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I wanted to talk about the Mantoux test and this is spelled ma n tou X kind of an interesting spelling after a French doctor who popularized it and another way you might hear this referred to as a PPD or a TST and what these things stand for is the PPD stands for purified protein derivative and actually gives us a clue as to what we're using in this test which is that we're using specifically TB protein OPA that in parentheses and the the location of the test is actually also going to be kind of a clue here with TST this is a tuberculous again referring to tuberculosis tuberculous skin test this tells you where we're gonna put all that protein right we're gonna put it in the skin and you may have seen this and this is kind of a picture right here of someone doing the test sometimes this refers to as kind of that bubble test a lot of people say oh yeah you know my doctor you know injected some liquid in my forearm and it kind of bubbled up and this is how people usually think about this test they remember that because a very obvious visual and so what I wanted to do is kind of give you an example or a diagram of what's actually happening when you get this test done so let's imagine this is your skin layer this is also referred to as the dermis and below the dermis is some subcutaneous so below the skin subcutaneous layer and usually not layer one of the most common things is fat so I'm just gonna draw that in here this is the subcutaneous fat so the idea here is that you're basically putting a little needle in here which is what you're seeing in that picture on the on the right there and that needle is full of some TB protein so this purified protein derivative is in that needle it's actually gonna be injected in so you've got all these little TB proteins in here and the volume you're putting in is a small volume it's about 1/10 of a milliliter so 0.1 milliliters and you're putting it intradermally intradermally this is actually an important point it's going into that dermis layer so it's intradermal injection and what happens is that if you then let's say moments later you remove the needle you throw it away and now what you're going notice that because you put a little volume in there a little 0.1 MLS that is gonna bubble up right because that volume is gonna make the skin puff out a little bit but if I came back over some time this protein is kind of diffused over this liquid has been absorbed into the skin and that bubble will disappear so if you come back you might see a little bit of redness because of course poking the skin causes a little bit of.