Step I Tricky board question... opinions?

[sevoflurane]

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Is a >5mm PPD considered positive in an 20 y/o asthmatic patient on flovent? Doens't seem right to have them in the same catergory as HIV and transplant patients... but I belive that anyone on chronic steroid therapy will be read as + if >5mm.... still doesn't sound right for a 20 y/o with no other comorbities beside asthma. Any thoughts?

 

[Gfunk6]

Perhaps if she was a severe ashmatic taking oral prednisone to control her symptoms, we could consider >5mm positive. However, I don't think there is too much systemic absorption going on with inhaled steroids.

 

[sevoflurane]

Perhaps if she was a severe ashmatic taking oral prednisone to control her symptoms, we could consider >5mm positive. However, I don't think there is too much systemic absorption going on with inhaled steroids.

No systemic absorption, but the steroids are at the site where TB is going to establish colonization/infection- the lungs via respiratory droplets. I presume inhaled steroids will prevent an immune response at the level of the alveoli. Maybe I'm overthinking this stuff.

 

[ytiffwang]

teacher told me that this kind of q won't appear on the board exam cuz in real situation , the practice standard varies form hospital to hospital...

 

[HiddenTruth]

No systemic absorption, but the steroids are at the site where TB is going to establish colonization/infection- the lungs via respiratory droplets. I presume inhaled steroids will prevent an immune response at the level of the alveoli. Maybe I'm overthinking this stuff.

yea, but the positive PPD is a systemic response of intact CMI. I would highly doubt that inhaled steroids would suppress a systemic CMI response. And, usually steroids for asthma, depending on the severity of the ds, would not be given at remendously high doses to suppress a response to the extent of someone having HIV.

 

[Samoa]

It depends on whether the patient is rinsing their mouth out after using the inhaler. If not, I'd treat them like someone on systemic steroids.