American Board of Internal Medicine (ABIM) Certification Practice Exam

Which condition increases the duration of the continuation phase in tuberculosis treatment?

1. Positive HIV status

2. Cavitary pulmonary disease at diagnosis

3. History of organ transplant

4. Age over 65

The correct answer is: Cavitary pulmonary disease at diagnosis

The continuation phase of tuberculosis (TB) treatment is an essential part of the regimen designed to eradicate the bacteria and prevent recurrence. The duration of this phase can be influenced by several factors related to the severity and type of the disease at the time of diagnosis. Cavitary pulmonary disease at diagnosis is a particularly significant factor because it often indicates a more extensive and severe infection. Cavitary lesions in the lungs suggest that the TB bacteria have a more robust capacity to spread and persist, potentially leading to greater complications in managing the disease. Patients with cavitary pulmonary disease are at higher risk for treatment failure and relapse, necessitating a longer duration of therapy to ensure complete sterilization of the bacteria and resolution of the disease. While other factors such as HIV status, a history of organ transplant, and age over 65 can impact the overall management and complexity of treatment for TB, they do not specifically mandate an extension of the continuation phase as a direct consequence of the disease presentation itself. In contrast, the presence of cavitary pulmonary disease directly affects the treatment strategy, leading to an adjusted duration to mitigate the risks associated with this more severe form of TB. This is why the duration of the continuation phase is increased in cases of cavitary pulmonary disease at diagnosis.