GP ILA 6: TB Flashcards

1
Q

Risk factors for TB

A

o Endemic countries (South Asia, Sub-Saharan)
o Neonates and young children
o Drug users
o Ethanol use
o Malnutrition and poverty
o Immunosuppressed (HIV/AIDS, cancer, diabetes)
o Close contacts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

TB - investigations

a) Pulmonary TB
b) Non-pulmonary TB
c) Screen for what other infections?
d) Other investigations/screening

A

a) Pulmonary - CXR, THREE sputum samples for Ziehl-Nielsen stain for acid-fast bacilli
b) Non-pulmonary - samples: lymph node biopsies, aspirated pus, urine or other samples
c) Check HIV, hepatitis B and hepatitis C status
d) Mantoux test (or IGRA if positive on Mantoux, or if patient has had bCG) for close contacts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pneumonia risk assessment:

a) Community
b) In hospital

A

a) CRB-65

b) CURB-65: 1 (community), 2 (inpatient), 3+ (HDU/ICU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pneumonia management

a) Supportive
b) Low severity
c) Mod-severe
d) Severe legionella treatment

A

a) Oxygen, fluids, nebulised saline, analgesia
b) Amoxicillin (or macrolide or doxycycline)
c) Amoxicillin AND macrolide (or more severe: co-amoxiclav and a macrolide)
d) Rifampicin, macrolide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

TB - management

a) General
b) TB meningitis

A

a) 6 months - rifampicin, isoniazid; 2 months - pyrizinamide, ethambutol
b) 12 months R/I and a course of prednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tetracyclines (e.g. doxycycline)

a) Indications
b) Advise patients when taking…?
c) In STI managment?

A

a) Pneumonia, malaria prophylaxis
b) Don’t have with dairy, use factor 50 (photosensitivity)
c) Chlamydia: doxycline (1/52) OR azithromycin (stat)
PID: ceftriaxone (stat) AND metronidazole (2/52) AND doxycycline (2/52)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

TB appearance on CXR

A

Typical TB appearances include:
Central apical portion with a left lower-lobe infiltrate or pleural effusion
Patchy or nodular shadows in the upper zones, loss of volume, fibrosis ± cavitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Rusty coloured sputum

A

Strep pneumonia (pneumococcal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Neonatal pneumonia

A

Group B strep

Gram neg - klebsiella, e. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pott’s disease

A

TB of the spine

Worry if point tenderness, endemic country, HIV or immunosuppressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Whooping cough

  • How could you elicit?
  • Rx?
  • Also, must do what
  • How long recovery?
A

Tongue depressor – impressive cough
Macrolide treatment (if within 3 weeks of onset)
Notify PHE (within 3 days)
Possibly a few months – 100 day cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Acute infective asthma exacerbation:

a) Assessment
b) Management

A
a) Assessment:
Vitals – RR, HR, BP, SpO2, Temp
Examine chest – any focal signs?
Assess peak flow
Assess need for admission based on the above

b) Management:
Bronchodilator – check technique with spacer use
Oral prednisolone
Antibiotics only if signs of infection
Review in 48 hours – review medication, need for ICS, etc., offer smoking cessation, asthma action plan, asthma review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Suspected heart failure

a) Investigations
b) Management (if confirmed)

A

a) NT-proBNP blood test +/- echo
b) Beta-blocker, loop diuretic, +/- spiro
Lifestyle advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly