Tuberculosis

Question 1

What are the symptoms of TB (5)

Answer 1

Long term productive cough
Weight Loss
Chest and shoulder pain intermittently
Fever
Sweats

Question 2

Investigations

Answer 2

Sputum samples that test positive for AAFB
Bronchoscopy with BAL
Endobronchial ultrasound
Lumbar puncture (CNS)
Urine (urogenital)
As[irate/biopsy

Question 3

What drug can some strains be resistant to and how is this found out

Answer 3

Isoniazid can be treated with Fluoroquinolone

Reference Lab

Question 4

Treatment

Answer 4

Direct Observed Therapy for a minimum of 6 months
Isoniazid
Pyrazinamide
Rifampicin
Ethambutol

Question 5

What organism is responsible for causing TB

Answer 5

Mycobacteria:
M. Tuberculosis
M.africanum
M. bovis (bovine TB)

Question 6

What type of organism is M. tuberculosis

Answer 6

Non motile bacillus, very slowly growing

Aerobic

Question 7

What are TB organisms resistant to

Answer 7

Acids, alkalis and detergents

Neutrophil and macrophage destruction

Question 8

Transmission

Answer 8

Airborne

Question 9

Immunopathology

Answer 9

Activated macrophages become epitheloid cells and develop into Langhan’s Giant cells

Question 10

What does the accumulation of macrophages, epitheloid and Langhan’s giant cells form

Answer 10

Granuloma

Question 11

What response tries to eliminate/reduce invading mycobacteria and what is the complication

Answer 11

Th1 and tissue destruction

Question 12

Primary Infection

Answer 12

Spread via lymphatics (Hilar LN)
Erythema Nodosum
Calcification (Ghon focus + complex)

Question 13

Complications

Answer 13

Bronchopneumonia
Miliary TB
CNS TB

Question 14

Features of Bronchopneumonia

Answer 14

Focus continues to enlarge (Cavitation)
Enlarged hilar LN compress bronchi, lobar collapse
Enlarged LN discharges into bronchus

Question 15

Features of miliary TB

Answer 15

Looks like millet seeds in autopsy
Develops with hematogenous spread of bacteria
Fine mottling on X-Ray, widespread small granulomata

Question 16

3 outcomes of TB

Answer 16

Progressive TB
Contained latent
Cleared

Question 17

Post-Primary TB (reactivated)

Answer 17

Mediastinal lymphadenopathy
Pleural effusion
Miliary
Pneumonic lesion with enlarged hilar nodes

Question 18

Why are multiple drug therapy necessary

Answer 18

Bacterial may develop resistance to antimicrobial agents used

Question 19

What tests should be done when considering treatment

Answer 19

Hep B and C

HIV

Question 20

What should be given with Isoniazid and why

Answer 20

Pyridoxine (Vitamin B6) to reduce the risk of neuropathy

Question 21

For CNS, miliary, pericardial what can be used to additionally treat

Answer 21

Steroids

Question 22

Who should be screened for TB

Answer 22

New entrants from high epidemic areas
Patients on immunosuppressants
Outbreaks
Asymptomatic with positive mantoux skin test or Interferon Gamma Release Assay