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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Recognize the common signs and symptoms, physical examination, laboratory, and radiographic findings in a patient with active pulmonary tuberculosis.

  • Design a therapeutic regimen for treatment of a patient with newly diagnosed active pulmonary tuberculosis based on clinical presentation, patient-specific history and physical characteristics, subjective and objective findings, comorbidities, and desired clinical response.

  • Define the goals of therapy for a patient with active pulmonary tuberculosis, as well as the monitoring parameters that should be used to assess the response to therapy and to prevent/minimize the occurrence of adverse effects.

  • Provide patient education on the proper administration of drug therapy for active pulmonary tuberculosis including directions for use, administration of therapy in relation to meals, the importance of adherence, and potential side effects of the medications.

  • Recognize potential drug interactions that may occur with antituberculosis medication.

PATIENT PRESENTATION

Chief Complaint

“I have been coughing up blood for the past 3 days.”

HPI

José Rodriguez is a 35-year-old Hispanic man who presents to the ED at the county hospital in Indianapolis, Indiana with a 3- to 4-week history of a productive cough, which was originally productive of yellow sputum but is now accompanied by the presence of blood streaks in the sputum for the past 3 days. He also complains of subjective fevers, chills, night sweats, dyspnea that worsens on exertion, fatigue, and an unintentional 20-lb weight loss over the past several weeks.

PMH

None

FH

Mother has DM and HTN.

Father died of MI 6 months ago.

SH

The patient moved to the United States from Mexico 4 years ago but has not recently traveled. Patient has a 10-pack-year history of smoking but quit several weeks ago when the current illness started. The patient denies illicit drug use but does report drinking alcohol socially on weekends. He is a laborer and is currently working for cash on a new home construction project in close contact with other workers. Several of his coworkers have recently moved to the United States from Mexico and have similar respiratory symptoms. The patient does not have any medical insurance. He lives with several adult friends in an apartment.

Meds

Over-the-counter antitussives, which have not provided any relief

All

No known drug allergies

ROS

Negative except for the complaints noted above

Physical Examination

Gen

Somewhat thin-appearing Hispanic man ...

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