Respiratory Medicine in Dundee
Questions on Tuberculosis
1) The incidence of TB is currently in decline.
Incorrect
CORRECT!
TB is on the rise, and is the second leading infectious cause of death worldwide, after AIDS. It must be considered as a differential diagnosis in patients with slow to resolve chest infections, weight loss, haemoptysis and CXR abnormalities.
2) TB usually affects the lower lobes.
Incorrect
CORRECT!
TB tends to affect the upper lobes.
3) Antituberculosis chemotherapy is usually given for at least 12 months.
Incorrect
CORRECT!
Quadruple therapy is usually given for 6 months. Remember that it is given as 4 drugs for 2 months then 2 drugs for 4 months
4 Drugs – Rifampicin, Isoniazid, Pyrazinamide and Ethambutol
2 Drugs – Rifampicin and Isoniazid
(I remember it as RIPE, and you drop the PE after 2 months)
4) Rifampicin is usually given throughout the whole duration of treatment.
CORRECT!
See above.
Incorrect
5) Ethambutol may cause optic neuritis and blindness.
CORRECT!
Prior to starting treatment patients should have their visual acuity recorded with a Snellen chart and if they encounter any visual problems while on the drug it should be stopped immediately.
Incorrect
6) Bronchoscopy is always needed to make a microbiological diagnosis.
Incorrect
CORRECT!
Sputum expectorated by the patient may be sufficient to make a diagnosis, and a positive result on smear testing can be made inside 24hours. Culture can take up to 6 weeks. Bronchoscopy should be considered when there is minimal or non diagnostic sputum and the clinical suspicion is high.
7) Atypical mycobacteria often occur in patients with HIV infection.
CORRECT!
Impaired immune system function can allow these organisms to colonise patients with HIV
Incorrect
8) Peripheral neuropathy is a side-effect of isonized therapy.
CORRECT!
The other major side effect to check for is liver function impairment.
Incorrect
9) The presence of mycobacterium tuberculosis on a Ziel-Nielsson stain is sufficient basis to start empirical antibiotic chemotherapy.
CORRECT!
This is essentially smear positive.
Incorrect
10) Reactivation TB may occur even after 30 years after successful treatment
CORRECT!
Reactivation (post primary) TB can occur if there are mycobacterium that are safely encased in granulomas during the first period of treatment and can reactivate during a period of impaired immunity many years later.
Incorrect
