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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
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B. and repeat ppd in 3 months
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does cavitatory TB will be high risk? y not c?
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if it is not C then WHY they did CXR on him, because if the answer is C then we need the CXR
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where are this questions from ?
can you please tell us.
thank you
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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.
