ILA 6 - Bugs and Foreign Health Flashcards
Differentials for an acute cough
pneumonia, acute exacerbation of COPD, asthma or bronchiectasis, pneumothorax, pulmonary embolism, whooping cough
Differentials for a chronic cough
COPD, asthma, ACE inhibitor, gastro-oesophageal reflex disease, smoking, lung cancer, lymphoma, pulmonary TB, foreign body aspiration, bronchiectasis.
TB bacteria
Mycobacterium tuberculosis
Risk factors for TB
High prevalence country (India, Pakistan, Somalia), close contact with active TB patient, immunocompromised e.g. HIV, homeless, over-crowded living conditions, alcohol or drug abuse
Complications fo TB
cor pulmonale, drug resistance, death
Symptoms and signs of TB
tachypnoea, hypoxia, apical lung sounds, weight loss, anorexia, haemoptysis, persistent productive cough, breathless, night sweats.
CXR and histology for TB
Consolidation, calcification, fibrosis, cavitation.
Histology = caveating granulomas.
Investigations for TB
Be careful about making patient cough or close contact due to risk of contagious. Sputum sample for acid0-fast bacilli/Ziehl-Neelson stain microscopy. CXR. Mantoux test for latent TB
Complete management of a TBV patient
NOTIFIABLE DISEASE, Isoniazid and Rifampicin (6months) and Pyrazinamide and Ethambutol for first 2 months. Contact tracing, CXR of treatment/clearance.
New patients from over-seas issues to discuss
Immunisation history, dental hygiene, mental health, nutritional and metabolic status, contraception education, infection considerations (malaria, enteric fever, TB, HIV)
Rifampicin side effects
Hepatitis
Orange secretions
Flu like symptoms
Isoniazid side effects
Hepatitis, abnormal LFTs, agranulocytosis
Pyrazinamide side effects
Gout, arthralgia, myalgia, hepatitis
Ethambutol side effects
Optic neuritis
Screen latent TB
Mantoux test
