Question

Mr. McCallahan is an 81-year-old resident of a private retirement complex. He has been very active and healthy until recently. He passed his last physical (almost a year ago) with “flying colors.” Mr. McCallahan has reported to the resident nurse with complaints of increasing fatigue over the last two months and loss of appetite. He reports that he “just don’t feel like doin’ nothin’.” He also complains of an increasingly frequent cough and some chest pain. He tells the nurse that this morning after coughing quite forcefully into his handkerchief, it seemed to be tinged with blood.

Laboratory Diagnosis

A sputum sample collected in a sterile specimen cup revealed acid-fast bacilli. Based on this information, the laboratory issued a tentative diagnosis and proceeded to concentrate the sample to achieve quicker growth of a culture. This technique uses N-acetylcysteine to dissolve mucus, combined with the antibacterial effect of a weak sodium hydroxide solution to kill less-resistant normal flora. The material is filtered, neutralized and inoculated to selective Lowenstein-Jensen media. This specimen was also plated directly onto antimicrobial-containing media for susceptibility tests.

Which of the following is the most likely diagnosis of Mr. McCallahan's condition?  

		Pertussis
		Bronchitis
		Tuberculosis
		Pneumonia

In the United States which of the following can be used in diagnosing a case of TB? (Give all correct answers).

		X-ray or CT scan of the lungs
		Xpert MTB/RIF PCR test
		microscopic examination of sputum smears
		tuberculin skin test

True or False? A significant factor in the increase of TB in the United States in recent decades is increased susceptibility by those with HIV infection.

True

False

Which of the following is likely to be included in the treatment of patients with active TB? (Mark all correct answers.)

		Simultaneous multi-drug therapy
		Long term antimicrobial therapy of 6 months or more
		A switch from first-line drugs to second-line drugs in cases of drug resistant strains.
		Initial 3-6 week therapy with penicillin

True or False? Worldwide, the incidence of TB is declining significantly and rarely do individuals die of TB today.

True

False

Answer 1

1.Which of the following is the most likely diagnosis of Mr. McCallahan's condition?  

		Tuberculosis

2.In the United States which of the following can be used in diagnosing a case of TB? (Give all correct answers).

All the given answers are valid for testing TB in United states, except CT. Most relevant ones are sputum testing with tuberculin testing and Xpert MTB/RIF PCR test.

		X-ray or CT scan of the lungs
		Xpert MTB/RIF PCR test
		microscopic examination of sputum smears
		tuberculin skin test

3.True or False? A significant factor in the increase of TB in the United States in recent decades is increased susceptibility by those with HIV infection.

True

Low immunity status is the main cause of this illness, so more cases are found in patients affected with HIV.

4.Which of the following is likely to be included in the treatment of patients with active TB? (Mark all correct answers.)

Multi drug therapy for 6 months or more , in which intensive therapy with 3 first line drugs or more in the first 8 weeks. Then continue the treatment with INH and Rifampicin for 18 weeks. A switch from first line to second line drugs is done in drug resistant TB cases.

So the answers are:

		Simultaneous multi-drug therapy
		Long term antimicrobial therapy of 6 months or more
		A switch from first-line drugs to second-line drugs in cases of drug resistant strains.

True or False? Worldwide, the incidence of TB is declining significantly and rarely do individuals die of TB today.

True

Improved over all health of the individuals, educational status and developments in medical technology and treatment modalities have led to decreased incidence of TB cases. Even though detected with TB, they can get the best treatment and cure is sure, so TB deaths are rarest of the rare.