Tuberculosis

Question 1

State effects of systemic miliary TB on different organs x5

Answer 1

Kidneys - sterile pyuria and raised WBC in urine
Brain - meningitis
Adrenal glands - Addisons disease
Lumbar vertebrae - Potts disease
Liver - hepatitis

Question 2

Clinical features of TB x5+

Answer 2

Most common- Cough, dyspnea
Systemic- fever, night sweats, anorexia, decreased activity

Question 3

Approach to TB diagnosis x6

Answer 3

Careful history and examination
Tuberculin skin test and CXR
Bacteriological confirmation and HIV testing

Question 4

Risk factors for TB in children x4

Answer 4

Contacts with a case of pulmonary TB
Age less than 5 years
HIV infection
Severe malnutrition - can cause reactivation

Question 5

Physical signs highly suggestive of extra pulmonary TB x2

Answer 5

1. Gibbus- collapse in vertebrae resulting in kyphosis
2. Non painful enlarged cervical lymphadenopathy

Question 6

When is a TST used in children x2

Answer 6

1. In a suspected child with negative contacts
2. In an exposed child

Question 7

When should a TST be regarded positive x2

Answer 7

In immunosuppressed >5mm transverse diameter of induration
In other children > 10mm transverse diameter induration

Question 8

3 advantages of cultures in MTB

Answer 8

1.TB in young children is paucibacillary ie few so culture amplifies it
2.It differentiates between M.tuberculosis and non tuberculous mycobacteria
3. It allows drug susceptibility testing

Question 9

Indications of bacteriological confirmation x3

Answer 9

1. Suspected drug resistant TB
2. Complicated or severe TB
3. HIV infection

Question 10

Advantages of Xpert MTB/RIF test x3

Answer 10

Takes less time- 2 hours
It is non hazardous
Detects M.tuberculosis +/- genetic mutations for rifampicin resistance

Question 11

Children living with HIV have an increased risk of what in relation to tb x4

Answer 11

TB exposure and infection
Progression of tb disease
TB related morbidity and mortality

Question 12

Challenges in diagnosis of tb in hiv positive children x4

Answer 12

1. TST is less sensitive
2. Co infection can mask response to therapy
3. High Incidence of lung diseases other than tb
4. Overlap of radiographic findings in tb and hiv related lung diseases

Question 13

Who gets isoniazid preventive therapy x2

Answer 13

HIV positive contacts of any age
HIV negative children < 5 years

Question 14

Objectives of anti tb treatment x5

Answer 14

Cure tb
Prevent death from tb or its late effects
Prevent relapse of tb
Reduce transmission to others
Prevent development and transmission of drug resistant tb

Question 15

Dosage of isoniazid

Answer 15

10-15 mg/kg max 300mg/day

Question 16

Dosage of rifampicin

Answer 16

15mg/kg max 600mg/day

Question 17

Dosage of pyrazinamide

Answer 17

35mg/kg range 30-40

Question 18

Dosage of ethambutol

Answer 18

20mg/kg range 15-25

Question 19

Indications of corticosteroid in tb treatment x3

Answer 19

1.Pericardial tb to reduce risk of developing constrictive pericarditis
2.TB meningitis
3.Complications of airway obstruction by tb lymph glands

Question 20

Function and Indications of pyridoxine(B6) x3 + dose

Answer 20

It protects against isoniazid induced peripheral neuropathy
All children
HIV positive
Malnourished children
25mg/day

Question 21

Prevention of tb x5

Answer 21

Neonatal BCG vaccination
Prevention of mother to child transmission of hiv
TB screening in all hiv children
Screening all children with infectious tb cases
HIV Testing for all children with tb and their families

Question 22

Effect of BCG in hiv positive infants x2

Answer 22

Fatal disseminated BCG disease
BCG induced IRIS (immune reconstitution inflammatory syndrome)