Paper II — 2024 December (Supplementary) (2019 Scheme) — Q2
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Paper II
2024 December (Supplementary) (2019 Scheme) · 100 marks · 180 min
Question
A 45-year-old male factory worker weighing 60 kg reports to the hospital with cough and expectoration,
mild chest pain, weakness and fatigue for the last one month. In addition, he has developed low grade
fever for the last one week. He gives history of having suffered from tuberculosis of the lung one year back
for which he took treatment from the hospital and became all right in 2 months. He stopped taking the
medicines after another 1 month, though he was told by the doctor to continue treatment. The sputum was
found to be positive for AFB and X-ray chest showed a 5 cm cavitary lesion in the right middle lobe and
fibrotic changes in the upper lobe. He was diagnosed to be a previously treated and defaulted patient of
pulmonary tuberculosis.
(a) Enumerate the first line antitubercular drugs which he would have received in the past. Mention one
characteristic adverse effect of each. 4 mark(s)
(b) What should be the regimen of antitubercular drugs for this patient now. Explain. 4 mark(s)
(c) Write briefly on chemoprophylaxis of tuberculosis. 2 mark(s)
Q210 marksEssays
Answer
a) First-line antitubercular drugs previously received, with one characteristic adverse effect each
Isoniazid — peripheral neuropathy
Rifampicin — orange-red discoloration of body fluids (hepatotoxicity is also characteristic)
Pyrazinamide — hyperuricemia
Ethambutol — optic neuritis (red-green color blindness)
b) Regimen for this patient now
This patient is a previously treated, defaulted case with a cavitary lesion and current sputum-positive disease — treatment must not simply repeat the original regimen, since incomplete prior therapy raises the risk of drug resistance having emerged. He should be started on an extended regimen with an additional drug (a five-drug intensive phase, e.g. Isoniazid + Rifampicin + Pyrazinamide + Ethambutol + Streptomycin/a fluoroquinolone), with drug susceptibility testing performed to rule out multidrug-resistant TB before or promptly after starting therapy — since default/relapse is a recognized major risk factor for resistance, empirical treatment must be reassessed rather than simply restarting the original first-line regimen unchanged.
c) Chemoprophylaxis of tuberculosis
Isoniazid given alone for 6-9 months to close contacts of active TB cases and to individuals with latent TB infection (positive tuberculin/IGRA test without active disease), preventing progression from latent infection to active disease. Also used in HIV-positive individuals with latent TB infection, and in infants born to mothers with active TB.
