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2. Exercise: 20 CXRs Estimate the probability of TB Graham Bothamley Homerton University Hospital NHS Foundation Trust, London; UK Christoph Lange Clinical Infectious Diseases, Research Center Borstel University of Lübeck; Germany

3. 8.091 M 75yrs ex-painter and decorator Afro-Caribbean Jamaica UK 1950 Fever Night sweats Dementia Alcohol Diabetes smoker lives alone wbc 8.0/nL CRP 35 mg/L

4. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

5. 8.138

6. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

7. 8.138 F 41yr housewife White-UK No contacts cough 3m sputum 3m weight loss 5 kg Alcoholic Smoker BCG+

8. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

9. 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

10. 8.078 M 47 yr unemployed White-UK No contacts Travel to W. Indies cough 3 months sputum 3 months fever 3 months sweats 3 months weight loss 12 kg Alcoholic Diabetes Hepatitis C Smoker BCG-

11. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

12. 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

13. 5

14. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

15. Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3

16. 8.087 M 42yr

17. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

18. 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

19. 47 M Temp: 37. 8 C SaO2: 89% wbc: 10.0 Neutrophils: 9.5 CRP: 120 mg/L

20. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

21. 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

22. M 32yrs IT White Cough 4 weeks Sputum 4 w Weight loss 1 kg Night sweats Smokes cannabis BCG+ 9.009

23. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

24. 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

25. F 70 yrs Ex school assistant White UK No TB contact Cough Sputum Weight loss 1 kg Smoker 20/day >50 yrs No BCG 9

26. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

27. 8.078 47 M Temp: 37. 8 C SaO2: 93% wbc: 8.0 Neutrophils: 7.5 CRP: 35 mg/L

28. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

29. 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

30. 8.078 47 M Temp: 37 C SaO2: 93% wbc: 8.0 Neutrophils: 7.5 CRP: <5 mg/L

31. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

32. 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

33. M 47 yr unemployed White-UK No contacts Travel to W. Indies cough 3 months sputum 3 months fever 3 months sweats 3 months weight loss 12 kg Alcoholic Diabetes Hepatitis C Smoker BCG-

34. Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3

35. F 32yr shop assistant Afro-Caribbean No TB contacts Travel to Jamaica cough 3m no sputum haemoptysis x 1 anti-depressants BCG+

36. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

37. M 32yrs IT Russian UK 9 yrs Friend had TB Cough 4 weeks Sputum 4 w Weight loss 1 kg Night sweats Smokes cannabis BCG+

38. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

39. 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

40. M 42yr unemployed Born in Gambia In UK 14 years Smoker BCG+ Temp 37.8 C SaO2 92% wbc 8.0 Neutrophils 7.0 CRP 25 mg/L

41. Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

42. 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

43. Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3

44. F 70 yrs White UK No TB contact Fever Night sweats Weight loss 1 kg Smoker 20/day >50 yrs

45. Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

46. F 16yrs student Belgium UK 3 yrs Grandmother may have had TB Cough 2m No sputum Fever Night sweats Temp 37.8 C SaO2 93% wbc 8.0 Neutrophils 7.5 CRP 35 mg/L 9.072

47. Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

48. 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

49. 9.011 M 48 “housekeeper”

50. Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

51. 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

52. F 16yrs student Belgium UK 3 yrs Grandmother may have had TB Cough 2m No sputum Fever Night sweats Temp 37.8 C SaO2 89% wbc 10.0 Neutrophils 9.0 CRP 35 mg/L

53. Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

54. 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

55. M 36 yr Cough 5m BCG+ SaO 2 91% Fbc -microcytic anaemia CRP 8 mg/L

56. Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

57. Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3

58. M 48yr “housekeeper” Nepal In UK 4 months neck lymph node smoker BCG+

59. Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

60. 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

61. F 16yrs student Belgium UK 3 yrs Grandmother may have had TB Cough 2m No sputum Fever Night sweats Temp 37 C SaO2 93% wbc 8.0 Neutrophils 7.5 CRP <5 mg/L

62. Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

63. 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

64. Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3

65. M 36 yr business Poland UK 9 yrs Travel to Poland No TB contact Flu-like illness Cough 5m Weight loss 10 kg 2 bottles spirits/wk BCG+ SaO 2 91% Fbc -microcytic anaemia CRP 8 mg/L

66. Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% 5.90-100% Please vote

67. Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3