A family physician cares for a family consisting of a 45-year old husband, 43-year-old wife
and a 12-year-old daughter. The family reports that recently the 77-year-old maternal
grandmother who lived with them died after a prolonged respiratory infection. Autopsy
subsequently confirms that she had active pulmonary tuberculosis at the time of death. The
organism tested sensitive to all anti-tuberculosis drugs. In responding to the grandmother’s
illness, which of the following is the most appropriate step in management?
A. Obtain leukocyte counts on all family members
B. Obtain sputum cultures for acid fast bacilli
C. Obtain chest computerized tomograms on all members
D. Place protein purified derivative (PPD) test on all members
E. Schedule bronchoscopy lavage for the adults
Explanation:
The correct answer is D. The immediate step is to screen the family for TB exposure. The most
effective manner in which to accomplish this is by placing PPDs on all members and working up
those with a positive test. The white cell count may be elevated for a variety of reasons and
would not necessarily help in diagnosis or management (choice A).
Sputum cultures will take 6 months to grow and may be too cumbersome to obtain (choice B).
Chest CT scans may show the tuberculosis lesion but a more effective method would be to place
the PPD and perhaps then scan those with a positive test (choice C).
A bronchoscopy would be too invasive an option at this point (choice E).