A 56 year old Mien man presents to clinic with a cough of 6 weeks duration. The cough is non-productive and he denies hemoptysis. He is mildly short of breath. He has a fever, but denies night sweats or weight loss. He has a 64 pk/yr smoking history. He has been treated in the past for several episodes of bronchitis and wants cough medicine. He is a married male who has lived in Seattle for 4 years. He was a shaman in Laos, but lives on SSI in Seattle. When asked about TB contacts he doesn’t recall any. When asked about latent TB he points to a scar on his arm and says he was screened. He says he had a chest x-ray at immigration that was clear and he was treated with medication in a camp in Thailand. Aside from a low grade fever 101.6 F his exam is unremarkable. He has an old film on file from arrival that shows an old apical scar and bronchiectasis.
Question: What are your first thoughts?
b) Not TB since he has been treated for latent disease.
d) Acute bronchitis, routine care.