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Medicine Notes Clinical Respiratory Notes

Tuberculosis Notes

Updated Tuberculosis Notes

Clinical Respiratory Notes

Clinical Respiratory

Approximately 29 pages

This series of notes is on clinical respiratory. It includes respiratory basics, physiology, common diseases, treatment and complications. These notes were made using a variety of textbooks, notes from tutorials with consultants and knowledge gained on the ward with doctors. These notes helped me a achieve a good grade of 77% in the end of year exams....

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The following is a more accessible plain text extract of the PDF sample above, taken from our Clinical Respiratory Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Tuberculosis (TB)

  • Definition

    • Causes of death of most HIV

    • 8200/yr; 350 deaths/yr (UK)

  • Clinical features/Presentation

    • Travel high incidence TB area

    • Chronic cough (non-smoker)

    • Haemoptysis

    • Night sweats

    • Weight loss

  • Examination findings

    • Reduced expansion

    • Dull to percussion

    • Reduced breath sounds

    • Crackles

    • Increased vocal resonance

  • Diagnosis

    • Specific tests

      • LATENT TB

        • Mantoux test- + do interferon gamma testing

      • ACTIVE TB

        • CXR suggests, take sputum

        • Acid-fast bacilli resist acid on ZN staining

        • Bronchoscopy/lavage may be needed if no sputum produced

      • ACTIVE NON-RESP TB

        • Samples: Sputum, pleura/pleural fluid, urine, pus, bone marrow, CSF

        • Culture

        • CXR to find coexisting resp. TB

      • PCR

        • Rapid identification of rifampicin resistance

      • HISTOLOGY

        • Caseating granulomas

      • CXR

        • Consolidation; Cavitation; Fibrosis; Calcification

      • IMMUNOLOGICAL EVIDENCE (TB skin test)

    • GENREAL

      • Increased temp; Increased WCC/CRP; Anaemia

  • Management

    • ABC

    • Ziehl-Nielsen/Silver stain (acid fast bacilli)

    • Notify authorities; Vaccinate contacts (BCG); Isolation

    • Test for HIV

    • Look for signs of spread (meningeal irritation; bones; joints; dysuria; pelvic)

    • Confirmed= Refer to TB service

    • 4 ABX

      • Rifampicin & Isoniazid (4 months)

      • Pyrazinamide & Ethambutol (2 months)

Sarcoidosis

  • General

    • Multisystem non-caseating granulomatous

    • African-Carribeans more affected & more severe

    • HLA-DRB1 & DQB1

    • Pathogenesis= Inflammation--> Fibrosis--> Adheres to lung pleura

  • Clinical features

    • Pulmonary

      • Bilateral hilar lymphadenopathy

        • DDx= Sarcoidosis; Lymphoma; TB

      • Dry cough; Progressive dyspnoea; Decreased exercise; Chest pain

    • Non-pulmonary

      • Lungs; Liver; Brain (neuro-sarcoid); Heart (prolonged Q-R); Skin; Kidney; Eyes

  • Tests

    • Bloods Increased ESR; Lymphopenia; Increased LFT; Hypercalcaemia; IG

    • 24h urine Hypercalcaemia

    • Tuberculin Negative 2/3

    • CXR S1= Norm; S2= BHL; S3= Peripheral; S4= Fibrosis; Bulla; Pleural

    • Lung functions Normal/reduced lung volumes; Restrictive

    • Biopsy NON-CASEATING GRANULOMAS

    • BA lavage Increased lymphocytes; Increased neutrophils (fibrosis)

  • Management

    • Acute= NSAIDs and bed...

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