04-18-2011, 01:51 PM
A 34-year-old Honduran man comes to your clinic for a follow-up visit. He was diagnosed with pulmonary tuberculosis with two sputum samples showing acid-fast bacilli (AFB). He was started on anti-tuberculosis medications five weeks ago, and has improved clinically. The last set of AFB in sputum is negative. He is gaining weight. His appetite has improved. His night sweats have disappeared, and his cough has decreased; however, he is complaining of a progressive shortness of breath for the past six days. His temperature is 36.7 C (98 F), blood pressure is 120/76 mmHg, pulse is 80/min, and respirations are 18/min. Physical examination reveals decreased breath sounds and dullness to percussion on the left base of the thorax. A chest x-ray is done, which shows a new left pleural effusion. Which of the following is the most appropriate next step in his management?
A. Stop anti-tuberculosis medication
B. Add one second-line anti-tuberculosis drug
C. Start a work-up for multidrug resistant (MDR) tuberculosis
D. Do a thoracentesis
E. Add broad-spectrum antibiotics
A. Stop anti-tuberculosis medication
B. Add one second-line anti-tuberculosis drug
C. Start a work-up for multidrug resistant (MDR) tuberculosis
D. Do a thoracentesis
E. Add broad-spectrum antibiotics