neo335
Forum Elite
Topics: 39
Posts: 174
|
24y F asian immigrant comes in for ante checkup at 6 wk gestation.her work up reveals a PPD of 12 mm. the next step wud b?
i missed this.. it shud b CXR coz she falls under the >10mm category (immigrant) 
the Qs is that in the explaination they hav said := undergo a CXR to see if there is any lesion or not. If the lesion is present n pt asympt, she shud start on INH n B6 prophy. if CXR is negative, no workup is necessary.
however kaplan/ fisher has said that pts with a neg CXR meaning no active disease or a +ve CXR but negative sputum sample do need INH n B6 for 9 mo...
dont these explanations conflict.. or am i making a mistake in interpreting them?
thanking u n wishing u the best for ur exam
|
| Justice
Forum Fanatic
Topics: 117
Posts: 2,323
|
I am also confused with this, but my personal opinion is no work-up is necessary if CXR shows no lesion.
___________________
Don't live in a town where there are no doctors
|
| nadiabarati
|
with a positive PPD we do CXR to rule out ACTIVE tuberculosis. If there is no active we must go for prophylaxis based on positive PPD, with INH for 9 months.
|
| neo335
Forum Elite
Topics: 39
Posts: 174
|
hmm... a mixed response... anyone else? y dont these USMLE ppl make themselves cklear about things as imp as TB !!! 
|
| vradojc1
Forum Elite
Topics: 21
Posts: 309
|
nadia is right. CXR is done to exclude active TB which needs to be treated accordingly (usualy four drug regimen since resistance in present in >80% of US population). If no active TB is found LTBI is "treated" with 9 months of INH+B6 (6 months can be used as well if patient is not <18 years old and/or HIV+) or rifampin for 4 months, or Rifampin+PZA for 2 months (the last regimen is the least active and should be used only as alternative)
|
| vradojc1
Forum Elite
Topics: 21
Posts: 309
|
Correction, resistance is present in the >80% of the US area (not population).
|
| coolmavs
Forum Guru
Topics: 37
Posts: 570
|
Guys, not to add to the confusion, but is the prophylaxis for 6 mths or 9 mths, since I seem to be remembering 6 mths from the Gyn lecture for some strange reason, while the consensus over here is 9 mths?
___________________
You know my creds........
|
| vradojc1
Forum Elite
Topics: 21
Posts: 309
|
9 months is preferred and if offered pick that one!
|
| neo335
Forum Elite
Topics: 39
Posts: 174
|
yes.. its 9 mo so as to include the HIV +ve pts into the picture.. thus they have decided as 9mo for everyone.
|
| coolmavs
Forum Guru
Topics: 37
Posts: 570
|
2005-06 kaplan notes states explicitly that PPD+ and CXR- --> 6 months Anti-TB prophylaxis with INH & B6.
___________________
You know my creds........
|
|
| |
| | | | | | | | | | |
