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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...
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.the question is:
1)Which of the following is the most likely diagnosis of Mr. McCallahan's condition?
Pneumonia
Tuberculosis
Pertussis
Bronchitis
2)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
tuberculin skin test
microscopic examination of sputum smears
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
False
4)Which of the following is likely to be included in the treatment of patients with active TB? (Mark all correct answers.)
A switch from first-line drugs to second-line drugs in cases of drug resistant strains.
Initial 3-6 week therapy with penicillin
Simultaneous multi-drug therapy
Long term antimicrobial therapy of 6 months or more
5)True or False? Worldwide, the incidence of TB is declining significantly and rarely do individuals die of TB today.
True
False
