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Author15 Posts
  #1

30 yr old male PPD skin test done induration >15mm

next best step??

1) start with INH prophylaxis

2) do chest X ray to rule out active disease and then start with prophylaxis

3) do chest X ray and three consecutive sputum specimen to rule out active disease and then start with prophylaxis?





  #2

3?



  #3

3


  #4

1
CAN T.B. hide itself?


  #5

i'll go for 2.


  #6

if the chest x-ray is normal-prophylaxis.

if the chest x-ray is abnormal then do three consecutive sputum specimens. if positive then give 4 drug TB therapy. if negative, give INH prophylaxis.



  #7

Acchilles you are right. I.e. I was wrong.


  #8

happens to all of us msyamp...and this is just one of those rare moments when you got a question wrong !!smiling face you usually get all of them right...and mesh still hasnt given the answer so i guess we should still wait.





  #9

thank you all....

i dont have the ans...came up with this question myself.

thnks achilles for the explanation.....now i think its 2.....earlier it was 3 on my mind....

thanks....

theres another related query but from different topic....about screening of prostate cancer....

---60yr old patient ...DRE rock hard prostate......wat is the next step..??

1) PSA

2) biopsy....

thanks once againsmiling face















  #10

it is PSA. biopsy is done later and also not very sensitive.



  #11

PSA is the wrong answer

Understand how to answer a question in 45 seconds.

1. PSA is not specific or sensitive or diagnostic

2. Pt. is over 60 years old

3. hard rock solid mass

4. prostate cancer is very prevalent and pts do DIE !!

So what is the answer !!

What do you do with a high PSA ?

What do you do with a low PSA ?

What they really want to ask you is PSA is actually called prostate non-specific antigens?



Please remember the rules of engagement in examination.

It is a real war out there to score 100% perfect score and you got to understand what's going on?

Understand means real understanding of the sensitivity and specificity of PSa and what yoy do with PSA. Read and study Kaplan !





  #12

2


  #13

I will go wth 3 as PPD test can be +ve in pts who had TB in the past or those who are immunised wth BCG.
--------------------------------------
if u wonder how to do a job , get started and wonder how u did it !


  #14

In U.S. it is considered that BCG vaccine does not make the PPD test positive. So I'll go with 2.


  #15

Hi Folk
TB is coming back
first of all the PPD is (5 -10 -!5)
based on the risk factors like in HIV pt w/ PPD of 5mm start PPX w/ INH
In any Open Pulmonary TB ( 3 consecutive AFB in adults and in kids Early gastric specmien as they can not spit -up) u do for KIDS INH PPX REARDLESS of their PPD status or their chest x_ray as those in close contacts and u suppose to Iolate that Open TB untill u get 3 Neagtive AFB , in adults it depends on the age If more than 35 Yrs most likely u give the PPX if under u can follow -up w/ x_rays and AFB as the INH has too many Complications and the immune System under 35 can fight aganist and localise he infections
For more Details look at ( boards and Wards very good Expalntion there ) for the QS u mention the Answer is # 2 ( x _ ray and PPX ) even us when u work for A hospital that is exactly what u should do PPD neagtive done
PPD borederline or positive >>>> ( X_ray ) if _VE (INH PPX x9 months
IF positive ( 3 consecutive AFB IF POSITIVE 4 drugs regimen if all Negative ...INH ppx for 9 months if u are > 35 yrs or if< 35 yrs u can go either NO PPX and serial follow _up or INH ppx for 9 months ( Big Board concept know that it on every board know the Algogrthym. Good luck Every one





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