TB

Question 1

Signs & symptoms of TB:

Answer 1

• fever
• cough
  (Like pneumonia) +
• hemoptysis
• night sweat
• wt loss

Question 2

For the diagnosis of Active TB: […]

Answer 2

AFB smear (sputum culture)
“Acid Fast Bacilli”

Question 3

For the diagnosis of Latent TB: […]

Answer 3

PPD test
IFN-gamma assay (IGRA)

Question 4

[…] staining is the method to detect TB in sputum

Answer 4

Ziehl-neelsen

Question 5

The transmission of TB is […] patients need to be isolated in -ve pressure room

Answer 5

Airborne
(Not droplet!!)

Question 6

CXR finding of TB:

Answer 6

Apical cavitation

Question 7

TB associated pleural effusion will have elevated […] level & positive […]

Answer 7

🔺ADA “adenosin deaminase”
➕ AFB culture

Question 8

Which pneumoconiosis associated with TB or predispose to TB?

Answer 8

Silicosis

Question 9

In active TB (symptomatic, CXR +ve)
1. Isolation (-ve pressure)
2. Sputum culture AFB
3. Treatment

Answer 9

😉
AntiTB not given empirically due to high risk of resistance

Question 10

+ve PPD in general population […] mm

Answer 10

15

Question 11

10 mm PPD is strongly positive if :

Answer 11

• Child <4 yrs
• recent travel high prevalence country 5yr
• IV drug user
• mycobacteriology lab / employee
  🧒🏻🎒💉

Question 12

5 mm PPD is strongly positive if :

Answer 12

• HIV
• Organ transplant
• Recent contact with active TB
• CXR: Nodular or fibrotic changes

Question 13

⭐️ In case PPD is positive
Your next step:

Answer 13

Chest XR

🔸 +ve PPD & +ve CXR = active TB
🔸 +ve PPD & -ve CXR = latent TB

Question 14

Treatment of Active TB

Answer 14

• Isoniazid (6m) + vit6 “pyridoxine”
• Rifampicin (6m)
• Ethambutol (2m)
• Pyrazinamide (2m)

Question 15

Treatment of latent TB:

Answer 15

INH (6m)
or Rifampicin (4m)
or INH + Rifampicin (3m)

Question 16

Before starting anti-TB medications you should order […]

Answer 16

LFTs
All anti-TB meds are hepatotoxic

Question 17

Most hepatotoxic anti-TB […]

Answer 17

Pyrazinamide

Question 18

Side effects of Isoniazid:

Answer 18

• Iron “sideroblastic anemia”
• Neuritis peripheral (add B6)
• Hepatotoxic

Question 19

Side effect of Rifampicin

Answer 19

Red orange metabolites

Question 20

Side effects of Ethambutol:

Answer 20

Eye
Optic neuritis, dec visual acuity

Question 21

Side effects of Pyrazinamide:

Answer 21

Hyperurecemia

Question 22

You should add […] to INH for anti-TB treatment

Answer 22

VitB6 (Pyridoxine)

Question 23

Rifampicin […] CYP-450 and therefore affect effective medication levels

Answer 23

Rump-up (🔺)
You should inc medication doses

Question 24

If LFT increase to […] you should Stop all anti-TB medications

Answer 24

> 5 folds
Or > 3 folds + Sx ( jaundice, abd pain)

Question 25

You need to stop Rifampicin if:

Answer 25

Cholestatic jaundice
(High CB, ALP & GGT)

Question 26

You need to stop Ethambutol if:

Answer 26

Optic neuritis

Question 27

Patient with history of TB
Present with 🔺JVP, hepatosplenomegaly
Most likely diagnosis : […]

Answer 27

Constrictive pericarditis

Question 28

Who can breastfeed her child?
A. HIV mother, direct Breastfeed
B. HIV mother, Expressed milk
C. TB mother, direct Breastfeed
D. TB mother, Expressed milk

Answer 28

D. TB mother, Expressed milk