Thank you for viewing this presentation.

We would like to remind you that this material is the property of the author.

It is provided to you by the ERS for your personal use only, as submitted by the

author.

2012 by the author

Exercise: 20 CXRsEstimate the probability of TB

Graham BothamleyHomerton University HospitalNHS Foundation Trust, London; UKChristoph LangeClinical Infectious Diseases, Research Center BorstelUniversity of Lübeck; Germany

8.091

M 75yrs ex-painterand decorator

Afro-CaribbeanJamaicaUK 1950

FeverNight sweatsDementia

AlcoholDiabetessmokerlives alone

wbc 8.0/nLCRP 35 mg/L

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

8.138

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

8.138

F 41yr housewife

White-UKNo contacts

cough 3msputum 3mweight loss 5 kg

AlcoholicSmoker

BCG+

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Respiratory isolation

2. Send sputum for TB smear examination

3. Treat with antibiotics e.g. moxifloxacin

4. 1 and 2 above

5. 1, 2 and 3 above

8.078

M 47 yr unemployed

White-UKNo contactsTravel to W. Indies

cough 3 monthssputum 3 monthsfever 3 monthssweats 3 monthsweight loss 12 kg

AlcoholicDiabetesHepatitis CSmoker

BCG-

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Respiratory isolation

2. Send sputum for TB smear examination

3. Treat with antibiotics e.g. moxifloxacin

4. 1 and 2 above

5. 1, 2 and 3 above

5

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

Further investigations

1. Bronchoscopy

2. CT scan

3. IGRA and/or tuberculin skin test

4. 1 and 2

5. 1, 2 and 3

8.087

M 42yr

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Treat with antibiotics

2. Send sputum for TB smear examination

3. Respiratory isolation

4. 1 and 2 above

5. 2 and 3 above

47 M

Temp: 37. 8 CSaO2: 89%wbc: 10.0Neutrophils: 9.5CRP: 120 mg/L

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Respiratory isolation

2. Send sputum for TB smear examination

3. Treat with antibiotics e.g. moxifloxacin

4. 1 and 2 above

5. 1, 2 and 3 above

M 32yrs IT

White

Cough 4 weeksSputum 4 wWeight loss 1 kgNight sweats

Smokes cannabis

BCG+

9.009

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Respiratory isolation

2. Send sputum for TB smear examination

3. Treat with antibiotics

4. 1 and 2 above

5. 1, 2 and 3 above

F 70 yrs Ex school assistant

White UKNo TB contact

CoughSputumWeight loss 1 kg

Smoker20/day >50 yrs

No BCG

9

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

8.078

47 M

Temp: 37. 8 CSaO2: 93%wbc: 8.0Neutrophils: 7.5CRP: 35 mg/L

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Respiratory isolation

2. Send sputum for TB smear examination

3. Treat with antibiotics e.g. moxifloxacin

4. 1 and 2 above

5. 1, 2 and 3 above

8.078

47 M

Temp: 37 CSaO2: 93%wbc: 8.0Neutrophils: 7.5CRP: <5 mg/L

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Respiratory isolation

2. Send sputum for TB smear examination

3. Treat with antibiotics

4. 1 and 2 above

5. 1, 2 and 3 above

M 47 yr unemployed

White-UKNo contactsTravel to W. Indies

cough 3 monthssputum 3 monthsfever 3 monthssweats 3 monthsweight loss 12 kg

AlcoholicDiabetesHepatitis CSmoker

BCG-

Further investigations

1. Bronchoscopy

2. CT scan

3. IGRA and/or tuberculin skin test

4. 1 and 2

5. 1, 2 and 3

F 32yr shop assistant

Afro-CaribbeanNo TB contactsTravel to Jamaica

cough 3mno sputumhaemoptysis x 1

anti-depressants

BCG+

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

M 32yrs IT

RussianUK 9 yrsFriend had TB

Cough 4 weeksSputum 4 wWeight loss 1 kgNight sweats

Smokes cannabis

BCG+

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Respiratory isolation

2. Send sputum for TB smear examination

3. Treat with antibiotics

4. 1 and 2 above

5. 1, 2 and 3 above

M 42yr unemployed

Born in GambiaIn UK 14 yearsSmokerBCG+

Temp 37.8 CSaO2 92%wbc 8.0Neutrophils 7.0CRP 25 mg/L

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Treat with antibiotics

2. Send sputum for TB smear examination

3. Respiratory isolation

4. 1 and 2 above

5. 2 and 3 above

Further investigations

1. Bronchoscopy

2. CT scan

3. IGRA and/or tuberculin skin test

4. 1 and 2

5. 1, 2 and 3

F 70 yrs

White UKNo TB contact

FeverNight sweatsWeight loss 1 kg

Smoker20/day >50 yrs

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

F 16yrs student

BelgiumUK 3 yrsGrandmother may have had TB

Cough 2mNo sputumFeverNight sweats

Temp 37.8 CSaO2 93%wbc 8.0Neutrophils 7.5CRP 35 mg/L

9.072

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Treat with antibiotics

2. Send sputum for TB smear examination

3. Respiratory isolation

4. 1 and 2 above

5. 2 and 3 above

9.011

M 48“housekeeper”

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Treat with antibiotics

2. Send sputum for TB smear examination

3. Respiratory isolation

4. 1 and 2 above

5. 2 and 3 above

F 16yrs student

BelgiumUK 3 yrsGrandmother may have had TB

Cough 2mNo sputumFeverNight sweats

Temp 37.8 CSaO2 89%wbc 10.0Neutrophils 9.0CRP 35 mg/L

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Treat with antibiotics

2. Send sputum for TB smear examination

3. Respiratory isolation

4. 1 and 2 above

5. 2 and 3 above

M 36 yr

Cough 5m

BCG+

SaO2 91%Fbc -microcytic anaemiaCRP 8 mg/L

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

Further investigations

1. Bronchoscopy

2. CT scan

3. IGRA and/or tuberculin skin test

4. 1 and 2

5. 1, 2 and 3

M 48yr “housekeeper”

NepalIn UK 4 months

neck lymph node

smoker

BCG+

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

Further investigations

1. FNA for cytology

2. CT scan

3. IGRA and/or tuberculin skin test

4. Lymph node biopsy

5. 1, 2 and 3

F 16yrs student

BelgiumUK 3 yrsGrandmother may have had TB

Cough 2mNo sputumFeverNight sweats

Temp 37 CSaO2 93%wbc 8.0Neutrophils 7.5CRP <5 mg/L

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

The following actions should be taken:

1. Treat with antibiotics

2. Send sputum for TB smear examination

3. Respiratory isolation

4. 1 and 2 above

5. 2 and 3 above

Further investigations

1. Bronchoscopy

2. CT scan

3. IGRA and/or tuberculin skin test

4. 1 and 2

5. 1, 2 and 3

M 36 yr business

PolandUK 9 yrsTravel to PolandNo TB contact

Flu-like illnessCough 5mWeight loss 10 kg

2 bottles spirits/wkBCG+

SaO2 91%Fbc -microcytic anaemiaCRP 8 mg/L

Estimate the likelihood of active tuberculosis

1. 0 – 10%

2. 11 – 39%

3. 40 – 60%

4. 61 – 89%

5. 90-100%

Please vote

Further investigations

1. Bronchoscopy

2. CT scan

3. IGRA and/or tuberculin skin test

4. 1 and 2

5. 1, 2 and 3