Tuberculosis Quiz

See Presentation. Option C is correct because pulmonary tuberculosis has a gradual onset, with constitutional symptoms (general symptoms of illness affecting the whole body) such as tiredness, weight loss and fever, often with sweats, together with a cough that may be dry or productive. Haemoptysis, which is coughing up blood, can occur because of the haemorrhage in the cavity of the lung, but it does not happen in every patient. There may be crackles on listening to the chest, but there may also be no abnormal signs, which is why a chest radiograph is essential in establishing the diagnosis. TB is more likely, and should therefore be considered, in people who were born outside the UK, have recently travelled to an area where TB is common, are immunocompromised, or have been in close contact with someone with TB. The slow, smouldering pattern reflects the chronic cell-mediated inflammation of the infection. A useful reminder is that TB is a slow burn, not a sudden event.

• Onset: gradual.
• General symptoms: tiredness, weight loss, fever and sweats.
• Cough: dry or productive, with haemoptysis in some patients.
• Risk factors: birth outside the UK, recent travel to a high-incidence area, immunocompromise or close contact with a case.

In a stem, look for the slow tempo and the whole-body symptoms to identify tuberculosis, and then look for the risk factors such as birth or travel in a high-incidence area, immunocompromise or close contact with a case.