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Old 06-15-2011
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Lungs When is PPD test considered positive?

A 38 year old male presents to u for a routine Physical when he was noticed to have a 6mm induration on PPD test. He is HIV -ve and has no history of contact with Tb.
What is your next step in management?

1...Retest the patient with another PPD in 2 weeks
2...Order a CXR
3...Start treatment with 300 mg INH per day
4....perfrom a PPD on all his close contacts
5...Inform the patient that his indurtion is insignificant and would not require treatnment
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Old 06-15-2011
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its 2..to order cxr
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Old 06-15-2011
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depends on nationality of patient If of asian origin then nothing to worry if he is cuacasian with no travel history then order a cxr
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Old 06-15-2011
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there is no risk factor and the induration is not significant

role 5, 10 , 15 mm

if patient is health care worker( or other risk group ) i would go for 1 to repeat PPD ( TWO stage testing )

but also confuse about last one which number 5 NOT SIGNIFICANT INDURATION
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Old 06-15-2011
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Knowing how to read PPD tests is definitely important for Step 2.

The following is combined info from both UW and Kaplan:

induration >5
considered pos in:
-HIV
-recent exposure
-immunocompromised
-signs of TB on xray

induration >10
considered pos in:
-recently emigrated from TB endemic area
-at risk health worker (prison, homeless shelter)
-injection drug users
-children under 4
-teens exposed to high risk people
-DM, CKD, fibrotic lung disease, hematologic malignancy

induration >15
considered pos in:
-healthy people without risk factors

What to do when the PPD test is positive?

-do CXR, if neg do ppx
-if pos, do 3 sputums, if one is pos, treat for active TB, if not, do ppx
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Old 06-15-2011
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i think 1...Retest the patient with another PPD in 2 weeks
cuz no risk factor
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