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qq - raheem
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12-05-2011, 08:44 PM
#1 A 37-year-old health care worker had a PPD skin test reactive at 17 mm ten years ago at the end of her internship. She never took the recommended isoniazid. What is appropriate for this patient? (A) Do nothing (B) Start isoniazid for the next nine months © Perform a single PPD now (D) Yearly chest x-rays (E) Two-stage PPD testing
12-06-2011, 04:08 PM
(A) Do nothing
Explanation: If the patient had not developed tuberculosis because of the previous exposure, she is not going to now. A positive skin test confers a 10% lifetime risk of developing tuberculosis. Almost all of this is within the first two years of developing a positive reaction. There is no point in giving a patient isoniazid now to prevent tuberculosis that would have happened years ago after the initial exposure. Once a tuberculosis skin test is positive, there is no point in ever repeating the test. It will always be positive. There is no benefit to yearly chest x-rays in anyone. Two-stage PPD testing is performed in those who have either never been tested before or who had negative skin tests in the past and it has been longer than a year since the last positive test. The two-stage test is to confirm that the first test is truly negative. |
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