Infectious disease/ skin Flashcards

1
Q

Common cx pneumonia in alcoholics

A

Klibsielal

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2
Q

Pneumonia with influenza predispsoses to?

A

Staphj aureus pneumonia

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3
Q

flu-like symptoms, bilateral consolidation and erythema multiforme, painful vesicles in ear, renal impairment, low platelets

A

Mycoplasma - to serology. TX: doxycycline/ erythromycine/ clindamycin

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4
Q

Derranged LFts, flu like SX, cough, bradycardia, lymphopenia, confusion low sodium

A

Legionella - erythromycin/ clarithromycin. confirm urinary antigen

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5
Q

fishy smell’ down below. Microscopy reveals the presence of clue cells.

A

Gardnerella vaginalis - 5 days metronidazole 400mg BD

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6
Q

fever, malaise, and myalgia, which may precede the appearance of painful vesicular eruptions in the genital area.

A

Herpes Simplex

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7
Q

Campylobacter enteritis TX

A

Clarithromycin

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8
Q

Salmonella/ shigella TX

A

Ciprofloxacin

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9
Q

Pelvic inflammatory disease TX

A

Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole

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10
Q

Animal or human bite TX abx

A

Co-amox (allergy - doxy and metronidazole)

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11
Q

Mastitis during breast feeding?

A

Fluclox

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12
Q

Meningitis tx summary: if
meningoccocal?
if <3m or 50+
if listeria suspected?
when to start dexamethasone?
What to give contacts?

when to delay LP?

what could suggest cryptococcal meningitis?

A

IV cefotaxime, if <3 months or 50+ add amoxicillin (or ampicillin).
If meningococcal - ben pen or cefotaxime.
listeria give IV amoxicillin and gent.
IV dex before abx, avoid in septic shock, in sus pneumococcal meningitis in adults

contact: Oral ciprofloxacin or rifampicin for 7 days

delay LP: GCS<12, focal neuro sx, papilloaedema, seizures continued

cryptococal meng - high opening pressure LP, sex worker, AIDS, yeast and capsule in CSF stained with india ink

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13
Q

Painless genital ulcers causes?

A

Syphilis (single) - Treponema pallidum.
Lymphogranuloma venereum (LGV) - cuased by chlamydia, tx doxycycline.
donovanosis (granuloma inguinal)
multiple - HPV warts

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14
Q

Unilateral, painful inguinal lymph node enlargement. with single painful genital ulcer? sharp, jagged border

A

Chancroid - Haemophilus ducreyi (painful, patients do cry)

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15
Q

Tetanus vaccine uk?

A

2, 3, 4 months
3-5 yrs,
13-18 yrs

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16
Q

Cellulitis TX

A

flucloxacillin,
allergy - macrolide such as clarithromycin or erythromycin or another medication such as doxycycline.

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17
Q

UTI TX in pregnancy women

A

tx asap 7 days first-line: nitrofurantoin (should be avoided near term)
second-line: amoxicillin or cefalexin
trimethoprim is teratogenic in the first trimester and should be avoided during pregnancy

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18
Q

GE with short intubation period and severe vomitting no diarrhoea

A

Staphylococcus aureus

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19
Q

GE incubation period of 3-4 days and causes diarrhoea that usually becomes bloody, lasting up to a week.

A

E-coli

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20
Q

48-72 hrs GE A flu-like prodrome, crampy abdominal pains, fever and diarrhoea which may be bloody
May mimic appendicitis
Complications include Guillain-Barre syndrome

A

Campylobacter - tx clarithromycin

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21
Q

HIV patient, hepatospenlomegaly, pneumonia signs, clear chest. cx?
tx?

A

Pneumocystitis jiroveci. Need broncheolar lavage, TX co-trimoxazole. Risk pneumothorax. need proph abx if cd4 <200.
tx: co-trimoxazole. consider steroids if hypoxic

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22
Q

lymes disease progression? early (in 30 days. late?
and tx?

first line test?

A

early: erythema migrans 1-4 weeks after, painless, malaise, arthralgia.

later: heart block, peri/myocarditis. :neurological:
facial nerve palsy,radicular pain,meningitis.

TX:
doxycycline / amoxicillin - in pregnancy/allergy as doxy is CI./ if disseminated - ceftriaxone

IX: ELISA antibody to borrelia burgdorferi. if neg and still sus, do in 4-6 weeks after

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23
Q

Flu sx, raised, red painful rash on legs and face?

A

erysipelas- Flucloxacillin* (clarithromycin, erythromycin or doxycycline if penicillin-allergic)

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24
Q

ID cx: difficulty in breathing and swallowing. A grey coating surrounding the tonsils, fever, and cervical lymphadenopathy, travel to india

A

Diptheria - can present with cranial nerve sydfunction. IM penicillin

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25
Q

pneumonia cx: worsening flu-like symptoms and a dry cough. Erythema multiforme is noted on examination. Infective changes on CXR

A

Mycoplasma pneumoninae

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26
Q

URTI SX, given amoxicillin then got rash? DX? lymphadenopathy, raised ALT,

A

EBV/ glandular fever. do monospot test, do FBC and LFT (lymphocytosis, raised ALT, haemolytic anaemia)

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27
Q

Fishy discharge, clue cells. allergic to penicillin

A

Metronidazole if not allergic/
topical clindamycin for BV

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28
Q

Cellulitis - abx for pregnant and pen allergy?

A

pregnant - erythromycin
Pen allergy - clarithromycin

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29
Q

Syphillis stages?
6-10 weeks after?
tx?

A

painless chancre on penis, local painless LN, men / or lesion on cervix

6-10 weeks: fevers, LN, snail track buccal ulcers, condulomata lata (painless warty lesions on genitalia, rash on trunk and arms

risks: aortic aneurysms, gummas, tabes dosalis - neuro issues/ bladder issues/ muscle wasting, argyll-robertson pupil

Normal: IM benzathine penicillin
or doxyclycine (not in pregnancy)
Common reaction - fever, tachy, fever no wheeze. (jarisch herxheimer reaction)

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30
Q

Non-bloody diarrhoea, fatty stools, 15 days after exposure, bloating, flatulent

A

Giardiasis is caused by the flagellate protozoan Giardia lamblia. Swimming anal sex etc. chronic - risk of low vitamins, malnoutrition

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31
Q

purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)

A

Kaposi’s sarcoma - radiotherapy/ resection. Caused by HHV 8.

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32
Q

malaise,headache and mild abdominal pain. Constipation, bloated, sparse, macular rash on chest. CX of GE?

what are other complications?
common risk in sickle cell disease?

A

Salmonella typhi - enteric fever (constipation and rose spots), low HR

risks: osteomyelitis (esp sickle cell), GIB, meng, cholecystitis,

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33
Q

single painless ulcer with small lymphadenopathy/ then 2 months later widespread maculopapular rash and ulcers in mouth, systemic features

A

Stages of syphillis, trepenoma pallidum.

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34
Q

t2DM on SGLT2 - dapagliflozin, painful and numb to touch in perineum, purple rash with bullae

A

Necrotising fascitis / fournier’s gangrene (in perineum)
other type - t1DM post op

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35
Q

what are the live vaccines? (MY BOOTI)

A

MMR, yellow fever, BCG, ORal polio, oral rotavirus, typhoid, intranasal influenza

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36
Q

Tx for toxoplasmosis in immunocompromised ppl?

A

Pyrimethamine and sulphadiazine are management options for immunocompromised patients. complications: chorioretiinits, seziures, anaemia

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37
Q

multiple painful blisters and ulcers around her labia. She has been feeling like she has the flu for the past five days. It is extremely painful when she urinates.

A

Herpes simplex

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38
Q

oral ulcers, genital ulcers and uveitis. Venous thromboembolism is also seen.

A

Small cell vasculitis, behcet’s

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39
Q

Chlamydia treatment? pregnant ?

A

Doxycycline 7 days, if pregnancy - erythromycin, azithromycin,

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40
Q

Dry cough, target lesions around trunk, works in school?
CXR?

A

Mycoplasma pneumoniae (erythema multiforme)
CXR: reticulo nodular shadowing of right lung

41
Q

URTI in CF, hot tub folliculutus, otitis externa in diabetics, UTIs.

A

Pseudomonas aeruginosa

42
Q

EBV associated malignancies?

A

Burkitt’s lymphoma*
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas

43
Q

non tender LN with cats at home, unwell, fever, sore throat? How does neuro manifestation of this condition present?

A

toxoplasmosis:
in HIV aids - most common is neuropsych/ hemiperesis/speech abdnormality

44
Q

dysentry, no sx, liver mass from recent travel?

A

AMoebiasis
tx - metronidazole, uss

45
Q

urticarial rash on body swimming in thialand lake, very unwell generally, myalgia ?

A

shistosomiasis

46
Q

malaria detected by

A

giesma stained thicka nd thin blood films

47
Q

typhoid fever characteristics?

A

7-14 post ingestion
fever worsens over day and gets better by morning
1st week: GI sx, truncal blanching/ inflamed peyers patches and maculopapules
week2: splenomegaly, brady cardia
week3: abdo distension, pea soup diarrhoea, nectroic peyers pathces lead to perforation/ peritonitis
IX: bone marrow culture

48
Q

face flushing, chills, skin mottling before fever on 3rd day lasting 5-7 days. children get fever that gets better for 1 day then returns. bleeding from gums/ melena/ haemorrhagic effects

A

Dengue fever cx aedes mosquitos
need serology
raised antibody titre in apired IGG/ IGM

low patelets, leukopenia

also: abdo pain, hypotension, restlessness,

49
Q

aplastic anaemia?

marrow criteria and film critera?

cx?

A

bone marrow failure with peripheral pancytopenia, marrow hypoplasia (marrow criteria)
film criteria:
neutrophil <0.9, platelet <20
reticulocyte <1%
bimodal age distribution

cx: autoimmune, infections, anti drugs (abx, anti cancer, antiepileptic, antithyroid, antiemetic, anticancer, antihyperglycaemics

SX: bleeding, anaemia, infections

50
Q

allergic contact dermatitis and tubercilin tests example of?

A

Type 4 sens. lymphocytes, secondary cellular response

51
Q

erythema nodosum is an example of what type of hypersensitivity?

A

type 3: immune complexes, activate complement and cause local damage

52
Q

Causes of haemolytic anaemia/ features?

A

jaundice, anaemia, splenomegaly

Autoimmune - warm (IGG, cold IGM
Microangiopathic haemolytic anaemia - DIC, ITP, TTP,
inherited: G6pd (x linked

53
Q

21YO, genetic disorder. changed diet recently - has ataxia/ collapsing attacks after rash on face, arms and legs, becomes anxious/ emotional/ aggressive?

A

hartnup syndrome (AR).
attacks normally happen from 3-9YO. this is rare. need high protein diet.

54
Q

is AO and AB parent have children could they be blood gorup o/

A

no absence of A/B give O group. AB can donate to anyone

55
Q

explain blood group donation?

A

a can donate to AB and A
B can donate to AB and B
O can donate to anyone
AB can receive from anyone but only donate to AB
O can donate to anyone

56
Q

what is sideroblastic anaemia ?

A

body produces iron but is not able to put into HB. iron accumulation in the mitochondria of erythoid precursors

57
Q

ESR in sickle cell?

A

low bc unable to form rouleax

58
Q

post splenectomy, what infections ar eu most likely to get?
Shin Skis

what vaccines do you get?

A

spleen protects against encapsulated microbes
SHIN SKIs
step pneumoniae
h influenzae
neisseria meng
Group B strept
klibsiella
salmonella tphyi

vaccines:hib, pneumococcl, meningococcal, annual flu

59
Q

Likelihood of getting down’s syndrome?
20/ 30/ 40/ 35/ 40/ 45?

A

20:1/1500,
30:1/800,
35: 1/270
40: 1/100
45: 1/50+

60
Q

Child recurrent sinusitis, chronic diarrhoea, URTI, / has reactions to IVG / transfusions?

A

selective immunoglobulin IGA deficiency

61
Q

classic malaria symptom re fever?

A

fever paroxysm: suddenly cold, with rigor then fever and sweating

62
Q

when does rash appear for lyme disease?
Cx?
TX?

A

7 days post bite, unwell, fever, neuro sx.
CX: borrelia burgdorferi
TX: doxycycline 14-21 days (CI pregnancy)/ amox then cefuroxime
<12 YO: amoxicillin then cefuroxime

63
Q

undiagnosed neuro condition is CI to which vaccine?

A

MMR

64
Q

25YO hiv+, diarrhoea, ziehl neelson cysts on stool sample

A

cryptosporidiosis

65
Q

what is passive and active immunity?

A

passive - provide IGG., short lived
active - acquired/ natural exposing body to antigen to respond

66
Q

erythematous, well demarcated warm plaque sharp border 6cm upper arm, malaise, fever 48 hours. skin biopsy: beta-haemolytic group A streptococcal infection in the upper dermis.

abx tx?

A

ersyipelas - flucloxacillin

67
Q

farmer, high fever, sweating. several black blisters which produce foul smelling discharge. cx organism?

A

clostridium perfringens - can cause gas gangrene and haemolysis

68
Q

infection from canned foods and honey
prevents acetylcholine (ACh) release leading to flaccid paralysis

A

clostridium boutilism

69
Q

Impetigo abx tx?

A

topical hydrogen peroxide/ orial fluclox or erythromycin if widespread

70
Q

GE causes: sudden vomiting and non blood D, with short intubation period?

similar to above but presents in children < 5

N+V cramp like pain, bloody D, longer intubation 3-4 days, abdominal crmaping??

A

sudeen GE - norovirus. resolve within 72 hs

child <5 - rotavirus

3-4 day intubation epriod = ecoli

appendicitis like: cambylobnacter. tx clarithromycin

71
Q

B/G chlamydia with RUQ pain, low grade fever. negative pregnancy test, negative KUB and urine dip neg.

A

Fitx-hugh curtis (perihepatitis) caused by chlamydia, PID

72
Q

complications of chlamydia?
IX/DX

A

epididymitis
pelvic inflammatory disease
endometritis
ectopic pregnancies
infertility
reactive arthritis
perihepatitis (Fitz-Hugh-Curtis syndrome)

IX: women - vulvovaginal swba first line
men - urine. 2 weeks after exposure

TX: doxycycline 7 days. if CI - azithromycin
pregnanct: azithromycin/ erythromucin/ amox

73
Q

sore throat, fever, LN anterier and posterior neck. bruises in mouth, raised ALT, haemolytic anaemia. tried amoxicillin for URTI but got rash? cx?

AF/ other sx?

when to sx resolve?

DX?

A

glandular fever - EBV/HHV4
AF: splenomegaly, palatal petechiae, rash after pencillin, haemolytic anaemia (cold agglutin IMG), rash after penicllin. low socioeconomic status

sx go in 2-4 weeks

DX: monospot (heterophil antibody)

74
Q

hx of sickle cell disease, low platelets, HB, WBC (all cell lines), recent febrile illness. now has petechiae and bruises over trunk and limbs.

DX?

aplastic slaptastic crisis?

A

parvovirus b19 - pancytopenia - also causes slapped cheek

75
Q

Jarisch herxheimer reaction seen in?

A

this is fever, rash after first abx dose.
syphillis, lymes, glandular fever

76
Q

Exposure to hep C tx?

A

do monthly PCR, if seroconversaion give interferon+- ribavirin

77
Q

Person with incomplete course of hep B vaccine is exposed to a positive hep B patient, how do we treat?

if we don’t know the exposed blood was hep b positive?

A

not responder if anti-HBs <10 in 1-2 months post immunization.
give hep B IG and booster vaccine.
if unknown source - give vaccine / accelerated vaccine

78
Q

Person immune to hep b already and a responder exposed to patient with Hep B positive?

what if unknown exposure?

A

give booster or consider giving booster if unknown source

79
Q

post exposure HIV tx?

A

oral antiretrovirals within 1-2 hrs, but could be started up to 72 hrs after for 4 weeks. do testing at 12 weeks after completion

80
Q

most common cx of bronchiectasis exacerbations/ acute epiglottitis/ CAP?

A

Haemophilus influenzae

81
Q

cx of penumonia - erythema multiforme, normocytic anaemia?

A

mycoplasma pneumoniae

82
Q

UTI tx men/ pregnant? non pregnant?

when to send urine culture?

when to give prophylaxis

A

nitro/trim 3 days.
do MSU in 65+/ visable/ non visable haematura/ men
tx in asymptomatic pregnany women

pregnant/ men/ catheter - 7 days.

83
Q

farmer with initial mild flu like sx red eyes.
then unwell with AKI. cx?

DX?

tx?

A

leptospirosis
first subconjivical haemorrhages, flue. then aKI/ hepatitis/ asceptic meningitis

DX?- serology (antibodies after 7 days), PCR, CSF

leptospirosis tx: doxy/ azithromycin then IV benpen if severe

84
Q

Complications of hep B?

immunisation of hep B schedule?
how to test for hep b repsonse?

A

chronic hep, HCC, GN, polyateritis nodosa, crytpoglobulinaemia

child - 2,3,4 months, occupational workers
test for occupation exposure: do anti HBs. is 100+ - adequate response. give booster in 5 yrs
10 -100 - sub-optimal response, give another dose. no testing needed
<10- test for past infection/ give 3 doses again. no response then consider HB1G

85
Q

BV - pathogen?

Amsel’s criteria for dx?

tx?

risks if BV in pregnancy?

how does trichomonas rpesent?

A

gardngerella vaginalis

amsel’s - 3+ of thin white discharge, clue cells, ph 4.5+, positive whiff

tx: metronidazole if sx 5-7 days/ 2g metronidazole if adherence issue. topical clindamycin.

pregnany risks: chorioamniotis, late miscarriage, LBW, preterm labour

TV: frothy, yellow green, vulvovagintis, strawberry cervic, motile trophozoites

86
Q

common cx of infection in animal bites?

A

strepococci spp, staph A, eikenella, fusobacterium, prevotella

87
Q

Which antimalarial should be avoided in someone with hx of depression/ epilepsy and taken weekly?

which one is photosensitive?

which should be given with folate supplementation

A

mefloquine (mental health)

photosens - doxycylcine

folate with proguanil

88
Q

cx of coup/ bronchiolitis

common cold cx?

pneumonia cx likely in smokers?

IECOPD most common cx?

A

croup - parainfluenza, bronch - RSV
cold - rhinovirus
smoker’s pneumonia - streptococcus pneumoniae

IECOPD - haemophilus influenzae

89
Q

Cellultiis tx? if pen allergy? if pregnant?

when to consider admitting?

A

fluclox,
po clarithromycin ( if allergy). erythromycin if pregnant

eron class 3-4 (sepsis/ systemic upset or co-morbilities, vasc compromise, lymphedema, facial cellulitis, frail or <1yr

90
Q

HBsAG positive how long what does it mean?
Anti hbs?. anti hbc?

A

HBsAg - acute disease (present for 1-6 months)
> 6 months then this implies chronic disease (i.e. Infective)
Anti-HBs immunity/ exposure. negative in chronic disease
Anti-HBc previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months
HbeAg - infectivity

91
Q

risks of chronic hep C (6 months)

A

rheumatoid, sojrens, cirrhosis, HCC, cryoglobulinaemia, porphyria cutanea tarda
memranoproliferatvie GN

92
Q

Tetanus when to give booster/ ig?
what is clean wound

A

clean:Wounds less than 6 hours old, non-penetrating with negligible tissue damage

if 10yrs +/ unknown/ not vaccinated - give booster regardless. if high risk/ tetanus prone - give IG

93
Q

Complications of mycoplasma penumonia?

A

haemoyltic anaemia (igM)
erythema multiforme, erythema nodosum
GBS, bullous myringitis (painful vesicles on Tympanic membrane)
GI - hep/pancreatitis
acute GN

94
Q

young man, painful blisters and ulcers on penis, unprotected sex. dysuria and pruritus. malaise dx? tx?

mx in pregnancy?

A

genital herpes. aciclovir. HSV1 and 2
genital warts - HPV 6 and 11

recurrent eps less severe. other first sx: inguinal LN, urine retention

DX: NAAT. HSV serology if unknown cause of ulcer

pregnant - if 28weeks+, C-s. if recurrent, suppressive therapy

95
Q

Sx of metronidazole with alcohol?

A

disulfiram like reaction - head and neck flushing, N+V, sweating, headache, palpatations

96
Q

Tx of genital warts?

A

HPV 6+ 11
topical podophyllum (for multiple non keratinised)/ cyrotherapy (single keratinised)
imiquimod topical (2nd line)

97
Q

before giving BCG vaccine, what to test?

A

tuberculin test in anyone over 6YO who have had no contact with TB.
CI: HIV, pregnancy, positive tuberculin, past TB,

98
Q

HIV DX tests and screening.
when would you test in asymptomatic patients? if negative and still sus?

A

p24 antigen (1-4 week) and HIV antibody (4-6 weeks after infection positive).
no sx: do 4 weeks after possible exposure. if negative, repeat test at 12 weeks

99
Q

Worker in africa, incidental CXR of 2cm calcified nodule in mid right zone, non smoker.

A

TB latent - ghon complex
TX: RI - 3 months (I+P) or 6 months ISOniazid +Pyridoxine