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A 29-year-old physician returns from a project wit - resi_hopeful
#1
A 29-year-old physician returns from a project with Doctors Without Borders in Guatemala. He is required to have a tuberculin skin test (PPD) before he returns to work in the United States. His last PPD test was 2 years ago and was negative; he is currently asymptomatic and denies exposure to patients with active tuberculosis. A tuberculosis skin test is performed 6 weeks after his return from Guatemala. Three days later the area has a 14-mm area of erythema and induration of 11 mm.
Should the physician be treated for latent infection?

A.No, because he is asymptomatic
B.No, because his induration does not exceed 15 mm
C.No, because the test was done too early; he needs a repeated PPD test 12 weeks after exposure
D.Yes, because an induration &8805;10 mm is considered positive in health care workers
E.Yes, because an induration &8805;5 mm is considered positive in health care workers
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#2
dd
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#3
can someone revise tb ppd...

shudnt this pt take an X-ray and see if it is active or inactive...then decide..

or do we only take an X-ray when pt is symptomatic....
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#4
you take X-ray to check for active disease and thats after you have a positive PPD test

but if you have a negative PPD test and still suspect TB like from risk factors and sx, do AFB sputum stain
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#5
so in this pt, who comes from guatemala.. is considered high risk... so if that was the choice we wud choose afb sputum...

so is it true, that if pt is high risk...without X-ray, asymptomatic pt, we can go ahead and start isoniazid...
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#6
this pt has latent infection and yes you do X-ray next but the vignette doesn't describe that stuff so since he's already proven to have latent infection, you treat it......but outside the vignette ..you do X-ray to check for active disease and if found you start the RIPE therapy.
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#7
if non active disease.... isoniazid


active....ripe...


great, thanks...
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#8
This pt visited guatemala (endemic region) and he's healthcare worker too (2 risk factors) so first you do PPD test

Latent infection is asymptomatic but you still gotta treat so you test for it with PPD test... You do X-ray only if its positive to check if active disease present.
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#9
great, thank u....
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#10
Additional info

http://gyazo.com/6e905beabc010dbed71cedbf13c78a6b
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