TB and Pleural Infection

Question 1

What would white on a lung CXR indicate?

Answer 1

Mass, fluid, lung

Question 2

How could you tell the difference between TB and lobar pneumonia on a CXR?

Answer 2

lobar pneumonia doesn’t go to the top?

Question 3

Which lung problems go to top of lungs?

Answer 3

Airborne diseases eg. TB

Question 4

What are TB granuloma walls like?

Answer 4

Thickened

Question 5

When does TB cause pulmonary disease?

Answer 5

if the granuloma bursts

Question 6

how many people infected with TB have primary tuberculosis?

Answer 6

5%

Question 7

What are the clinical features of TB?

Answer 7

weight loss
malaise
night sweats
cough
heamoptysis
breathlessness
upper zone crackles

Question 8

what symptoms are linked to meningeal TB?

Answer 8

Headache. drowsy, fits

Question 9

what are symptoms of GI TB?

Answer 9

Pain
bowel obstruction
perforation
perironitis

Question 10

what are symptoms of spinal TB?

Answer 10

Pain
deformity
paraplegia

Question 11

what are signs of pericardial TB?

Answer 11

tamponade

Question 12

what are symptoms of renal TB?

Answer 12

renal failure

Question 13

What are some 20th century TB tests?

Answer 13

ZN stain, AAFB

auramine

Question 14

What test can show if a person has an inactive and active TB?

Answer 14

PCR

Question 15

Why is PCR useful for diagnosing TB?

Answer 15

Can tell if it’s resistant to drugs- rifampracin

Question 16

What is the histology of TB like?

Answer 16

Multinucleate giant cell granulomas
caseating necrosis
visible mycobacteria

Question 17

what are key characteristics of TB in radiology?

Answer 17

Upper lobe predominance
cavity formation
tissue destruction
scarring and shrinkage
heals with calcification

Question 18

what is miliary TB?

Answer 18

when myobacteria gets into the bloodstream?

also worry about renal cancer

Question 19

How do you treat TB?

Answer 19

Two months of: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol

Then four months of: Rifampicin, Isoniazid

Question 20

Who can a person TB affect?

Answer 20

Everyone around them!!

Question 21

what are side effects of rifampicin?

Answer 21

Colours urine

Has many interactions with other drugs- eg. some contraceptive pills

Question 22

What are side effects of Ethambutol?

Answer 22

Can cause optic neuritis

Question 23

What are side effects of Isoniazid?

Answer 23

B-6 neuropathy

Question 24

When would you expect to see a sudden fall in actively replicating bacilli?

Answer 24

2 weeks after treatment

Question 25

What are types of TB drug resistance?

Answer 25

Single agent- Isoniazid MDR- Rifmapicin & Isoniazid XDR- MDR and quinolone and injectable

Question 26

If a person had HIV and TB which would you likely treat first?

Answer 26

HIV

Question 27

What is latent TB?

Answer 27

symptom free culture negative Balance between your organism and your immune system (between a quarter and third of worlds population have this)

Question 28

What is IGRA test?

Answer 28

blood test, dectecys previous exposure to TB

Question 29

What is Mantoux test?

Answer 29

skin test, detecects previous exposure to TB and BCG

Question 30

Which test would be used for mass contact tracing?

Answer 30

IGRA

Question 31

how do you manage latent TB?

Answer 31

Treat or leave alone anti-TNF drugs: 6 months isoniazid or 3 months rifampicin and isoniazid

Question 32

What increases risk of latent TB reactivation?

Answer 32

rheumatoid arthritis TNFi steroids/ immunosuppressant drugs

Question 33

How to stop spread of TB?

Answer 33

``` Contact tracing screening of high risk groups isolation of infectious causes BCG immunisation social measures ```

Question 34

What test should all TB patients be offered?

Answer 34

HIV

Question 35

What should all patients with HIV be offered?

Answer 35

Chest X-ray

Question 36

What does 'smear positive' indicate?

Answer 36

active TB

Question 37

what is a d-shape on CXR associated with?

Answer 37

empyema

Question 38

who is at risk of pleural infection?

Answer 38

``` Diabetes immunosuppression gastro-oesophageal reflux alcohol missuse IV drug abuse ```

Question 39

what are different types of pleural infection?

Answer 39

Simple parapneumponic effusion complicated parapneumonic effusion empyema

Question 40

what Pleural infection is pussy?

Answer 40

Empyema

Question 41

How do you manage pleural infection?

Answer 41

``` Antibiotics Drain effusion as needed early discussion with surgeons if persistent sepsis nutrition (albumin levels) VTE prophylaxis ```

Question 42

which antibiotic is good for reaching the pleural space?

Answer 42

Vancamicin