Upper & Lower Respiratory Infections - Cheat Sheet
Your 30-minute exam-ready reference covering upper & lower respiratory infections, with special emphasis on TB (Philippine NTP priority), pneumonia management, and high-yield pharmacology. Memorise the RIPE regimen, DOTS principles, GeneXpert, airborne vs. droplet precautions, and antibiotic first-lines.
SINUSITIS
Important facts
- Most are VIRAL — supportive care (saline irrigation, steam, decongestants, analgesics).
- Bacterial suspected when symptoms persist >10 days or worsen after initial improvement.
- First-line antibiotic: amoxicillin.
- Classic signs: facial pressure/pain, post-nasal drip, nasal congestion, headache.
- Teach warm compresses, increased fluids, and saline irrigation.
Key definitions
Sinusitis
Example
Facial pain worse on bending forward + purulent nasal discharge after a cold = likely bacterial sinusitis.
Inflammation of paranasal sinuses; mostly viral, bacterial if persisting >10 days or worsening after initial improvement.
PHARYNGITIS (SORE THROAT)
Important facts
- Majority of pharyngitis is VIRAL — supportive care only.
- Identify GABHS: sudden onset, high fever, tonsillar exudate, tender anterior cervical nodes, ABSENCE of cough.
- Confirm with rapid antigen test or throat culture before starting antibiotics.
- First-line treatment for GABHS: penicillin (full course) or amoxicillin.
- If penicillin-allergic: macrolide (azithromycin, clarithromycin) — FULL COURSE mandatory.
- CRITICAL TEACHING: complete the entire antibiotic course even after symptoms resolve — THIS prevents rheumatic fever.
- Viral pharyngitis: fluids, analgesics, warm saline gargles.
Key definitions
Pharyngitis
Example
Sudden sore throat + fever + tonsillar exudate + tender anterior cervical nodes + NO cough = GABHS (strep throat).
Pharyngeal inflammation; mostly viral, but Group A beta-haemolytic streptococcus (GABHS) requires full antibiotic course to prevent rheumatic fever.
GABHS (Strep Throat)
Example
Positive rapid antigen test or throat culture + fever + exudate = treat with full course penicillin or amoxicillin.
Group A beta-haemolytic streptococcus; critical because untreated cases lead to acute rheumatic fever (ARF) and acute glomerulonephritis (AGN).
INFLUENZA (FLU)
Important facts
- MORE SYSTEMIC & ABRUPT than common cold.
- High-risk for complications: viral/secondary bacterial pneumonia (elderly, pregnant, chronic disease).
- Antivirals (oseltamivir) MOST EFFECTIVE within 48 hours of symptom onset.
- After 48 hours: supportive care (rest, fluids, antipyretics).
- Prevention: annual influenza vaccine (high-risk groups), respiratory/droplet precautions, hand hygiene.
- Teach cough etiquette and contact precautions.
Key definitions
Influenza
Example
Abrupt onset + high fever + myalgia + dry cough + fatigue = influenza (not common cold).
Acute viral respiratory illness (Influenza A & B) with abrupt onset, high fever, myalgia, headache, dry cough, profound fatigue.
ACUTE BRONCHITIS
Important facts
- Hallmark: initially DRY cough → becomes PRODUCTIVE, lasts up to 3 weeks.
- May have low-grade fever and chest discomfort.
- MANAGEMENT IS SUPPORTIVE ONLY: fluids, rest, humidification, antipyretics/analgesics.
- ANTIBIOTICS NOT INDICATED — it is viral; unnecessary antibiotics drive resistance.
- Teach smoking cessation and warning signs of pneumonia: high fever, dyspnoea, pleuritic pain.
Key definitions
Acute Bronchitis
Example
Productive cough lasting 3 weeks after a cold + low-grade fever + chest discomfort = acute bronchitis.
Bronchial inflammation; mostly viral, self-limiting, often following upper respiratory infection.
PNEUMONIA — Overview & Pathophysiology
Important facts
- Alveolar consolidation reduces surface area for gas exchange → hypoxaemia.
- Consolidated lung transmits sound differently: increased fremitus, dullness to percussion, bronchial breath sounds.
- Three main types: Community-Acquired (CAP), Hospital-Acquired/Nosocomial (HAP), Aspiration.
Key definitions
Pneumonia
Example
Pathogens reach alveoli → inflammatory response → alveoli fill with exudate/WBCs (consolidation) → reduced gas exchange.
Infection of lung parenchyma causing alveolar consolidation with exudate, impairing gas exchange and causing hypoxaemia.
PNEUMONIA — Types & Causative Agents
Important facts
- CAP most common: S. pneumoniae (produces rust-coloured sputum — HIGH-YIELD).
- HAP/VAP: resistant Gram-negatives (e.g., Pseudomonas) + S. aureus.
- Aspiration: risk factors = impaired swallowing, decreased LOC, NG tube feeding, GORD.
Key definitions
Community-Acquired Pneumonia (CAP)
Example
Patient presents with fever, productive cough, pleuritic pain; CXR shows infiltrate = CAP.
Pneumonia acquired in the community; most common bacterial cause is Streptococcus pneumoniae; also viral and atypical organisms (Mycoplasma, Legionella).
Hospital-Acquired / Nosocomial Pneumonia (HAP)
Example
Patient intubated 72 hours ago develops fever, purulent sputum = HAP (ventilator-associated pneumonia if intubated).
Pneumonia occurring >48 hours after hospital admission; often more resistant Gram-negative organisms and Staphylococcus aureus.
Aspiration Pneumonia
Example
Unconscious patient or patient with dysphagia develops pneumonia in dependent (lower) lung segments.
From inhalation of gastric contents/secretions; high risk with impaired swallowing, decreased LOC, NG feeding.
PNEUMONIA — Clinical Manifestations & Assessment
Important facts
- Fever & chills, productive cough with purulent or RUST-COLOURED sputum (pneumococcal — classic).
- Pleuritic chest pain, dyspnoea, tachypnoea.
- Physical exam findings: crackles & bronchial breath sounds over consolidation, dullness to percussion, increased tactile fremitus, positive egophony.
- IN THE ELDERLY: atypical presentation — confusion, lethargy, falls may be ONLY signs; blunted fever response.
- ELDERLY CONFUSION = KEY EXAM POINT — do not miss subtle presentations in older adults.
Key definitions
Egophony
Example
Patient says 'ee' over consolidated area, auscultation sounds like 'ay' = positive egophony.
Increased resonance of voice over consolidated lung tissue (patient says 'ee', sounds like 'ay'); sign of consolidation.
PNEUMONIA — Diagnostics
Important facts
- CHEST X-RAY: shows infiltrates/consolidation (confirms diagnosis).
- SPUTUM Gram stain & culture: collect BEFORE starting antibiotics if possible.
- CBC: leukocytosis (elevated WBC count).
- Blood cultures: if severe/sepsis suspected.
- Pulse oximetry & ABG: assess oxygenation status.
- Order investigations BEFORE antibiotics for best diagnostic yield.
Key definitions
Chest X-Ray (CXR)
Example
Fever + cough + CXR infiltrate = confirms pneumonia diagnosis.
Gold standard for pneumonia diagnosis; shows infiltrates/consolidation confirming the infection.
PNEUMONIA — Nursing Management & Priority Interventions
Important facts
- PRIORITY #1: MAINTAIN PATENT AIRWAY & ADEQUATE OXYGENATION.
- Give oxygen to maintain SpO2 within target; position in HIGH-FOWLER'S.
- AIRWAY CLEARANCE: encourage deep breathing, coughing, incentive spirometry, adequate hydration (2–3 L/day unless contraindicated) to loosen secretions.
- Perform chest physiotherapy/suctioning as needed to mobilise secretions.
- ANTIBIOTICS: give promptly & on time to maintain therapeutic blood levels; monitor response.
- Manage fever (paracetamol), provide rest, cluster care to conserve energy.
- Monitor for deterioration: rising RR, falling SpO2, confusion, worsening hypoxaemia.
Key definitions
High-Fowler's Position
Example
Dyspnoeic patient with pneumonia placed in high-Fowler's to improve ventilation and gas exchange.
Head of bed elevated 45–90 degrees; maximises lung expansion and facilitates easier breathing in respiratory distress.
PNEUMONIA — Pharmacology
Important facts
- CAP FIRST-LINE: amoxicillin OR macrolide (azithromycin, clarithromycin).
- Severe/comorbid CAP: respiratory fluoroquinolone (levofloxacin) OR beta-lactam + macrolide.
- MACROLIDES (azithromycin, clarithromycin): GI upset; monitor for QT prolongation.
- FLUOROQUINOLONES (levofloxacin): risk of tendon rupture & QT prolongation; caution in elderly; affects blood glucose.
- Antipyretics/analgesics: paracetamol for fever & pleuritic pain.
- PREVENTION: pneumococcal & influenza vaccines for at-risk (elderly, chronic illness).
- Duration: typically 7–10 days for CAP (adjust based on response).
Key definitions
CAP First-Line Antibiotic
Example
Uncomplicated CAP in primary care → amoxicillin or azithromycin; severe CAP or comorbidities → levofloxacin or amoxicillin-clavulanate + azithromycin.
Amoxicillin or macrolide (azithromycin, clarithromycin); fluoroquinolone or beta-lactam + macrolide for severe/comorbid cases.
PNEUMONIA — Complications
Important facts
- Pleural effusion & empyema (pus in pleural space).
- Sepsis & septic shock (systemic inflammatory response).
- Respiratory failure & ARDS (acute respiratory distress syndrome).
- Atelectasis (lung collapse).
- Lung abscess (localised necrosis/pus collection).
TUBERCULOSIS (TB) — Philippine Priority
Important facts
- Philippines has ONE OF THE HIGHEST TB BURDENS in the world — very high-yield NLE topic.
- Spread: AIRBORNE droplet nuclei (cough, sneeze, talk).
- TB is AIRBORNE, not droplet — CRITICAL for precautions.
- Pathophysiology: bacilli inhaled → lodge in alveoli → immune system forms granuloma → latent TB (usually) or reactivation → active TB.
- Cough ≥2 WEEKS is the key screening trigger in Philippine context.
Key definitions
Tuberculosis (TB)
Example
Chronic cough ≥2 weeks + low-grade fever + night sweats + weight loss = TB until proven otherwise.
Infection by Mycobacterium tuberculosis (acid-fast bacillus) spread via airborne droplet nuclei; leading cause of illness/death in Philippines; highest-yield NLE topic.
Latent TB Infection (LTBI)
Example
Close contact of TB patient with positive Mantoux test but no symptoms, normal CXR = LTBI.
Person is infected with M. tuberculosis but NOT infectious, asymptomatic; immune system walls off bacilli into granuloma; positive PPD/TST.
Active (Pulmonary) TB
Example
Productive cough ≥2 weeks + fever + haemoptysis + upper-lobe infiltrates on CXR = active TB.
Bacilli reactivate (immunosuppression, HIV, diabetes, malnutrition), causing tissue destruction & cavitation; person is infectious.
TUBERCULOSIS — Manifestations & Assessment
Important facts
- CLASSIC TRIAD (high-yield): chronic productive cough ≥2 weeks + low-grade afternoon fever + night sweats.
- Unexplained weight loss, fatigue, anorexia, haemoptysis (blood-streaked sputum).
- COUGH ≥2 WEEKS = screen for TB in Philippine setting.
TUBERCULOSIS — Diagnostics (Philippine NTP First-Line)
Important facts
- GENEEXPERT MTB/RIF: PHILIPPINE NTP FIRST-LINE TEST (primary diagnostic).
- Detects TB + rifampicin resistance in ~2 hours (rapid).
- Sputum AFB smear: collect per NTP protocol; still used for treatment monitoring.
- CXR: supports diagnosis (upper-lobe infiltrates, cavitation) but NOT confirmatory alone.
- Mantoux/PPD: READ AT 48–72 HOURS; measure INDURATION (not redness).
- Mantoux positive indicates infection/exposure but NOT active disease; can be positive in BCG-vaccinated individuals.
Key definitions
GeneXpert MTB/RIF
Example
Presumptive TB patient → GeneXpert MTB/RIF → results within 2 hours; if positive, start DOTS; if resistant, escalate to MDR-TB regimen.
Rapid molecular diagnostic test; detects M. tuberculosis AND rifampicin resistance in ~2 hours; Philippine NTP first-line primary diagnostic (has replaced sputum smear as initial test).
Sputum AFB Smear Microscopy (DSSM)
Example
Patient on TB treatment; DSSM at months 2, 5, 6 to confirm bacteriological response.
Microscopic examination for acid-fast bacilli; still used for monitoring treatment response per NTP protocol.
Tuberculin Skin Test (Mantoux / PPD)
Example
Inject 0.1 mL PPD intradermally → measure induration at 48–72 h; ≥5 mm = positive in TB contacts; ≥10 mm = positive in general population.
Intradermal injection of purified protein derivative; READ AT 48–72 HOURS measuring INDURATION (not redness); indicates infection/exposure, not active disease.
TUBERCULOSIS — DOTS & National TB Control Program (NTP)
Important facts
- DOTS PRINCIPLE: health worker directly watches patient swallow EVERY dose.
- DOTS prevents MDR-TB by ensuring ADHERENCE — the single biggest reason NOT to stop treatment early.
- TB diagnosis & full drug regimen provided FREE through DOTS.
- Non-adherence = incomplete treatment = MULTIDRUG-RESISTANT TB (MDR-TB) = much longer, more toxic regimen.
- Treatment partner (family member) can also directly observe doses if trained.
Key definitions
DOTS (Directly Observed Therapy, Short-Course)
Example
TB patient takes daily rifampicin under direct observation of health worker at clinic; ensures 100% adherence.
Backbone of NTP; trained treatment partner/health worker directly watches patient swallow every dose to guarantee adherence; incomplete treatment breeds MDR-TB.
Philippine National TB Control Program (NTP)
Example
Patient diagnosed with TB at barangay health station → referred to district TB facility → enrolled in DOTS → receives free drugs × 6 months under direct observation.
Government programme providing TB diagnosis, full drug regimen, and DOTS support FREE through public health facilities; GeneXpert MTB/RIF is first-line diagnostic.
TUBERCULOSIS — RIPE Drug Regimen (MUST MEMORISE)
Formulas
RIPE Intensive Phase (2 months) + Continuation Phase (4 months) = 6 months total
Meaning
Intensive phase = 4 drugs daily (RIPE); Continuation phase = 2 drugs daily (R + I)
Watch out
Do NOT stop after 2 months; must complete full 6 months or MDR-TB develops. Missing doses = treatment failure.
When to use
All drug-susceptible TB patients follow this standard regimen unless contraindicated.
Common values
Value
450–600 mg
Symbol
~10 mg/kg/day
Quantity
Rifampicin dose
Value
300 mg
Symbol
~5 mg/kg/day
Quantity
Isoniazid dose
Value
Variable (~25 mg/kg/day)
Symbol
Weight-based
Quantity
Pyrazinamide dose
Value
Variable (~15 mg/kg/day)
Symbol
Weight-based
Quantity
Ethambutol dose
Important facts
- INTENSIVE PHASE (2 MONTHS): 4 drugs daily — R, I, P, E.
- CONTINUATION PHASE (4 MONTHS): 2 drugs daily — R (rifampicin) + I (isoniazid).
- TAKE ON EMPTY STOMACH (best absorption) unless GI upset; single daily dose.
- R, I, P are ALL HEPATOTOXIC — monitor LFTs; teach patient to AVOID ALCOHOL; report jaundice, dark urine, nausea, RUQ pain.
- RIFAMPICIN: orange-red body fluids (harmless), reduces OCP efficacy (use barrier contraception).
- ISONIAZID: ALWAYS give PYRIDOXINE (B6) to prevent peripheral neuropathy — EXAM FAVOURITE.
- PYRAZINAMIDE: raises uric acid (gout risk).
- ETHAMBUTOL: optic neuritis risk — report visual changes immediately; baseline vision check required.
Key definitions
Rifampicin (R)
Example
Patient taking rifampicin notices orange-red urine; assure them this is normal & harmless. Also counsel to use barrier contraception because rifampicin reduces OCP effectiveness.
~10 mg/kg/day (usually 450–600 mg). Signature effect: orange-red body fluids (urine, sweat, tears) — reassure patient this is HARMLESS. Hepatotoxic; potent ENZYME INDUCER that REDUCES oral contraceptive efficacy.
Isoniazid (INH)
Example
Patient on isoniazid must receive pyridoxine (B6) concurrently; if develops tingling/numbness in hands/feet, report immediately (neuropathy).
~5 mg/kg/day (usually 300 mg). Signature effect: PERIPHERAL NEUROPATHY — ALWAYS give PYRIDOXINE (vitamin B6) to prevent. Hepatotoxic.
Pyrazinamide (P)
Example
Patient develops sudden joint pain (especially big toe); check uric acid; likely gout from pyrazinamide.
~25 mg/kg/day. Hepatotoxic; RAISES uric acid → hyperuricaemia/gout (joint pain).
Ethambutol (E)
Example
Patient on ethambutol reports blurred vision & colour blindness; STOP immediately & refer to ophthalmology; ethambutol-induced optic neuritis can cause permanent blindness.
~15 mg/kg/day. Signature effect: OPTIC NEURITIS — decreased visual acuity & RED-GREEN colour blindness. Patient MUST report visual changes immediately; baseline & periodic vision checks mandatory.
TUBERCULOSIS — Nursing Management & Priority Interventions
Important facts
- INFECTION CONTROL IS TOP PRIORITY.
- TB IS AIRBORNE — requires NEGATIVE-PRESSURE ISOLATION ROOM.
- Staff must wear N95 RESPIRATOR (NOT surgical mask) — CLASSIC NLE DISTRACTOR.
- Patient wears surgical mask during transport.
- Patient considered NON-INFECTIOUS after 2–3 weeks of effective therapy + clinical improvement + reduced cough.
- ADHERENCE IS SECOND PRIORITY — emphasise DOTS, use treatment partner, stress full 6-month completion.
- Promote nutrition, monitor drug toxicity, report to NTP for contact tracing.
- Teach cough etiquette: cover mouth, dispose tissues properly, ensure home ventilation.
- Contacts must be screened; infants in household receive BCG per national schedule.
Key definitions
Airborne Precautions (TB)
Example
Confirmed/suspected pulmonary TB admitted → place in negative-pressure isolation → staff use N95 respirators when entering → patient non-infectious after 2–3 weeks of effective treatment + symptom improvement.
Negative-pressure isolation room + N95 respirator for staff (NOT surgical mask). Patient wears surgical mask during transport. Maintained until patient is non-infectious (2–3 weeks into effective therapy + clinical improvement).
TUBERCULOSIS — Patient Teaching (Exam Favourite)
Important facts
- COMPLETE THE ENTIRE 6-MONTH REGIMEN — stopping early causes MDR-TB.
- Expect ORANGE-RED URINE/SECRETIONS from rifampicin (completely harmless).
- REPORT VISUAL CHANGES immediately (ethambutol optic neuritis) — do NOT wait.
- REPORT SIGNS OF LIVER PROBLEMS: jaundice, dark urine, nausea, RUQ pain.
- AVOID ALCOHOL completely (increases hepatotoxicity).
- TAKE PYRIDOXINE (B6) with isoniazid (prevents neuropathy).
- KEEP ALL DOTS APPOINTMENTS — do NOT miss doses.
- ENSURE HOUSEHOLD CONTACTS ARE SCREENED (TB spreads).
- Infants in household get BCG per national schedule.
- Use BARRIER CONTRACEPTION (rifampicin reduces OCP effectiveness).
- COUGH ETIQUETTE: cover mouth, dispose tissues, ensure good ventilation at home.
Must remember
- PNEUMONIA PRIORITY = AIRWAY + OXYGENATION: position high-Fowler's, give oxygen to maintain SpO2, encourage deep breathing & coughing, adequate hydration to loosen secretions. In ELDERLY, confusion/lethargy/falls may be ONLY signs — do not miss subtle presentations.
- TB IS AIRBORNE (not droplet): negative-pressure isolation room + N95 respirator for staff (NOT surgical mask). Classic NLE distractor — TB requires airborne, pneumonia requires droplet.
- PHILIPPINE NTP: GeneXpert MTB/RIF is FIRST-LINE primary diagnostic test (detects TB + rifampicin resistance in ~2 hours). Cough ≥2 weeks = screening trigger.
- RIPE REGIMEN = 2 months (R, I, P, E) + 4 months (R, I) = 6 months total. MUST complete full course or MDR-TB develops. Isoniazid ALWAYS gets pyridoxine (B6) to prevent peripheral neuropathy.
- RIFAMPICIN = orange-red body fluids (harmless), hepatotoxic, REDUCES OCP efficacy (use barrier contraception). Ethambutol = optic neuritis risk (report visual changes immediately). R, I, P all hepatotoxic — avoid alcohol, monitor LFTs.
- DOTS (Directly Observed Therapy) = health worker directly watches patient swallow EVERY dose; prevents MDR-TB by ensuring adherence; drugs & care provided FREE through NTP. Non-adherence = incomplete treatment = MDR-TB.
- CAP FIRST-LINE ANTIBIOTICS: amoxicillin OR macrolide (azithromycin/clarithromycin). Fluoroquinolones (levofloxacin) for severe/comorbid cases; watch for tendon rupture & QT prolongation. Rust-coloured sputum = pneumococcal (classic).
- STREP PHARYNGITIS = sudden sore throat + fever + tonsillar exudate + tender anterior cervical nodes + NO cough. MUST complete full antibiotic course (penicillin/amoxicillin) to PREVENT RHEUMATIC FEVER. This is the critical teaching point.
- TB PATIENT NON-INFECTIOUS after 2–3 weeks of effective therapy + clinical improvement + reduced cough. Ensure household contacts screened, infants receive BCG. Rifampicin reduces OCP efficacy — counsel barrier contraception.
- LATENT TB = infected but not infectious, asymptomatic, positive PPD/Mantoux (read at 48–72 hours measuring induration). ACTIVE TB = reactivation, person is infectious, requires 6-month DOTS. Distinguish clearly for exam.
Last minute tips
- TB precautions = AIRBORNE (negative-pressure + N95), NOT droplet. This distinction is tested every exam cycle. Pneumonia = droplet (surgical mask). Memorise this difference.
- Isoniazid ALWAYS pairs with pyridoxine (B6) — if you see isoniazid in a question without B6, the answer is usually asking you to ADD pyridoxine. Do not let this trap you.
- When you see 'cough ≥2 weeks' in a Filipino patient context → think TB first and screen with GeneXpert MTB/RIF. This is the Philippine NTP priority.
- For strep pharyngitis questions, the KEY teaching is completing the full antibiotic course (even after symptoms resolve) to prevent rheumatic fever & acute glomerulonephritis. Emphasise this in your answer; examiners love this clinical pearl.
- If a TB question mentions 'orange-red urine,' the answer includes reassuring the patient this is harmless from rifampicin. Do NOT tell the patient to stop the drug. This is a common wrong-answer trap.
Comparison tables
Upper Respiratory Infections: Quick Comparison
| Condition | Causative Agent | Key Manifestations | Management | Critical Point |
|---|---|---|---|---|
| Sinusitis | Mostly viral (sometimes bacterial) | Facial pain/pressure, post-nasal drip, nasal congestion | Supportive care; antibiotics (amoxicillin) if bacterial | Persistent >10 days or worsening = suspect bacterial |
| Pharyngitis (Viral) | Viral (non-strep) | Sore throat, mild fever, no exudate | Supportive: fluids, analgesics, warm saline gargles | No antibiotics needed |
| GABHS (Strep) | Group A Streptococcus | Sudden sore throat, fever, tonsillar exudate, NO cough | Penicillin or amoxicillin (full course); macrolide if allergic | COMPLETE FULL COURSE = prevents rheumatic fever |
| Influenza | Influenza A/B (viral) | Abrupt fever, myalgia, headache, dry cough, profound fatigue | Oseltamivir within 48 h; otherwise supportive | Complications: pneumonia (elderly, pregnant, chronic disease) |
| Acute Bronchitis | Mostly viral | Dry cough → productive, lasts 3 weeks, low-grade fever | Supportive only: fluids, rest, humidification, antipyretics | NO antibiotics (viral); teach warning signs of pneumonia |
Lower Respiratory Infections: Pneumonia vs. TB
| Feature | Community-Acquired Pneumonia (CAP) | Tuberculosis (Active) |
|---|---|---|
| Causative Agent | S. pneumoniae (most common), viral, atypical (Mycoplasma, Legionella) | Mycobacterium tuberculosis (acid-fast bacillus) |
| Transmission | Respiratory droplets (short-range); larger droplets | AIRBORNE droplet nuclei (long-range); suspended in air |
| Precautions | Droplet precautions (surgical mask) | AIRBORNE precautions (negative-pressure room, N95 respirator) |
| Onset | Acute (days); high fever, productive cough, pleuritic pain | Insidious (weeks); low-grade afternoon fever, night sweats, chronic cough |
| Cough Duration | Usually <3 weeks | ≥2 WEEKS (screening trigger in Philippines) |
| Sputum | Purulent or rust-coloured (pneumococcal) | May be blood-streaked (haemoptysis) |
| CXR Findings | Infiltrates/consolidation (lobar or segmental) | Upper-lobe infiltrates, cavitation (classic) |
| Diagnostics | CXR (gold standard), sputum Gram/culture, CBC, blood cultures | GeneXpert MTB/RIF (first-line NTP test, ~2 h), sputum AFB smear, Mantoux, CXR |
| First-Line Antibiotics | Amoxicillin or macrolide (azithromycin) | RIPE × 2 months (R, I, P, E) + R, I × 4 months (6 months total) |
| Non-Infectious After | 24–48 hours with effective therapy | 2–3 weeks with effective therapy + clinical improvement + reduced cough |
| Treatment Duration | 7–10 days (typical CAP) | 6 months (standard drug-susceptible TB) |
| Major Complication if Non-Adherent | Relapse, resistance | MULTIDRUG-RESISTANT TB (MDR-TB) — much longer, more toxic regimen |
TB Drug Regimen: RIPE Agents & Toxicities
| Drug | Typical Dose | Signature Toxicity / Effect | Monitoring / Intervention |
|---|---|---|---|
| Rifampicin (R) | ~10 mg/kg/day (450–600 mg) | Orange-red body fluids (urine, sweat, tears) — HARMLESS; HEPATOTOXIC; enzyme inducer (reduces OCP efficacy) | Reassure re: discolouration; LFTs; counsel barrier contraception |
| Isoniazid (I) | ~5 mg/kg/day (300 mg) | PERIPHERAL NEUROPATHY; HEPATOTOXIC | ALWAYS give PYRIDOXINE (B6); LFTs; teach to report tingling/numbness |
| Pyrazinamide (P) | ~25 mg/kg/day (weight-based) | HEPATOTOXIC; RAISES URIC ACID (hyperuricaemia/gout — joint pain) | LFTs; monitor for joint pain; uric acid if symptomatic |
| Ethambutol (E) | ~15 mg/kg/day (weight-based) | OPTIC NEURITIS (decreased acuity, RED-GREEN colour blindness); can cause permanent blindness | BASELINE & PERIODIC VISION CHECKS; patient reports visual changes immediately; stop drug if vision changes |
TB Diagnostic Tests: Comparison
| Test | What It Detects | Philippine NTP Role | Key Points |
|---|---|---|---|
| GeneXpert MTB/RIF | M. tuberculosis + rifampicin resistance | FIRST-LINE PRIMARY DIAGNOSTIC (has replaced sputum smear) | Results in ~2 hours; rapid; if positive → start DOTS; if resistant → escalate to MDR-TB regimen |
| Sputum AFB Smear Microscopy (DSSM) | Acid-fast bacilli in sputum | MONITORING treatment response (not initial diagnostic) | Collect per NTP protocol; read at months 2, 5, 6; negative smear = good response |
| Chest X-Ray | Upper-lobe infiltrates, cavitation | SUPPORTIVE (not confirmatory alone) | Classic TB findings = upper-lobe, cavitary; helps assess extent; monitor for complications |
| Mantoux / PPD | TB infection/exposure (induration only, NOT redness) | Contact screening, latent TB diagnosis | READ AT 48–72 HOURS; ≥5 mm = positive in contacts; ≥10 mm = positive in general population; positive in BCG-vaccinated individuals |
Diagrams
Upper & Lower Respiratory Infections: Complete Concept Map
Mind map showing the classification and key features of respiratory infections, distinguishing upper (sinusitis, pharyngitis, influenza) from lower (pneumonia, bronchitis, TB) respiratory tract infections.
TB Diagnostic & Management Flowchart (Philippine NTP)
Flowchart showing the Philippine NTP diagnostic algorithm starting with GeneXpert MTB/RIF (first-line) and the pathway to standard 6-month RIPE regimen with DOTS supervision, emphasising the critical difference between drug-susceptible and rifampicin-resistant TB.
Pneumonia Nursing Priority Interventions
Comprehensive flowchart of pneumonia nursing management priorities, emphasising airway/oxygenation first, airway clearance, antibiotic administration, and symptom management with close monitoring for complications.
TB Infection Control: Airborne vs. Standard Precautions
Flowchart distinguishing airborne precautions for TB (negative-pressure room, N95 respirator) from droplet precautions for other respiratory infections, highlighting this as a critical NLE examination point.
TB Progression: Latent to Active Disease
State diagram illustrating the progression from TB exposure through latent infection to potential reactivation as active disease, showing the critical role of immune status and the pathway to treatment vs. complications like MDR-TB from non-adherence.