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_ A family physician cares for a family consisting of a 45-year old husband, 43-year-old wife and a 12-year-old daughter. The family reports that recently the 77-year-old maternal grandmother who lived with them died after a prolonged respiratory infection. Autopsy subsequently confirms that she had active pulmonary tuberculosis at the time of death. The organism tested sensitive to all anti-tuberculosis drugs. In responding to the grandmother's illness, which of the following is the most appropriate step in management?
A. Obtain leukocyte counts on all family members
B. Obtain sputum cultures for acid fast bacilli
C. Obtain chest computerized tomograms on all members
D. Place protein purified derivative (PPD) test on all members
E. Schedule bronchoscopy lavage for the adults
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_ Hi manni, i will post the ans in the late of tonight.
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its D. +PPD at 5mm in these pts
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PPD+ if
+5mm in HIV,
+10mm in Ppl with TB exposure risk (Health care workers, the family in above case),
+15mm in 0 risk Ppl (not in Health care, etc)
Am I correct?
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PPD +ive
5mm: very high risk pts (HIV, close contact of active TB, chronic steroid use, immunocompromised, organ transplant)
10mm: high risk (Iv drug user, poverty, immigrants from high TB areas, healthcare workers, prisoners, nursing, homeless, pts w delibitating diseases)
15: general population
==> 5mm in these people
CXR if +ive PPD
-ive: latent TB - 6month INH prophylaxis
+ive: sputum induction: -ive prophylaxis; +ive 4 drug therapy
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nguoimientay,, the prophylaxis, these days is for 9 months , no longer 6 months
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Explanation:
The correct answer is
D. The immediate step is to screen the family for TB exposure. The most effective manner in which to accomplish this is by placing PPDs on all members and working up those with a positive test. The white cell count may be elevated for a variety of reasons and would not necessarily help in diagnosis or management (choice A).
Sputum cultures will take 6 months to grow and may be too cumbersome to obtain (choice B).
Chest CT scans may show the tuberculosis lesion but a more effective method would be to place the PPD and perhaps then scan those with a positive test (choice C).
A bronchoscopy would be too invasive an option at this point (choice E).
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