Correct!
4. 1 and 3

The CT scan confirms the presence of the effusion and shows little consolidation or mediastinal lymphadenopathy. Thoracentesis was performed and revealed an exudative effusion that was lymphocyte predominant on cell differential (85%). An adenosine deaminase (ADA) was performed and slightly elevated at 9.6 U/L (normal 0-9.4). Gram stain, silver stain and acid-fast smears were negative. A PCR for tuberculosis was also negative.

The patient was a native of India where tuberculosis is common and BCG, or bacille Calmette-Guerin, a vaccine for tuberculosis is given to most. He entered the US on a work visa and unlike an immigration visa, an evaluation for tuberculosis is not required. His gold quantiferon was positive.

Which of the following is/are true? (Click on the correct answer to proceed to the fifth of seven pages)

1. A negative acid-fast smear excludes tuberculous pleuritis
2. His negative PCR for tuberculosis excludes tuberculous pleuritis
3. His positive gold quantiferon is most likely secondary to his BCG vaccination
4. Pleural fluid ADA is a sensitive test for tuberculous pleuritis.
5. None of the above

Home/Pulmonary