TB and Pleural Infection

Question 1

When performing a bronchoscopy what seen, would indicate TB?

Answer 1

Tubercles and pus. Slide 4

Question 2

Why is TB often seen at the top of the lungs?

Answer 2

A it is inhaled and infection through the spread of airborne mycobacterium tuberculosis. Slide 6

Question 3

How long does it take to treat TB on average?

Answer 3

6 months. Slide 8

Question 4

What are the general and respiratory clinical features of TB?

Answer 4

Weight loss, malaise and night sweats.

Cough, haemoptysis, breathlessness. Upper zone crackles. Slide 11

Question 5

What other areas can you get TB in?

Answer 5

Meningeal - headache
Gastrointestinal - pain
Spinal - pain, paraplegia
Lymphadenophathy
Cold Abscess - no pain. Slide 12

Question 6

What clinical conditions could have TB as an underlying disease?

Answer 6

Pericardial Tamponade
Renal Failure
Septic Arthritis
Hypoadrenalism. Slide 13

Question 7

What tests can you perform to diagnose TB?

Answer 7

ZN staining sticks to mycobacteria, PCR which can also identify if it is rifampicin resistant. Slide 14-16

Question 8

From histological samples what can be seen if TB was present?

Answer 8

Multinucleated giant cell granulomas
Caseating necrosis
Sometimes there is visible mycobacteria. Slide 17

Question 9

Looking at a chest X-ray, if TB was present what would be seen?

Answer 9

Tissue destruction and cavity formation predominantly in the upper lobe. Slide 18

Question 10

What is miliary TB?

Answer 10

When mycobacteria spreads through the bloodstream and can be seen on a CXR of the full chest covered. If untreated it would be fatal. Slide 22

Question 11

What is the combination therapy of TB split into 2 months and 4 months of treatment?

Answer 11

2 months: Rifampicin, Isoniazid, Pyrazinamide and Ethambutol.
4 months: Rifampicin and Isoniazid. Slide 24

Question 12

What are side effects of rifampicin?

Answer 12

Male urine pink/orange.

Rapid breakdown of hormonal contraceptions. Slide 25

Question 13

What is a side effect of Ethambutol?

Answer 13

Optic neuritis. Slide 25

Question 14

If there wasn’t a rapid fall in two weeks of actively replicating bacteria what could be a cause?

Answer 14

They’re not taking their medication

It is resistant to the medication. Slide 26

Question 15

What are the 3 types of drug resistance and to what drugs?

Answer 15

Single - Isoniazid
MDR - Rifampicin and Isoniazid
XDR - MDR and quinolone. Slide 29

Question 16

What clinical condition effects the treatment of TB?

Answer 16

HIV. Slide 30

Question 17

What is Latent TB?

Answer 17

Symptom free and is dormant.
Balance between organism and immune system.
There is no evidence of active TB but evidence of previous TB infection. Slide 32-34

Question 18

What tests can be performed to test for previous exposure?

Answer 18

IGRA (Interferon Gamma Release Assay) - Detects previous exposure to TB
Mantoux test -Detects previous exposure to TB AND BCG. Slide 35

Question 19

If there is a possibility of latent TB in a rheumatoid Arthritis patient and they’re about to be treated with Anti-TNF what should happen?

Answer 19

The latent TB should be treated first cause the anti-TNF will cause the immune system to suppressed and so then the latent TB could reactivate and cause harm to the patient. Slide 40+41

Question 20

If a patient has had TB what evidence can be seen?

Answer 20

Scarring

Calcification on x-ray. Slide 34