American Board of Internal Medicine (ABIM) Certification Practice Exam

Prior to starting tumor necrosis factor α inhibitor therapy, patients should be screened for what condition?

1. Active tuberculosis

2. Latent tuberculosis

3. HIV

4. Chronic obstructive pulmonary disease

The correct answer is: Latent tuberculosis

Prior to initiating tumor necrosis factor α inhibitor therapy, it is critical to screen patients for latent tuberculosis. This screening is essential because TNF-α inhibitors can suppress the immune system, which increases the risk of reactivation of latent tuberculosis, leading to active disease. Patients with latent tuberculosis may not show symptoms but can develop tuberculosis infections once their immune response is compromised by the therapy. Therefore, identifying and treating latent tuberculosis before beginning TNF-α inhibitor therapy is a key step in preventing severe infections that can occur due to the immunosuppressive effect of the treatment. In contrast, while screening for active tuberculosis is also important, it is the latent form that merits specific attention before starting this class of medications. Other conditions, such as HIV and chronic obstructive pulmonary disease, while important to assess in the broader context of patient health, do not have the same level of direct relevance to the risks associated with TNF-α inhibitors as latent tuberculosis does.