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Atrial fibrillation — USMLE Step 2 CK MCQ

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HardInternal MedicineAtrial fibrillationUSMLE Step 2 CK

A 46-year-old woman will begin adalimumab for Crohn disease. She is asymptomatic, chest radiograph is normal and an interferon-gamma release assay is positive. HIV testing is negative, liver tests are normal and a prior isoniazid exposure caused a severe hypersensitivity reaction. Her medicines have no rifamycin interactions. Which latent-tuberculosis regimen is preferred?

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Correct answer: A — Give 4 months of daily rifampin

Four months of daily rifampin is an appropriate preferred short-course latent-TB regimen for an HIV-negative patient who cannot receive isoniazid and has no important rifamycin interaction. Weekly isoniazid-rifapentine, daily isoniazid-rifampin, and 6- or 9-month isoniazid regimens all re-expose this patient to the drug that caused severe hypersensitivity.

Reference: CDC clinical treatment of latent tuberculosis infection: https://www.cdc.gov/tb/hcp/treatment/latent-tuberculosis-infection.html