WBR0410

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Respiratory
Prompt	[[Prompt::48 year old male presents to the office with 4 month history of fatigue, dry cough and dyspnea. He says his cough and breathing difficulty is getting worse. He denies any fever, weight loss, chest pain and joint pain. He works in a glass factory and his past medical history is significant for hypertension. He is a chronic smoker and alcoholic. On examination pulse is 80/min, BP:130/80 mmHg, temperature 37 degree Celsius and O2 saturation is 93%. Physical examinations are normal and no cervical lymph nodes are noted. Cardiovascular and respiratory system examinations are normal. Chest X-ray show B/L hilar lymphadenopathy and prominent nodules in the upper lobe. After treating with O2, bronchodialotrs the patient feels better. Which of the following would be the best appropriate management in this patient?]]
Answer A	AnswerA::Start isoniazid
Answer A Explanation	[[AnswerAExp::Incorrect : Latent TB infection should be treated with isoniazid once confirmation is done. Active TB should be treated with multiple antituberculous drugs.]]
Answer B	AnswerB::No prophylactic measure needed
Answer B Explanation	[[AnswerBExp::Incorrect : Tuberculosis (TB) is a long recognized and well-established complication of silicosis and should always be screened when a patient with silicosis develops constitutional symptoms, worsening respiratory impairment, or changes in the chest radiograph.]]
Answer C	AnswerC::Yearly PFT’s
Answer C Explanation	[[AnswerCExp::Incorrect : In patients with silicosis, lung diseases begin slowly and insidiously and finally manifest themselves with the nonspecific symptom of dyspnea on exertion. Pulmonary function tests are an essential part of the workup of such patients; however patients with mild interstitial lung disease may have normal values for FVC and TLC.]]
Answer D	AnswerD::Yearly PPD
Answer D Explanation	[[AnswerDExp::Correct : A PPD reaction >10 mm is considered positive in silicosis patients. It is important to evaluate for active TB using microbiologic techniques if a positive tuberculin skin test is documented, since silicosis can mask the radiographic changes of active TB.]]
Answer E	AnswerE::Yearly Chest X-ray
Answer E Explanation	AnswerEExp::'''Incorrect''' : Since silicosis can mask the radiographic changes of active TB, chest X-ray is not used as a screening tool for tuberculosis.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Silicosis refers to a spectrum of pulmonary diseases caused by inhalation of free crystalline silica (silicon dioxide). Silicosis can occur in many industries and work settings including mining, quarrying, sandblasting, masonry, foundry work, and ceramics. Chronic silicosis develops slowly, usually appearing 10 to 30 years after first exposure. Accelerated silicosis develops within 10 years of initial exposure. Acute silicosis develops after exposure to high concentrations of respirable crystalline silica and results in symptoms within a few weeks to a few years after the initial exposure. Silicosis is associated with an increased risk of lung cancer, mycobacterial infection, autoimmune disorders, airflow obstruction, and chronic bronchitis. Patients with silicosis are at very high risk of active pulmonary tuberculosis and should be screened for evidence of latent infection. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::