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Old 07-02-2011
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Question 2 year old boy recently adopted

A 2 year old boy was recently adopted from Haiti. He appears to be healthy, and there are no abnormal symptoms. His weight and height are at the 25th percentile. His examination is normal. On screening you find a positive TB skin test using purified protein derivative (PPD) with 20 mm induration. He has history of receiving BCG vaccine at birth. Your management plan is which of the following?

A. Obtain chest x-ray and treat only if abnormal
B. Obtain a chest x-ray and initiate prophylactic treatment with Isoniazid
C. Repeat the test in 3-6 months
D. Attribute the positive PPD to the BCG vaccine and do serial yealry x-rays
E. Obtain sputum cultures
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  #2  
Old 07-03-2011
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Answer.B.Obtain a chest x-ray and initiate prophylactic treatment with Isoniazid
*BCG never causes PPD>20 mm
*sputum obtaining from a 2-year-old guy is quite difficult.
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Old 07-03-2011
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answer is b
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Old 07-05-2011
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Answer is B. Induration >10 mm is considered positive in children at greater risk of exposure to TB (age<4 years, lymphoma,diabetes or children born in high-prevalence areas). Radiographic evaluation of all children with a positive Tuberculin test is recommended. Children with latent Tb should receive phophylaxis usually 9 month of INH.
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