American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be done for patients with a positive tuberculin skin test?

1. Perform a biopsy

2. Conduct chest radiography to rule out active infection

3. Start treatment with antibiotics immediately

4. Conduct a mental health evaluation

The correct answer is: Conduct chest radiography to rule out active infection

For patients with a positive tuberculin skin test, conducting chest radiography is a crucial step to assess for active tuberculosis (TB) infection. The tuberculin skin test indicates exposure to the TB bacteria, but it does not distinguish between latent TB infection and active disease. Chest radiography is performed to identify any signs of active pulmonary TB, such as cavitary lesions or other abnormalities in the lung fields. If active tuberculosis is suspected based on the chest X-ray findings, further evaluation and treatment, such as starting antibiotic therapy, would then be warranted. This step is essential to ensure that patients with latent TB are appropriately managed without overlooking cases of active disease that could require immediate treatment and isolation to prevent transmission to others. In contrast, performing a biopsy is not routinely indicated solely based on a positive skin test. Starting antibiotics immediately without assessing for active disease could risk mismanagement. Conducting a mental health evaluation does not directly address the immediate concerns associated with a positive tuberculin test in the context of TB evaluation. Hence, performing chest radiography is the most appropriate action to ensure the patient's health and public safety.