NBME Step 2 CK Form 8 Begin isoniazid and vitamin B6 therapy (NBME Answers)

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77-year old patient with a positive PPD skin test (>10 mm positive in patient living in a high-risk facility) who is asymptomatic most consistent with latent tuberculosis
Key idea: 3 treatment options for latent tuberculosis are (1) Isoniazid and rifapentine weekly for 3 months (2) Isoniazid for 6-9 months (3) Rifampin for 4 months
Key idea: Patients with diabetes, uremia, alcoholism, malnutrition, HIV, pregnancy or epilepsy should always be given pyridoxine (vitamin B6) along with isoniazid due to increased risk of B6-deficiency while on isoniazid
Key idea: PPD induration (NOT erythema) required for positivity depends upon patient risk factors with >5 mm being positive in patients with significant immunosuppression (HIV, organ transplant, immunosuppressant meds), recent contact with patient with active TB or patients with CXR findings consistent with TB // >10 mm being positive for patients from Tb endemic countries, IVDU, residents of high-risk settings (prisons, nursing homes, homeless shelters, etc.), children < 4 years old and patients working in mycobacterial labs // >15 mm in all patients

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