MDcooper
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A 24 year old asian immigrant at 6 weeks gestation comes for the first prenatal visit.She has no history of serious illness,She doesnot smoke tobaccco,alchohol,or drugs.She takes vitamin supplements ,she takes no other medication.Lab studies show a negative DRL,positiv erubells titre,negative hepatitis serology and normal pap smear.She completed her MMR vaccinations as a child.PPD test shows an induration of 12mm.Which of the following is the most appropriate next step?
A.obtain FTA-ABS t rule out syphilis
B.obtain chest xray
C.start isoniazid and pyridoxine
D.start isoniazid ,rifampin and ethambutol
E.Reassurance and routine antenatal care
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| study_ing
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B. PPd positive means u have to get a CXr to decide on treatment regimen, i think.
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| MDcooper
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Can we do a chest Xray at this early stage of pregnancy?
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| cvgmdbe
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we cannot do chest xray in first trimester.
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| krsna
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why not D?
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| Guptashutosh
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ANC is no contraindication for anti TB , and she definitly have TB start with INH , Rif and Ethambutol - D
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| Guptashutosh
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Before that get an sputum for AFB
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| yasmeen
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x ray can b taken with abdominal shield ppd is,nt enough for diagnosis b is correct
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| goodyear
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Risk factors for this pt: Asian immigrant, PPD 12mm induration
Treatment should be initiated whenever the probability of TB is moderate to high. Untreated TB represents a greater hazard to pregnant woman & fetus than does its treatment. Even if the drug regimen crosses the placenta they do not have harmful effects on the fetus. Initial Tx. should be INH & Ethambutol & Vit B6 x 2 mos then INH & RIF daily or 2x weekly for 7 mos.
Streptomycin is C/I, PZA not used bec. of its unknown fetal effects.
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| cirrus
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most of asians are pdd+ve as they contract infection during child hood.i think cxr is the next step as it can be done after first trimester
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| bikerdoc
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According to USMLE world.....Radiation -diagnostic is prohibited less than 2 wks gest....risk is minimal after 6 wks....high to moderate 2-6wks....so I am guessing CXR is the best option and yes most Asians are PPD+ve (ask me..lol) since we get innoculated with BCG vaccination also.
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| farewel
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ANSWER IS C.
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| mjl1717
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I say shieild the uterus the best you can. And get CXR.
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| judy
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positive test :
recent immunization
previous TB test
past exposure to the disease
suggest a need for further test
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