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  #1  
Old 06-20-2012
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Question PPD again

A 60-year-old nurse at a local hospital has had annual tuberculin skin testing for 10 years. His last PPD a year ago was 5 mm. Today he presents at 72 hours for reading of his PPD placed earlier in the week. He is
healthy and denies any health problems; particularly no fevers, sweats, or weight loss.

This is an employee health check, and therefore no physical exam or other information is obtainable.

Laboratory:
PPD at 72 hours: 16 mm
CXR: Normal

Based on the data presented, which of the following should be done next?

A. Start INH 300 mg daily for 9 months
B. No treatment because he is older than 35 years old
C. 4-drug therapy because he is high risk, being in a hospital environment
D. If he is also HIV positive, you would start INH 300 mg daily for 12 months
E. Repeat PPD in 2 weeks; if still positive, then start therapy
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Old 06-20-2012
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I think INH prophylaxis for 9 months.
there is no reason for repeating PPD as once its positive it will always be positive.
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Old 06-20-2012
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Ideally
obtain a chest xray --- if +ve --- start 2HRZE +4 HR ie complete 6 month treatment

if CXR is -'ve ---- start with 9 month INH

in this patient--
newly positive PPD but no clinical symptoms are given in the history...
so most probably it is just exposure?

so i'd go with A- start INH for 9 months







B. No treatment because he is older than 35 years old --- definitely wrong
C. 4-drug therapy because he is high risk, being in a hospital environment -- cannot confirm diagnosis based on given info to treat
D. If he is also HIV positive, you would start INH 300 mg daily for 12 months -- dont think this is correct
E. Repeat PPD in 2 weeks; if still positive, then start therapy -- done only for person who is receiving PPD for first time
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Old 06-21-2012
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The next step after a positive PPD should be to do a chest xray to determine :
if there's PTB in which case you treat with the 4 drug regimen or
if no chest involvement in which case you treat for latent TB with isoniazid for 9 months.

Whatever, the case you have to treat positive PPD either as active or as latent. Normal Chest Xray means it's latent so A.
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Old 06-22-2012
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Help

Like almost everyone has said, answer is to give INH for 9 months along with Vit B6 (never forget this in your life guys) even if not given in the answer choices make sure your brain always links INH + Vit B6.

If the chest X Ray was not done then the next best step in management would'be to do that and then depending on what is found either INH or the triple drug regimen
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Old 06-22-2012
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Quote:
Originally Posted by XpaezX View Post
Like almost everyone has said, answer is to give INH for 9 months along with Vit B6 (never forget this in your life guys) even if not given in the answer choices make sure your brain always links INH + Vit B6.

If the chest X Ray was not done then the next best step in management would'be to do that and then depending on what is found either INH or the triple drug regimen
If this where Facebook, i would click on LIKE...
And also, the CXR would be the best next step, i could change the management
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