Tuberculosis
Also written as TB.
The correct regimen for management of miliary tuberculosis in children is:
Tuberculosis
- A communicable chronic granulomatous disease caused by Mycobacterium tuberculosis .
- The World Health Organization (WHO) considers TB the most common cause of death from a single infectious agent , with approximately 1.7 billion infected globally, 8–10 million new cases, and 1.5 million deaths annually.
- The reservoir is individuals with active pulmonary disease.
- Transmission occurs via inhalation of airborne organisms in aerosols produced during expectoration or from contaminated secretions.
- M. tuberculosis are slender rods that are acid-fast (resistant to decolorization with acid-alcohol after staining with carbolfuchsin using the Ziehl-Neelsen or fluorescent auramine-rhodamine stains).
Read this in Lung Pathology — Must-Know
Tuberculosis (TB)
- TB is a serious bacterial infection caused by Mycobacterium tuberculosis . It is a slow-growing bacterium that primarily affects the lungs but can spread to other organs.
- Why is TB special? - It has a very thick, waxy cell wall that makes it resistant to many antibiotics - It grows very slowly — treatment takes months - It can hide inside cells in an inactive (latent) stat
- [... middle excerpt for long-note safety ...]
- terol synthesis - Amphotericin B — binds directly to ergosterol and creates holes in the fungal membrane, killing the cell. It is the most powerful antifungal but also the most toxic
Read this in MASTER PHARMACOLOGY NOTES
What our notes say
- The correct regimen for management of miliary tuberculosis in children is: (Paediatrics end of first trimester exam (MBPE 4300): 27 November 2018, 49 of 50 )
- The protein level of the fluid from thoracentesis will be less than 3 g/dL if tuberculosis is the cause (Paediatrics end of fourth year main exam: 1 July 2019, Paper One, 99 of 100 MCQs)
- | Post-infectious (commonest, especially in Kenya) | Tuberculosis, severe pneumonia, measles, whooping cough, adenovirus | (Bronchiectasis)
- Infection and inflammation: tuberculosis, schistosomiasis, lymphogranuloma venereum, and Crohn disease. (Junior Clerkship in Reproductive Health (MBOG 4200): end of year examination, 4 )
- Others that could be chosen: tuberculosis (BCG), hepatitis B, Haemophilus influenzae type b, pneumococcal disease, rotavirus gastroenteritis. (Paediatrics and Child Health end of semester examination (MBPE): 10 January 2023)
- The diagnosis of tuberculosis can be identified using the following tests EXCEPT: (Paediatrics end of 2nd semester exam (MBPE 4300): 5 October 2021, 50 MCQs)
Study material on Tuberculosis
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- Examination of Respiratory system
- Paediatrics main exam (MBPE 4300): 24 January 2022, Paper One, 100 MCQs, 2 short essays and 2 long essays
- Respiratory system pathology mcqs
- Junior Clerkship in Internal Medicine (MBIM4100) main exam, Paper One: 31 January 2024
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- Weekly Year 2: Microbiology Exam - June 12, 2026 (Section A: MCQs)
- Weekly Year 2: Microbiology Exam - April 21, 2026 (Section A: MCQs)
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Practice questions on Tuberculosis
A patient with tuberculosis shows granulomas with central necrosis on biopsy. What type of necrosis characterizes tuberculous granulomas?
- Coagulative necrosis
- Liquefactive necrosis
- Caseous necrosis
- Fat necrosis
- Gangrenous necrosis
Answer: C. Tuberculous granulomas specifically show caseous necrosis - grossly it has a cheese-like appearance, and microscopically it appears as amorphous, structureless, eosinophilic granular debris with complete loss of cellular details. This is distinct from coagulative necrosis (where cell outlines are preserved, seen in infarcts) and liquefactive necrosis (complete digestion of cells, seen in brain infarcts and abscesses)
Which one of the following drugs is most likely to be effective against multi-drug-resistant (MDR) strains of M tuberculosis, including those resistant to streptomycin?
- Spectinomycin
- Clarithromycin
- Amikacin
- Gentamicin
- Meropenem
Answer: C. Amikacin is an aminoglycoside that is often effective against MDR-TB strains, including those resistant to streptomycin. It is one of the second-line agents used in the treatment of drug-resistant tuberculosis due to its different resistance profile compared to streptomycin. ---
The Ghon complex in primary tuberculosis consists of
- Caseous lymph node plus pleural effusion
- Subpleural nodule plus hilar/lymph node involvement
- Cavitary lesion plus apical scarring
- Miliary nodules plus bilateral infiltrates
Answer: B. The Ghon complex = Ghon focus (subpleural nodule, often upper part of lower lobe) + lymphatic drainage + hilar lymph node involvement. When calcified, it becomes the Ranke complex. ---
What is the first-line treatment regimen for drug-sensitive tuberculosis?
- Isoniazid + Rifampin + Pyrazinamide + Ethambutol
- Streptomycin + Ethionamide + Ciprofloxacin
- Linezolid + Bedaquiline + Clofazimine
- Azithromycin + Rifabutin
- , followed by Rifampin and Isoniazid for 4 months (continuation phase). This combination prevents resistance and ensures cur
Answer: A. The standard first-line regimen (RIPE therapy) consists of Rifampin, Isoniazid, Pyrazinamide, and Ethambutol for 2 months (intensive phase), followed by Rifampin and Isoniazid for 4 months (continuation phase). This combination prevents resistance and ensures cure. --- ---
Which tuberculosis drug requires co-administration with pyridoxine to prevent neuropathy?
- Rifampin
- Isoniazid
- Pyrazinamide
- Ethambutol
- This can cause peripheral neuropathy, especially in high-risk patients (diabetics, alcoholics, malnourished, pregnant women).…
Answer: B. Isoniazid interferes with pyridoxine (vitamin B6) metabolism by inhibiting pyridoxal phosphokinase. This can cause peripheral neuropathy, especially in high-risk patients (diabetics, alcoholics, malnourished, pregnant women). Pyridoxine 25-50 mg/day supplementation prevents this adverse effect. --- ---
Which of the following tuberculosis drugs has the highest risk of inducing hyperuricemia?
- Rifampin
- Isoniazid
- Pyrazinamide
- Ethambutol
Answer: C. Pyrazinamide inhibits renal tubular secretion of uric acid, leading to hyperuricemia in most patients. This can precipitate acute gout in susceptible individuals. Other adverse effects include hepatotoxicity and arthralgias. Uric acid levels should be monitored during treatment. --- ### ANESTHETICS & ANALGESICS ---