Delusional
Forum Elite
Topics: 41
Posts: 226
|
A 38 year old male presents to u for a routine Physical when he was noticed to have a 6mm induration on PPD test. He is HIV -ve and has no history of contact with Tb.
What is your next step in management?
1...Retest the patient with another PPD in 2 weeks
2...Order a CXR
3...Start treatment with 300 mg INH per day
4....perfrom a PPD on all his close contacts
5...Inform the patient that his indurtion is insignificant and would not require treatnment
|
| prep4usmle
Administrator
Topics: 289
Posts: 1,196
|
Inform the patient that his indurtion is insignificant and would not require treatnment
___________________
••• Support our forum » Upgrade to premium membership!
|
| Delusional
Forum Elite
Topics: 41
Posts: 226
|
That was fast...hehe
No ..... order a CXR..
Isn't a 6mm induration significant if the patient has old signs of TB on his CXR?
|
| prep4usmle
Administrator
Topics: 289
Posts: 1,196
|
Hi,
I don't see in q "old signs of TB on his CXR"
That was fast too!
___________________
••• Support our forum » Upgrade to premium membership!
|
| Delusional
Forum Elite
Topics: 41
Posts: 226
|
You don't have to......
for any patient with an induration of > 5 mm , it wld only be significant if the patient had
1..HIV
2..H/O contact with an active Tb case
3..Organ Transplant or steroid user
4..CXR showing signs of old healed Tb
all these wld qualify for the INH 9 month Treatment
and everything for this patient had been excluded except for the CXR...
so that is why it has to be next
if then all these in such a patient turn out to be -ve
then the next step in any patient is to make sure this wasn't a false negative and repeat the test in 2 weeks :wink:
|
| prep4usmle
Administrator
Topics: 289
Posts: 1,196
|
Tricky question.
Yes you need to have a look on his lungs.
In fact, any PPD skin test should be performed and interpreted only in healthy, asymptomatic individuals with a negative chest X-ray for active tuberculosis.
So without a CXR nobody can say that the 6mm is negative or positive for this case.
Thanks!
___________________
••• Support our forum » Upgrade to premium membership!
|
| Delusional
Forum Elite
Topics: 41
Posts: 226
|
Hi
Yes......you are right.....good try though... :wink:
|
| prep4usmle
Administrator
Topics: 289
Posts: 1,196
|
Let go with the same case, CXR is normal but he has a 16 mm induration.
What should you do?
___________________
••• Support our forum » Upgrade to premium membership!
|
| Delusional
Forum Elite
Topics: 41
Posts: 226
|
Good one.... i wld go for 3 AFB sputum analysis
|
| Delusional
Forum Elite
Topics: 41
Posts: 226
|
Well since he is asymptomatic ..... going for AFB when he has 16 mm isn't useful.....(ur right Prep) ...just a normal CXR and start INH 9months
no age cut off here......
Well how about this Question.......
He is HIV +ve and he shows no response.......what do u do next?
|
| smitha
Forum Elite
Topics: 53
Posts: 236
|
Though the HIV+ve pt.s show no response, which we call it "anergy", they still r at high risk for TB. so, u give them the t/t !!!!!!!wat do u say,del?
|
| Delusional
Forum Elite
Topics: 41
Posts: 226
|
Good Reply Smitha.....
But don't you think that it isn't worth it giving an HIV+ve patient who just turned HIV +ve a few moths ago treatment.....
So the next step isn't treatment.... next step is to determine if he has significant HIV disease and that is et a CD4 count.....if < 300 then cutaneous anergy is possible......
and Treatment with INH should be given....
Keep on thinking of scenarios with this patient and posting them.... this way they can never trick you with the PPD on the test.....lol
Okay take this one......
The same patient with 16 mm PPD test and abnormal CXR......
and take this one.......
4 year old child with h/o contact with a TB case...... PPD = 2 mm
|
| smitha
Forum Elite
Topics: 53
Posts: 236
|
Ok del.......this HIV pt. with 16mm induration & CXR abnormal...i guess, we need to do a 3 AFB sputum analysis, to check out for any active ds. now or not............if positive, start treatment, with all 4 drugs!!!!!!
And to add to this, if the pt. was symptomatic, with 16mm induration, we don't even need to wait for CXR to be done, we can start the t/t.
This 4 yo girl, with 2mm ppd, needs to be started on INH immediately for 3months.........then repeat PPD , if still <5mm, continue INH for 6 more months.......if neg, stop it........
And y is it that u need to be strict with children.........they have every chance to lan up in TB interstitial pneumonitis, & Meningitis.........
Is that ok?????? 
|
|
|
if he is HIV positive n skin test is negative then one should do skin test for candida i guess to rule out if its true negative or not. n if skin test is negative n there are no symptoms in HIV positive patient then wait n see.
|
| Delusional
Forum Elite
Topics: 41
Posts: 226
|
Nice one guest ..sorry for the delay
Yeah ..candida skin testing or dermatophyte skin testing is useful to check if the cell immunity is intact... thank u
|
|
| |
| | | | | | | | | | | | | | | |
Similar forum topics