Step I Tricky board question... opinions?

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sevoflurane

sevoflurane

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20+ Year Member
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?
 
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Gfunk6 said:
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.
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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.
 
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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...
 
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sevoflurane said:
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.
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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.
 
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