Tuberculosis Flashcards
What are the non respiratory symptoms of TB?
Erythema Nodosum Lymphadenopathy Meningitis Pericardial effusion Bine/joint issues Abdominal pain
What are the classic symptoms of TB?
Malaise Fever Nocturnal sweats Weight loss Cough +/- haemoptysis or purulent sputum (Cloudy due to WBC/Dead tissue)
What are the differentials of Haemoptysis?
Infective - TB, Pneumonia, Bronchiectasis/CF, Cavitating lung lesion (Usually Fungal)
Malignancy - Lung Ca or Mets
Haemorrhage - Bronchial artery erosion, Vasculitis, Coagulopathy
Other - PE
What is the management for a patient with suspected TB?
A-E
3x Sputum samples for AcidFast Bacilli
Admit patient to a side room and begin infection procedures
Bloods - FBC, U&Es, LFTs, HIV, Vit D, CRP
CXR - CT if not typical presentation
Inform TB nurse specialist - inform public health
Start TB treatment
How should you treat a patient where it is unclear whether they have Pneumonia or TB?
Give them the treatment for Pneumonia as per the CURB-65 score
How would the management of a patient differ if Miliary TB is suspected?
MRI brain/spine followed by lumbar puncture
Why is a patient’s weight important when being treated for TB?
The dose of drug depends on their weight
What is given with Isoniazid?
Pyridoxine (B6) as this is depleted by Isoniazid and may cause peripheral neuropathy
What is the treatment of TB?
R - Rifampicin
I - Isoniazid
P - Pyrazinamide
E - Ethambutol
What are the side effects of Rifampicin?
Orange/Red secretions
Hepatitis
Rash
Interacts with many drugs including Warfarin and OCP
What are the side effects of Isoniazid?
Peripheral Neuropathy (Depletes B6)
Psychosis
Hepatitis
Rash
What are the side effects of Pyrazinamide?
Arthralgia
Hepatitis
Rash
What are the side effects of Ethambutol?
Retrobulbar/Optic neuritis leading to visual acuity (So should never give to a patient who is unconscious as won’t be able to tell if loosing their sight)
What baseline tests should be performed before starting treatment for TB?
Visual acuity (Ability to distinguish shapes and objects) LFTs (Need to be monitored closely)
How long do you treat a patient with Anti TB therapy?
Rifampicin & Isoniazid (Full 6 months)
Pyrazinamide & Ethambutol (First 2 months)
