Tuberculosis

Question 1

What would you see on X-ray of someone with TB?

Answer 1

Patchy shadowing of the upper zones
Loss of volume
Cavitations
Fibrosis

Question 2

Give the drug regimen used for TB

Answer 2

Rifampin, isoniazid, pyrazinamide and ethambutol
All four for two months
Then just rifampicin and isoniazid for the next four months

Question 3

Side effects of rifampicin

Answer 3

Stains urine and body secretions pink
Induces liver enzymes
Increased liver enzymes and hepatitis
Thrombocytopenia

Question 4

Side effects of isoniazid

Answer 4

Polyneuropathy
Allergic reactions e.g. Skin rash and fever
Hepatitis
Psychosis

Question 5

Side effects of pyrazinamide

Answer 5

Hepatitis
Hyperuricaemia and gout
Rash
Arthralgia

Question 6

Side effects of ethambutol

Answer 6

Optic neuritis 
Should test: 
- visual acuity
- red/green colour blindness 
Before treatment begins to obtain a baseline

Question 7

What can be given in addition to pyrazinamide to prevent peripheral neuropathy?

Answer 7

Pyridoxine

10mg daily

Question 8

Give some risk factors for developing TB?

Answer 8

Past history
Contact with someone infected with TB
Recent travel to high risk area 
Born in high risk country 
Immunocompromised patient 
E.g. IVDU, HIV, solid organ transact recipient, DM, malnutrition, alcoholism

Question 9

Management of a TB patient

Answer 9

ABCDE approach
Get cultures - sputum x3 and early in the morning if possible
Bloods - FBC, U+Es, LFTs, HIV test, vitamin D levels
MRI is military TB is suspected

Question 10

What are the clinical features of TB?

Answer 10

Night sweats
Fever 
Recent travel 
Haemoptysis and purulent sputum
Weight loss
Malaise
Anorexia