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Chief Complaint

“I keep coughing and have lost so much weight. I need help”

History of Present Illness

HJ is a 22-year-old female who presents to urgent care with complaints of persistent dry cough with occasional flecks of thick white sputum and significant unintentional weight loss of 30 lb. (13.6 kg) over the last 7 weeks. Her COVID-19 and influenza testing are negative, and she was initially prescribed a course of doxycycline for suspected community acquired pneumonia. Based on her symptoms, radiologic and laboratory results, her physician now recommends that she start treatment for active pulmonary tuberculosis and her provider has contacted the local health department.

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. In patients with suspected active pulmonary Mycobacterium tuberculosis (MTB), what are the ATS/CDC recommended standard medication(s) and duration of treatment? How would this differ if the patient was also diagnosed with HIV?

    Hint: See Table 79-4 and Treatment in PPP

  2. What doses of standard therapy for active tuberculosis would you recommend for this patient?

    Hint: See Table 79-5 in PPP

  3. What laboratory monitoring from a safety standpoint would you recommend while on TB therapy?

    Hint: See Table 79-5 in PPP

  4. How do medications from standard therapy for active tuberculosis impact liver enzymes differently?

    Hint: See Treatment in PPP

  5. If suspecting hepatotoxicity from standard TB therapy, what adjustments to therapy would you recommend?

    Hint: See link to current treatment guidelines for tuberculosis (


Patient was placed in airborne isolation. Three induced sputum specimens were acid fast bacillus (AFB) stained, revealing organisms that were identified 6 weeks later (by culture and molecular typing) as Mycobacterium tuberculosis resistant to isoniazid (INH). How does this information change your recommended drug combination and duration of drug therapy?

Hint: See Treatment in PPP


Global Perspective

Though there is a cure for this preventable disease, Mycobacterium tuberculosis infects approximately one-third of the world’s population. Tuberculosis (TB) is contagious and can be spread from person to person through the air. The nonspecific signs and symptoms like cough, fevers, and night sweats are usually mild on disease onset, and result in the delay of care while increasing the number of those who are infected. Without the appropriate treatment, up to two-thirds of those infected with TB will die. Overall, the highest incidents of active TB patients reside in India, Southeast Asia, and Sub-Saharan Africa.

People infected with the Human Immunodeficiency Virus (HIV) are a particularly vulnerable population, resulting in significant morbidity ...

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