TUBERCULOSIS

Question 1

WHAT IS TUBERCULOSIS?

Answer 1

Infectious disease caused by mycobacterium tuberculosis. Inhale bacterium in respiratory droplets

Question 2

WHAT ARE THE 2 FORMS OF TUBERCULOSIS?

Answer 2

1) Latent - not clinically active TB, asymptomatic and not infectious
2) Active - symptomatic, progressive disease of lungs +/- other organs (extrapulmonary)

Question 3

WHAT ARE THE RISK FACTORS FOR TB?

Answer 3

1) PMH of TB
2) History of TB contact
3) Born in/ travel to country with high TB prevalence - Asia, eastern Europe, Africa
4) Immunosuppression

Question 4

WHAT ARE THE SYMPTOMS OF TB?

Answer 4

1) fever
2) night sweats
3) weight loss
4) malaise (tiredness)
5) respiratory TB- cough +/- purulent sputum, haemoptysis, pleural effusion
6) non-respiratory TB- bone or joint pain, pyuria, ascites

Question 5

WHAT ARE THE INVESTIGATIONS FOR TB?

Answer 5

1) CXR - lung apex consolidation with cavitation
2) Sputum culture- 3 sputum samples (1 early morning) for microscopy, histology shows caseating granuloma
3) Sputum acid-fast bacilli smear
4) FBC
5) Nucleic acid amplification test

Question 6

WHAT IS THE MANAGEMENT OF TB?

Answer 6

1) admit to side room
2) Routine bloods and HIV test
3) CT chest for pulmonary TB
4) MRI brain/ spine for miliary TB

Question 7

WHAT IS THE TREATMENT FOR TB?

Answer 7

1) Rifampicin
2) Isoniazid
3) Pyrazinamide
4) Ethambutol
4 antibiotics for first 2 months then 2 antibiotics for 4 months (R and I)
Do LFT’s due to hepatitis side effects
Compliance crucial and DOT