Ques - ira3 - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 3 (https://www.usmleforum.com/forumdisplay.php?fid=6) +--- Thread: Ques - ira3 (/showthread.php?tid=817330) Pages:
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Ques - ira3 - ArchivalUser - 11-08-2015 149) A 29 year old internal medicine resident physician has been exposed to a patient with cavitary pulmonary tuberculosis 1 month ago. He denies any symptoms. His physical examination is normal. A tuberculin skin test reaction is positive now at 6mm. His Skin test one year ago was negative. A chest X-ray is within normal limits and chemistry panel is normal. The most appropriate management optiuon for this patient is : A) Isoniazid, Pyrazinamide, Rifampin and Ethambutol for 9 months B) Observation as ≥ 10mm is considered positive in health care workers C) Isoniazid for 9 months D) Rifampin for 9 months E) Isoniazid for 6 months 0 - ArchivalUser - 11-08-2015 cc 0 - ArchivalUser - 11-08-2015 B. and repeat ppd in 3 months 0 - ArchivalUser - 11-08-2015 does cavitatory TB will be high risk? y not c? 0 - ArchivalUser - 11-09-2015 b 0 - ArchivalUser - 11-09-2015 if it is not C then WHY they did CXR on him, because if the answer is C then we need the CXR 0 - ArchivalUser - 11-09-2015 where are this questions from ? can you please tell us. thank you 0 - ArchivalUser - 11-09-2015 I go with B 0 - ArchivalUser - 11-10-2015 from archer 0 - ArchivalUser - 11-10-2015 It's not B because the cutoff is lower in health and prison workers. After treatment they receive follow-up chest x-rays If the patient gets any side-effects (i.e., vivid dreams) on Isoniazid (unrelated to B6 deficiency) you'd do LFTs, THEN switch them to Rifampin. This mans you remember to advise them about orange/red bodily fluids, and any meds they're taking metabolized through the cyp-P450 (especially OCPs), and monitoring liver enzymes. IIRC, LFTs rising to 5X their baseline is the cut-off for stopping Rifampin. The orange/red bodily fluids is not a side effect. It's because the drug is suspended in something orange/red. A harder question would be which drugs can't you give during pregnancy. |