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  1. #1
    hunteradam07 is offline Permanently Banned 511 points
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    Tb question for those who dare!

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    40 yo healthy female without hx of exposure to TB or previous TB condtions. Live in a suburb and got her PPD test. 72hrs later came back for PPD result which shows 12mm indurated area. What is the next appropriate step?

    A. Observe
    B. CXR
    C. INH for 6 mons
    D. INH for 9 mons
    E. 4 drugs treatment for 8 weeks








































































































    Answer is A. Observe. I have no idea why, but according UW it's depend on the size and risk of exposure to be + for TB with PPD. Ya i thought u do CXR too. I dont get this concept so if someone get it, be kind to explain.

  2. #2
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    MAGIC to remember is
    what they do
    what they have/suffer
    contact

    So if they are health care worker then the magic number is 10mm to be + for TB

    If the patient has AIDS or any other disease that weekends the immune system then the magic number to be + is 5mm.

    If the patient is someone that WAS NOT suppose to be check for in the first place like that patient, someone with no HX of exposure etc then magic number is 15mm

    That is why they did not went for Xray, if she was 15mm then the correct answer could have been Xray in those options and then Tx for 9 months

    I could be wrong!!!
    Moderator: USMLE AND Residency Forums.

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    why even bother with the obvious. Just know where you are need it and where you can help the most.

  3. #3
    monketteyax is offline Newbie 510 points
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    Quote Originally Posted by IMG SURVIVOR View Post
    MAGIC to remember is
    what they do
    what they have/suffer
    contact

    So if they are health care worker then the magic number is 10mm to be + for TB

    If the patient has AIDS or any other disease that weekends the immune system then the magic number to be + is 5mm.

    If the patient is someone that WAS NOT suppose to be check for in the first place like that patient, someone with no HX of exposure etc then magic number is 15mm

    That is why they did not went for Xray, if she was 15mm then the correct answer could have been Xray in those options and then Tx for 9 months

    I could be wrong!!!


    No, You're right. If you remember the numbers 5,10,15, you can't go wrong
    5mm-Immunocompromised paitents (AIDS, immunosuppressed)
    10mm-High risk populaitons (especially medical health care workers...thats YOU! lol)
    15mm-Low risk populations (your average person)

    Since this paitent has no history of travel to endemic places or risks for Tb exposure, a PPD of 12cm is acceptable and they shouldn't be subjected to radiography on INH treatment because there is no need

  4. #4
    Residenttutor is offline Newbie 510 points
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    Everyone seem to have it right on the money to OBSERVE this patient.

    There's really no need to add to this, however here are some more common type of tuberculosis CK questions (4) you are bound to get. If you can answer these ones, you really don't need to worry about checking your TB concepts again before your exam. See below for how to obtain answers.


    Q-1
    A 27-year old man gets a PPD skin test as he starts his medical residency. He is originally from India and has never been tested before. He has 12 mm of induration and a normal chest x-ray. He had BCG vaccination as a child and a booster at the age of 24. What should be your next step?


    A. You apologize for doing the test and say, “Oops! People with previous BCG vaccination should not be PPD tested!”
    B. Check three sputum acid-fast stains
    C. Repeat the PPD the following year
    D. Give him isoniazid and vitamin B6 for 9 months.

    Q-2
    A 38-year-old, HIV-positive woman finds out that someone at her workplace has tuberculosis. Her PPD at employee health is negative. Her chest x-ray is now normal, and her PPD last year was negative. What should you do next for her?


    A. Nothing further is required
    B. Repeat the PPD in 3 months
    C. Start INH and stop in 3 months if the PPD is negative
    D. Start INH for a full 9 months
    E. Yearly chest x-rays

    Q-3
    A 77-year-old man comes to your office for a PPD reading. The patient recalls being told he was PPD-negative 30 years ago. The patient has a history of hypertension, ischemic bowel disease, and gastric cancer, and his medications are prednisone 20 mg daily, multivitamins, and losartan. The patient denies exposure to anyone with active tuberculosis and has lived in Queens, New York, his whole life. He is a retired stockbroker and now works in a homeless shelter. He denies drinking alcohol or smoking tobacco but admits to occasional prostitute relations. You measure an area of erythema of 18 mm and an induration of 11 mm. His chest x-ray is normal. What would your next course of action be?

    A. Nothing further is necessary
    B. INH for 6 months
    C. INH for 9 months
    D. Repeat the PPD in 1 year
    E. Check three sputum acid-fast stains

    Q-3
    A 46-year-old man comes to the clinic with a fever, cough, and 20-lb weight loss over the past 10 weeks. The chest x-ray shows a right middle lobe infiltrate with ipsilateral hilar lymphadenopathy. The sputum acid-fast stain is positive. Mycobacterium tuberculosis is identified by polymerase chain reaction (PCR). His medications are lamivudine, zidovudine, and ritonavir. His CD4 count is 224/μL with an undetectable viral load. The rate of isoniazid resistance is documented to be 6% in his community. Which regimen is the best while waiting for drug susceptibility?

    A. INH, rifampin, and pyrazinamide for 2 months, followed by INH and rifampin for 4 months
    B. INH, rifampin, and streptomycin for 6 months, and substitute nevirapin for lamivudine
    C. INH, rifabutin, pyrazinamide, and ethambutol for 6 months, and substitute efavirenz for ritonavir
    D. INH, rifabutin, and pyrazinamide for 2 months, followed by INH and rifabutin for 4 months
    E. Stop all HIV medications until the treatment for tuberculosis is complete


    If you need answers to them in a jiffy drop me your response at ([email protected]).

    I'm a resident, private tutor with years of experience tutoring step 2 & 3 both for kaplan and with over 400 students, and with excellent scores in the chicago area.

  5. #5
    CSREVIEW is offline Newbie 510 points
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    5/10/15 is all you need

  6. #6
    Residenttutor is offline Newbie 510 points
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    If that's all you need CSREVIEW, then I sincerely wish you all the best.
    However, if you're seeking knowledge & insight into basic USMLE Step 2 CK & 3 Tuberculosis concepts like those addressed in questions above then I implore you to avoid narrow-ended thinking and endeavor to broaden your clinical thinking. The latter has been the key to great success for those who have in the past & recently excelled on the boards.

    I say this to you because every student start off wanting to do really well. However, the road to success is never paved in gold rather upheavals and challenges. How we prepare will determine how we get to finish line.

  7. #7
    offdan is offline Newbie 510 points
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    just observe

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