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 UW question.280  



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Author14 Posts
  #1

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





  #2

B. PPd positive means u have to get a CXr to decide on treatment regimen, i think.



  #3

Can we do a chest Xray at this early stage of pregnancy?


  #4

we cannot do chest xray in first trimester.


  #5

why not D?


  #6

ANC is no contraindication for anti TB , and she definitly have TB start with INH , Rif and Ethambutol - D


  #7

Before that get an sputum for AFB


  #8

x ray can b taken with abdominal shield ppd is,nt enough for diagnosis b is correct


  #9

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.


  #10

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


  #11

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.


  #12

ANSWER IS C.


  #13

I say shieild the uterus the best you can. And get CXR.


  #14

positive test :
recent immunization
previous TB test
past exposure to the disease


suggest a need for further test





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