The PPD
prepared by C.Chong
Goal
— the rational use of the PPD
|
Learning 1. epidemiology of 2. indications for screening 3. interpretation – comorbidities, BCG, risk 4. prophylaxis – when and |
Readings
Cases
Answer
the FIRST FIVE questions in the City
Health Information handout. ANSWERS
Now
answer the following questions.
1. An 18 year old male comes comes to your office for a physical examination prior to
starting college away from home. PPD is
listed under optional tests. Should you
plant a PPD? ANSWER
2. A 26 y.o.
female newly immigrated from Mexico has a +
PPD; she is also pregnant. She never had
a TB test before. She otherwise has no
other medical problems. What is your
management? ANSWER
3. A 47 y.o.
diabetic has 11-mm induration at the PPD site. The chart states “negative PPD” 1 year
ago. What is your plan? ANSWER
4. A 37 y.o.
male’s room mate was diagnosed with active TB last week. He is well but concerned about his risk. What do you offer him? His records indicate he was PPD negative 3 years ago. You plant
a PPD and it is negative. What advice do
you give him? ANSWER
5. A 40 y.o.
female with SLE x 15 years has been on chronic steroids for the past three years. She presents with a 10 lb weight loss, night
sweats and cough with occasionally blood-tinged sputum for 3 weeks. What is your differential? What tests do you request? Her CXR shows hilar
adenopathy, right apical streaking and
? a right cavitary lesion. Her PPD is negative. What is your plan? ANSWER
6. A 39 y.o.
who immigrated from China three years ago presents with
a cough and 14-mm PPD. The CXR is
negative. What is your plan? ANSWER
7. A 39 y.o.
health care worker has an employment physical which requests TB testing. She recalls a + PPD “years ago” and being
told never to repeat the test. She is
clinically well. What do you do? ANSWER
8.
A 43 y.o. IVDA presents for a physical prior
to entering a residential rehab program.
He is otherwise well. Should a
PPD be planted? The PPD is 6 mm. What do you plan? ANSWER
9.
You are working in HIV clinic with continuity patients who are doing
well on their cocktail. Your boss is mad
because a chart audit revealed their last PPD’s were
2 years ago. Is your boss just picking
on you? ANSWER
10. Mr. T was hospitalized for
CHF and COPD on 3E. The medical student
sent sputum for AFB because his CXR didn’t clear completely and he had a h/o a cough productive of blood flecked sputum. 6 weeks later, it is positive. What now?
ANSWER
