fever
polyneuropathy (vitamin 6 deficiency)
hepatotoxicity

Question 6

SE pyrazinamide

Question 7

SE ethambutol

Answer 7

optic neuritis

Question 8

SE streptomycin

Answer 8

ototoxicity

allergic rxn

Question 9

Which anti-TB is hepatotoxic?

Answer 9

RIP

Question 10

Which anti-TB most commonly cause rash?

Answer 10

All tb drugs cause rash

Isoniazid + Pyrazinamide

Question 11

Which anti-TB is assoc with thrombocytopenia?

Question 12

TST result

Question 13

What is MDR-TB?

Answer 13

resistance to both rifampicin and isoniazid

Question 14

What is extensively drug-resistant (XDR-TB)?

Answer 14

high level resistance to rifampicin, isoniazid, fluoroquinolones and at least 1 injectable agent such as amikacin, capreomycin or kanamycin

Question 15

factors ass w increased risk of drug resistant TB

Question 16

type of BCG vaccination

Question 17

TST result

Question 18

causes of reactivation of TB

Answer 18

1. HIV co-infection
2. Immunosuppressant
3. DM
4. ESKD (dt relative immune paresis)
5. Malnutrition
6. Aging

Question 19

what is Immune Reconstitution Inflammatory Syndrome (IRIS)?

Answer 19

RIS is an augmented inflammatory response that occurs in patients commenced on HAART and antiTB.
It may cause clinical deterioration but does not primarily contribute to mortality.

Question 20

TB investigation active

Question 21

TB investigation latent

Question 22

mx tb

Question 23

how to ix for HIV

Answer 23

ELISA -> +ve -> western blot

viral load CD4 count

Question 24

What is relapse TB and how to manage?

Question 25

Define active TB and latent TB

Answer 25

Latent TB is defined as infection with Mycobacterium tuberculosis complex, where the bacteria may be alive but in the state of dormancy and not currently causing any active disease/symptoms

Question 26

Mantoux test reading

Question 27

how does miliary tb spread? findings on cxr

Answer 27

numerous miliary tb nodules on cxr

Question 28

examples of aids defining illness

Answer 28

TB, cmv retinitis, cerebral toxoplasmosis, crytptococcal meningitis, pneumocystis pneumonia, karposi sarcoma

Question 28

examples of aids defining illness

Answer 28

TB, cmv retinitis, cerebral toxoplasmosis, crytptococcal meningitis, pneumocystis pneumonia, karposi sarcoma