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Chapter 75. Tuberculosis

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SJ is a 42-year-old man who has a yearly purified protein derivative (PPD) skin test performed because he works at a long-term care facility. Forty-eight hours after the PPD test was placed, he had a 12-mm area of induration. This is the first time he has reacted to this test. His chest radiograph is negative. Which one of the following is appropriate in view of SJ’s PPD response?

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A. No treatment is necessary and SJ should have another PPD test done in 1 year.

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B. Another PPD test should be performed in 1 week to see if this is a booster effect.

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C. SJ should be monitored closely, but no treatment is necessary because he is over 35 years of age.

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D. SJ should be started on isoniazid 300 mg daily for 6 months.

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What LTBI treatment regimen should be recommended for patients who have a positive IFN-γ test and have been exposed to isoniazid resistant TB?

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A. Isoniazid and rifapentine for 3 months

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B. Isoniazid, rifampin, and ethambutol or pyrazinamide for 4 months

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C. Rifampin for 4 months

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D. Rifampin for 6 months

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Treatment for an HIV-positive patient with TB should:

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A. Be delayed until the patient’s CD4 count is more than 1000 cells/mm3 (109/L)

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B. Be at least 6 months

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C. Consist of higher doses of antituberculosis medications

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D. Be initiated 6 months after antiretroviral therapy is started

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Rifabutin should be chosen over rifapentine or rifampin when a patient is being treated for TB and is on certain combined antiretroviral therapy (cART) regimens because it:

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A. Has a better side effect profile in HIV-positive patients

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B. Is less likely to induce hepatic clearance of the cART drugs

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C. Has a lower risk of anterior uveitis in HIV-positive patients

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D. Is easier to obtain serum concentrations of rifabutin

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A 70-year-old HIV positive Vietamese man was recently infected with M. tuberculosis 3 months ago. He is a current smoker and has a history of IV drug use. His past medical history includes small cell lung cancer, hypertension, ...

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