Wednesday, December 15, 2010

This is the chest X-ray I saw in the general medicine ward of a 30 year-old man who presented with the following complaints:

1) Chronic productive cough x 6/12 associated with
-Exertional dyspnoea
-Multiple episodes of hemoptysis worsened over the past one month
-Greenish sputum

2) On and off low grade fever associated with night sweats chills and rigors x1/12

3) Significant weight loss with decreased oral intake due to poor appetite

Physical examination revealed decreased chest expansion over the upper chest. Percussion over the chest revealed dullness over the right upper lobe with apical crepitation on auscultation. Several enlarged cervical lymph nodes were present as well.
Chest X-Ray of another patient with active PTB. Note the cavitation. consolidation and deviated trachea(mediastinum) due to scarring.

Yes, you are right, he was having active pulmonary tuberculosis.

Tuberculosis is one of the common topics that can be tested in an undergraduate exam (obviously not in Monash) and questions are commonly asked about the treatment and its side effects. The first line medications for TB and their associated adverse drug effects are as follow:

Rifampicin-cholestatic jaundice, orange urine, thrombocytopenia, enzyme inducer( OCP less effective)
Isoniazid-Peripheral neuropathy, hepatitis, pyridoxine deficiency, drug induced lupus!
Pyrazinamide-hepatitis, hyperuricemia (Gout)
Ethambutol-Optic neuritis
Streptomycin-ototoxicity and nephrotixicity