Question 1

A patient who diagnosed with human immunodeficiency virus (HIV) infection has a negative tuberculosis skin test with induration less than 10 mm. The provider learns that the patient lives with a person who has active tuberculosis. What is the next step in managing this patient?

A) Begin empirical antibiotic therapy.
B) Order a chest radiograph.
C) Perform an interferon gamma release assay.
D) Refer to an infectious disease specialist.

B

Accepted Answer

A chest radiograph is recommended to rule out active tuberculosis in an HIV-positive patient with a negative skin test but significant exposure to TB.

Question 2

A provider is concerned that a young child may have latent tuberculosis infection (LTBI). Which test will be performed initially to screen for this infection?&#10;A) Chest radiograph&#10;B) Interferon gamma release assay&#10;C) Mantoux test&#10;D) Two-step TST

Accepted Answer

The Mantoux test is the initial screening tool to diagnose LTBI in a child. It involves injecting a small amount of purified protein derivative (PPD) intradermally in the forearm and observing the area for any reaction after 48-72 hours.

Question 3

A 25-year-old patient has a tuberculosis (TB) skin test which reveals an area of induration of 12 mm. The patient is a recent immigrant from Mexico and lives in a homeless shelter. What is the recommended treatment for this patient?

A) Administer the bacillus Calmette-Guérin (BCG) vaccine
B) Begin isoniazid (INH) preventive therapy
C) Order isoniazid (INH) and Rifampin
D) Perform regular TB skin testing every few months

B

Accepted Answer

A TB skin test induration >10mm in a recent immigrant from a high TB incidence country living in crowded conditions such as a homeless shelter indicates a positive result that makes this patient eligible for INH preventive therapy. The BCG vaccine is not indicated for treatment and is not commonly used in the United States. Ordering INH and Rifampin is not indicated for a positive TB skin test without evidence of active TB disease. Regular TB skin testing every few months is not indicated in this patient, as a positive TB skin test indicates latent TB infection and routine testing is not necessary.

Deck 214: Tuberculosis