daira
Forum Senior
Topics: 29
Posts: 138
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1) whats the difference between primary and secondary TB
2) whats the MC extrapulmonary organ involved
3) Best initial test and findings on it
4) What test should trigger Rx
5) Whats the single most sensitive test
6) CSF findings on Tuberculous meningitis
7) When steroids should be added to Rx
8 ) PPD +ve, normal Xray, completely healthy, never tested before, Rx ?
9) What are the cut-off values for PPD in healthy, high risk and low risk
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| Healer4life
Forum Newbie
Topics: 4
Posts: 20
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Ok Qalandar,
Here we go with TB meningitis:
CSF= (same for fungal Cryptococcal meningitis in AIDS pts). Think of it as a mix of bacterial and viral- Low glucose (<50), high cells (>100) which are predominantly LYMPHOCYTES!!! Increased CSF pressure also (>200). Fluid will be yellow in color.
Interesting tidbits: Acid-Fast stains of CSF are negative and cultures may also be negative. TB skin test can be + or - in these pts.
CXR- often reveals abnormalities assoc. with TB, but may be normal!!!
Key to diagnosis: GRADUAL onset, CSF, and evidence of TB elsewhere point to diagnosis.
TX: Presumptive diagnosis followed by EARLY, empirical anti-TB TX to minimize sequelae. Even if cultures are not +, a full course of TX is warranted if clinical suspicion is high!!! TX just like with Pulm. TB using Isonaizid, Rifampin, Pyrazinamide, and Ethambutol.
Next up: Pulm TB, PPD, and extra pulmonary TB!!! The TB Bonnanza!!! 
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| dpk
Forum Junior
Topics: 10
Posts: 66
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hi
these are the answers according to me...
1....primary TB is wht one develops with first time exposure...ghon's complex
secondary TB is wht one develops uopn reactivation of primary ds.
2..mc extrapulmonary organ is lymph nodes.
3..best initial test...ppd(not specific)
4..not sure abt this.. may be sputum positive or active lesion CXR
5..i think most sensitive test is ppd....screening tests used are sensitive.
6..u got the answer to this one
7..steroids are added if there is evidence of TB pericarditis and meningitis.these r the only 2 indications of steroid in TB
8...INH and vit B6 for 9mths.....
9...PPD cut off...low risk...5mm
healthy....10mm
high risk...15mm
good luck
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| oddissy4u
Forum Guru
Topics: 107
Posts: 389
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agree with dpk at most places --
1.prim is ghon's n lower lobe ,sec is reactiv n upper lobe.
2.LN
3.PPD
4.PPD/Cx/sputum
5.PPD(not in acute cases)
7.TB menningitis n pericarditis
9.hih risk=>5mm
low=>10
healthy>15mm
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| tess
Forum Guru
Topics: 131
Posts: 368
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Agree with ur guys at most points; but when I started a job here last year, I hak PPD +, normal X-ray, totally symptoms-free, then what I was asked is that I should come back one year later and have another check; and come back anytime when I have symptom. Confused? :shock:
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| oddissy4u
Forum Guru
Topics: 107
Posts: 389
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thts true tess.
:arrow: id ppd +once and no other suggestive points (immigrant/Cx/Sputum/symptoms/contact/travel)then repeat ppd within 2 weeks---to rule out if still ppd+ then INH for 9mths if negative then i thnk forgotten case!! :roll:
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| dpk
Forum Junior
Topics: 10
Posts: 66
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i'm sorry..
i made a mistake while writing the answer of 9th ..it was my mistake ..i agree with u oddissy4u....u are right..i had same thing in mind but made a mistake while writing..
sorry everyone..
good luck
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| dpk
Forum Junior
Topics: 10
Posts: 66
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actually even i came back positive for ppd abt 9mths back but normal CXR and and no symptoms....the doctor told me to have INH AND VIT B6 for 9mths as he said it better for my sake as when i'm going to start doing residency i become at risk of another exposure and it may activate the latent TB...as u might know these days its not called prophylaxis of TB but Rx of latent TB...
I was telling this answer with my personal experience...and i'm on Rx...
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