vyseerx
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sulia robets 19 years old college junior from west virginia comes for annual checkup. she does not have fever, nightsweats , cough with expectoration . she admits to have several sexual partners and had wild nights. her HIV status is negative. her mantoux is 8 mm induration. what do you do?
a.start prophylaxis
b.dont start prophylaxis
c.wait for symptoms to develop
d.advice life style change
e.start on 4 drug therapy, since highrisk behaviour
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vyseerx
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| TONY PAUL
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d.advice life style change
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| vyseerx
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bravo tony, need some reading on PPD testing. remember this is highyield
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vyseerx
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| ANISHA
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answer is b
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| mahendra
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what is the correct ans? vyseerx
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| TONY PAUL
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Ok, now because she is having multiple patners, that puts her on the risk with TB and her mantox is 8, so I will take another guess and say answer is (A), I believe --- C/D/E are all wrong.
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| zaki
Forum Guru
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well she had a positive MT, as low risk popn the cut off point is >5, if her CXR is normal and her sputum AFB is negative she required tx of her positive ppd test. which is INH for 6months.
so the answer is A 
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Maverick
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| vyseerx
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C'MON ZAKI, you can't be serious! you are from the subcontinent, and you dont have an idea of PPD! MANTOUX (PPD) is considered positive if there is 10 mm induration. it is considered positive for low-risk group if it is 15 mm induration. iit is considered positive for HIV patients at 5 mm induration. sulia has many sexual partners, and that is it, she is not HIV positive, vignette never told that she is, and on the other hand it has clearly told the mantoux is just 8 mm induration. so, the answer is DONT START PROPHYLAXIS!
and yeah, TONY, does having multiple sexual partners put one at risk of TB? well, it certainly puts one at the risk of contracting HIV along with other STD diseases. sure, TB is many more times common in HIV pateints than normal population,but then, i am afraid that you can not EXTRAPOLATE like that.vignette asks , what do you want to do regarding her prophylaxis? answer is a clear no. DONT START ON PROPHYLAXIS
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vyseerx
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| zaki
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ohh sorry you are right :wink:
and in place of high risk i type low risk, thanx for correcting me.
thats clearly negative ppd and no need to give prophylaxis at that time.
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| TONY PAUL
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Now with all due respect, Mr. Vyseerx Sahib!!
you might be right with the answer, but quest. ask what do you do
not what do U do about the prophylaxis? I know in Usmle they do play with the words, so in a way, it's nice tricky quest.. but thanks for the answer!!
sulia robets 19 years old college junior from west virginia comes for annual checkup. she does not have fever, nightsweats , cough with expectoration . she admits to have several sexual partners and had wild nights. her HIV status is negative. her mantoux is 8 mm induration. what do you do? a.start prophylaxis
b.dont start prophylaxis
c.wait for symptoms to develop
d.advice life style change
e.start on 4 drug therapy, since highrisk behaviour
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| vyseerx
Forum Guru
Topics: 165
Posts: 378
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hi tony, got the point!
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| FarEastGrapplerMD
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oh no... im from west virginia... i think i know this girl - lol
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| fried water
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I STILL DIDNT GET IT WHY TONY CANT BE RIGHT AT THE FIRST PLACE.. YOU CAN STILL ADVICE HER LIFESTYLE CHANGE COZ SHE SURE IS @ HIGH RISK OF CONTRACTING HIV... ATLEAST TRY YOUR BEST DOCS... :-S STOP HER FROM HAVING ALL THE FUN DURING THOSE WILD NIGHTS WHEN WE ARE CRAMING FO STEP 2 :'(
.. I WUD STILL CHOSE 'D' .. MAYBE I AM A LIL JEALOUS HERE 
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