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Self-Assessment Questions

Infectious Diseases

Tuberculosis: Review Questions

George J. Alangaden, MD

Dr. Alangaden is an Associate Professor of Internal Medicine, Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI.

Choose the single best answer for each question.

1. Between 1992 and 1998, the number of cases of tuberculosis (TB) in the United States declined among each of the following groups EXCEPT:
  1. Adults between 25 and 44 years of age
  2. Children younger than 15 years
  3. Persons born in foreign countries
  4. Persons born in the United States
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2. A 54-year-old woman with diabetes mellitus who recently started working as a hospital volunteer has a tuberculin skin test (TST) as part of an annual TB testing and prevention program. She had not received the BCG vaccine, nor had she been tested before. The TST reveals 5 mm of induration at 48 hours. Which of the following is the most appropriate next step in this patient’s treatment?

  1. Classify the test as positive and start therapy for latent TB infection
  2. Obtain a chest radiograph to rule out active TB
  3. Repeat the test after 2 weeks to check for a booster reaction
  4. Report the test as negative and repeat after 1 year
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3. A 36-year-old man who is a recent immigrant from a TB-prevalent country has a positive result on a TST that was performed during the course of a routine medical evaluation. He has no symptoms of TB. His chest radiograph shows no abnormalities; he is HIV-seronegative. He drinks alcohol but reports no intravenous drug use. Each of the following treatment regimens for latent TB infection in this patient is appropriate EXCEPT:

  1. Isoniazid 300 mg daily for 6 months
  2. Isoniazid 300 mg daily for 9 months
  3. Rifampin (10 mg/kg body weight) daily for 4 months
  4. Rifampin (10 mg/kg) and pyrazinamide (15-20 mg/kg) daily for 2 months
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  4. A 26-year-old nursing aide in the second month of her pregnancy is evaluated for a 4-week history of fever, night sweats, and cough. A chest radiograph shows infiltrates in the apex of her right lung. A sputum examination reveals a few acid-fast bacilli. Which of the following is the most appropriate treatment?
  1. Administer isoniazid, rifampin, and ethambutol for 9 months
  2. Administer isoniazid, rifampin, pyrazinamide, and ethambutol for 6 months
  3. Administer isoniazid, rifampin, pyrazinamide, and streptomycin for 6 months
  4. Wait until the second trimester before starting anti-TB therapy
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5. A 35-year-old man admitted to the hospital because of a chronic cough and low-grade fever receives a diagnosis of pulmonary TB. Laboratory tests at the time of admission showed seropositivity for HIV. He begins therapy with isoniazid, rifampin, pyrazinamide, and ethambutol with prompt clinical response. When he is evaluated in the clinic 2 weeks after his discharge from the hospital, he has a CD4+ cell count of 52/mm3 and a plasma HIV RNA level of 500,000 copies/mL. Antiretroviral therapy with zidovudine, lamivudine, and indinavir is initiated, and his rifampin is changed to rifabutin. He is readmitted to the hospital 3 weeks later with high fevers. His chest radiograph now reveals intrathoracic lymphadenopathy and worsening lung infiltrates. His sputum Gram stains, acid-fast bacillus stains, and sputum and blood cultures are negative for any organisms. Which of the following is the most likely diagnosis?

  1. Drug-resistant tuberculosis
  2. Immune reconstitution
  3. Non-Hodgkin’s lymphoma
  4. Rifabutin hypersensitivity
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