scenerios of tuberculosis with answers

 Tuberculosis Scenario Questions & Answers

1. Secondary TB with Apical Cavitary Lesions

Question:
A 55-year-old man with a history of smoking presents with a 3-month history of chronic cough, night sweats, weight loss, and occasional blood-streaked sputum. Chest X-ray shows cavitary lesions in the upper lobes of the lungs. Sputum smear is positive for acid-fast bacilli (AFB).
👉 What is the likely diagnosis, and why are the lesions located in the upper lobes?

Answer:
The patient most likely has secondary (reactivation) tuberculosis. Secondary TB occurs due to reactivation of dormant Mycobacterium tuberculosis bacilli in a previously infected individual, often when immunity is weakened.

The lesions are typically located in the upper lobes because these areas have higher oxygen tension, which favors the aerobic growth of M. tuberculosis. Cavitary lesions result from caseous necrosis and tissue destruction, allowing the bacilli to multiply and be expectorated, making the patient contagious.

2. Primary TB in a Child with Ghon Complex

Question:
A 7-year-old child presents with mild fever and cough. Chest X-ray reveals a small, calcified lesion in the mid-zone of the right lung and enlarged hilar lymph nodes.
👉 What is the diagnosis, and what does the presence of the Ghon complex indicate?

Answer:
This presentation is typical of primary tuberculosis. The small calcified lesion in the lung parenchyma is called the Ghon focus, and when combined with the involved hilar lymph nodes, it is termed the Ghon complex.

The Ghon complex indicates the initial site of infection and spread to nearby lymph nodes. Calcification suggests healing or latent TB. Children often have primary TB because they have not been previously exposed to the bacteria.

3. Latent TB in a Healthcare Worker

Question:
A nurse undergoes routine screening and has a positive tuberculin skin test (TST) but no symptoms and a normal chest X-ray.
👉 What does this indicate, and how should this be managed?

Answer:
A positive TST with no clinical symptoms and a normal chest X-ray indicates latent tuberculosis infection (LTBI). The individual is infected with M. tuberculosis but does not have active disease and is not contagious.

Management typically involves preventive therapy (e.g., isoniazid for 6–9 months) to reduce the risk of progression to active TB, especially in healthcare workers who are at higher risk of exposure.

4. Miliary TB in an Immunocompromised Patient

Question:
A 35-year-old HIV-positive man presents with fever, weight loss, and general malaise. Chest X-ray is normal. Bone marrow biopsy shows granulomas with acid-fast bacilli.
👉 What type of TB is suspected, and why might the chest X-ray be normal?

Answer:
This patient likely has miliary tuberculosis, a disseminated form of TB where bacilli spread hematogenously to multiple organs, including bone marrow.

In immunocompromised patients, typical lung lesions may be absent or minimal, so chest X-rays can be normal or nonspecific. Diagnosis often requires biopsy or culture from extrapulmonary sites.

5. TB Transmission and Contact Screening

Question:
A college student who recently returned from a TB-endemic country develops a persistent cough. His roommate is worried about catching TB.
👉 How is tuberculosis transmitted, and what steps should be taken to screen close contacts?

Answer:
Tuberculosis is transmitted primarily by inhalation of airborne droplets expelled when an infected person coughs, sneezes, or talks.

Close contacts should be screened with a tuberculin skin test (TST) or interferon-gamma release assay (IGRA). Symptomatic contacts or those with positive screening tests should undergo chest X-rays and sputum analysis. Early detection and treatment prevent further transmission.

6. Reactivation TB due to Malnutrition

Question:
A previously healthy man develops weight loss and night sweats after a period of malnutrition.
👉 How does malnutrition lead to reactivation of tuberculosis, and what can be done to prevent this?

Answer:
Malnutrition weakens the immune system, particularly cell-mediated immunity, which is crucial to keep latent M. tuberculosis in check. Reduced immunity allows dormant bacilli to reactivate, causing secondary TB.

Prevention includes improving nutrition, screening at-risk populations for latent TB, and providing prophylactic treatment to those infected.

7. Suspected Drug-Resistant TB

Question:
A patient on first-line anti-TB drugs continues to test positive for acid-fast bacilli after 2 months of treatment.
👉 What should be suspected, and how is drug-resistant TB diagnosed?

Answer:
Multidrug-resistant tuberculosis (MDR-TB) should be suspected when there is persistent positivity after appropriate treatment.

Diagnosis involves drug susceptibility testing (DST) and molecular methods like GeneXpert MTB/RIF, which detect resistance to rifampicin and other drugs. Treatment then needs to be adjusted with second-line anti-TB drugs.

8. TB in Pregnancy

Question:
A pregnant woman in her second trimester is diagnosed with pulmonary TB.
👉 What are the considerations for managing TB in pregnancy?

Answer:
TB treatment is generally safe during pregnancy, and delaying treatment can harm both mother and fetus. First-line drugs like isoniazid, rifampicin, and ethambutol are used. Pyrazinamide is often avoided due to limited safety data but may be considered.

Monitoring and ensuring adherence to therapy is crucial, and folate supplementation is recommended with isoniazid to prevent neuropathy.

9. Extrapulmonary TB: Pott’s Disease

Question:
A patient complains of back pain and stiffness with neurological symptoms. Imaging shows destruction of vertebral bodies and a paravertebral abscess.
👉 What is the likely diagnosis, and how is it confirmed?

Answer:
This clinical picture suggests Pott’s disease (tuberculous spondylitis), an extrapulmonary manifestation of TB affecting the spine.

Diagnosis is confirmed by imaging (MRI or X-ray) and biopsy with microbiological confirmation of M. tuberculosis from vertebral tissue or abscess fluid.

10. Public Health Measures in TB Control

Question:
In a refugee camp, TB cases are increasing rapidly.
👉 What public health strategies should be implemented to control TB spread?

Answer:
Strategies include

  • Prompt identification and isolation of infectious cases

  • Mass screening for active and latent TB

  • Vaccination with BCG where appropriate

  • Providing directly observed therapy (DOT) to ensure treatment adherence

  • Improving living conditions and nutrition to reduce transmission and vulnerability


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