Syphilis

Which of the following statements is an example of the "direct approach" for talking to patients and/or partners?

"I stopped by to talk to you about the tests you recently had at the county clinic. One of the tests you took was for Chlamydia, which came back positive. I'm here to help you get this taken care of, as well as others who may be at risk."

Use the Visual Case Analysis Chart to answer the question. When plotting Martin's sexual exposure information, which box number represents this information:

3

Use the Visual Case Analysis Chart to answer the question. When plotting Martin's medical history information, which box number represents this information:

7

What is/are the primary reason(s) to link a person diagnosed with HIV to medical care?

A & B. Reduce infection and encourage quality care

What is the purpose of ghosting?

A & C

Which of the following is not a typical sign or symptom of gonococcal infection?

A genital rash

Gonorrhea is caused by which of the following?

A gram-negative diplococci that grows best in warm, moist conditions on or inside columnar epithelial cells.

The transition into discussing partners (the Disease Intervention section of the format) should include:

A review of confidentiality

Jarish-Herxheimer reaction refers to:

A short-term immunologic reaction commonly seen following antibiotic treatment of syphilis.

Which of the following statements regarding Chlamydia and Gonorrhea are true?

A,C, & D a) Chlamydia trachomatis, like N. gonorrhoeae, infects the urethra and rectum of men and women, and the cervix of women. c) NGU (nongonococcal urethritis) caused by chlamydia is less profuse and less purulent than gonoccocal urethritis. d) Neonatal opthalmia caused by chlamydia is limited to conjunctivitis. Chlamydial infection and gonorrhea are similar in many ways. Both C. trachomatis and N. gonorrhoeae infect only columnar or transitional cells. As a result, in the genital area, these microorganisms do infect the urethra and rectum of men and women, and the cervix of women. Largely because of this, both cause similar illnesses, including pelvic inflammatory disease (PID) in women. • Chlamydia trachomatis is more (not less) likely than N. gonorrhoeae to cause asymptomatic genital tract infection (up to 80-90 percent of Chlamydia infection in both men and women are asymptomatic). It is true that the discharge of NGU caused by C. trachomatis, is typically less profuse and less purulent than that of gonococcal urethritis. • Unlike gonococcal ophthalmia which can result in ulceration of the eye or blindness, chlamydial infection of the newborn's eye is limited to the conjunctiva, thereby causing conjunctivitis.

Partner Services Providers are often required to find and refer individuals who need medical attention for a variety of reasons. These notifications usually fall under which category?

All of above:lab tests, social contacts

Which of the following statements about the ways in which syphilis is transmitted is true?

All of the above 1. Most syphilis is transmitted through primary phase 2. 33% chance of getting it ... 3.

Diagnostic tests for syphilis include

All of the above a) Treponemal b) Nontreponemal c) Darkfield microsopy

Which of the following statements about latent syphilis is true?

All of the above:Latent syphilis is a stage in which neither signs nor symptoms are present to suggest infection, yet spirochetes are present in the body. The diagnosis of latent syphilis is made on the basis of a confirmed positive serologic test and a negative physical exam. All cases of syphilis are latent at some time during the course of an untreated infection. Latent simply means "without symptoms or signs"; spirochetes are present, and silent disease can be occurring.

At the end of each category (column) of the name first elicitation grid, what should the interviewer ask the patient?

Another partner/person in need of an exam

Which of the following is not typically covered during the Disease Comprehension section?

Causal route & condom's ability to stop transmission

Which of the following is not true of testing for and diagnosing of TB?

Chest x-rays can confirm whether or not a person has TB disease.

The two most infectious clinical manifestations of secondary syphilis are:

Condylomata lata and mucous patches

What does "evidence based" mean, related to partner services?

Considering key findings from scientific research in deciding how best to implement partner services

When an infected person identifies specific partner(s) to notify of possible exposure and agrees to do so in a set time period, after which the health department will notify any partners not successfully notified by the patient, it is called:

Contract Referral

CHART is an acronym that:

Describes potential motivations for identifying partners

Which of the following is not information you would routinely seek during a pre-interview analysis (from a clinic record, for instance):

Education level

Which of the following is not one of the four steps of the Cultural Competence Objectivity Model?

Employ Community Mapping

True or False. Social Contacts is the term used for sex and/or drug-injection partners named by an index patient.

False

People who test positive for HCV, should be counseled with the following messages:

HCV-positive women do not need to avoid pregnancy or breastfeeding. b) To reduce the risk for transmission to others, HCV-positive persons should be advised to 1) not donate blood, body organs, other tissue, or semen; 2) not share any personal items that might have blood on them (e.g., toothbrushes and razors); and 3) cover cuts and sores on the skin to keep from spreading infectious blood or secretions. Wrong

Which of the below are considered high priority referrals?

HIV and penicillan

Which type of viral hepatitis is not vaccine preventable?

Hep C

Which is not true of treatment for hepatitis?

Hepatitis A infection can be treated with antiviral drugs and interferon.

Which is not true about the incubation period for Gonorrhea?

IT can last up to 90 days

Which are true statements about acute and chronic hepatitis?

If the initial attack of acute viral hepatitis is not severe and not prolonged, the liver will heal itself with no long term damage.

Which of the following is not an advantage of provider referral (Health department delivered partner services)

Increases index patient disclosure skills

Which of the following is not an example of confrontation?

Informal Scolding Four forms of confrontation include: Present Information (confront the patient by stating the facts, based on case analysis, that challenge what the patient has told you); Direct Challenge (confront the patient with a direct challenge when s/he makes a statement that runs contrary to the truth); Self-Involvement (confront the patient by asking him/her to show you evidence of the truthfulness of his/her information in a direct way); Withdraw Reinforcement (Confront the patient by expressing disappointment with the patient's present behavior and/or withdraw positive feedback previously given).

Which is not a possible complication of Gonorrhea in pregnancy?

Interstitial keratitis

Three important points to remember about a primary lesion are:

It appears at the site of inoculation, it is highly infectious, and it resolves without treatment.

Which is not true of ophthalmia neonatorum?

It causes blindness within three days if not treated.

What are the benefits of open ended questions?

Keep the convo moving & less judgmental

Treatment consisting of 3 (2.4 mu each) doses of intramuscular benzathine penicillin G one week apart is recommended for which type of syphilis?

Late latent syphilis occurring more than 1 year after infection.

What are the components of medical evaluation for TB?

Medical History, Physical Examination; Tests for TB Infection; Chest x-ray; Bacteriological Examinations

To meet the surveillance case definition of HIV infection

Must be confirmed by lab testing

Which of the following actions help maintain confidentiality during field investigations?

Not leaving messages for family members with HIV STD info

A contract referral is when:

Notification is carried out by patient; however the provider or third party will complete the notification that does not happen within agreed upon parameters (such as a 24-48 hour time frame).

Which are the three components of the Foundation (the beginning point of Partner Elicitation and Coaching when using the Name First Method):

Number of partners, behaviors with partners and setting for meeting partners/having sex.

Which of the following is NOT a common barrier to communication?

Offering options not directives

In the course of HIV infection, which of the following is not true?

Once CD4+ cells decrease to less than 500 cell/mm3, they are considered to have "Stage 4" disease and will be persistently ill.

Which is true of the role the immune system plays in HIV infection?

Opportunistic infections occur when CD4+ cells (T helper cells) reach sufficiently low levels and the body can no longer mount an immune response.

Which of the following are not principles of partner services?

Partner services should be rational, relationship-based and required

Partner services are a broad array of services offered to which three groups of people:

Patients, partners and social contacts

Which of the following is not recommended for the treatment of uncomplicated gonococcal infection?

Penicillin

The minimum criteria for diagnosing PID in sexually active young women and women at risk are:

Presence of adnexal tenderness, cervical motion tenderness or uterine tenderness

Which of the following is not a reason partner services are offered:

Providing family planning services

What is not one of the four main sections of the Original Interview?

Sexual History

Which of the following statements about the characteristics of Treponema pallidum, the causative agent of syphilis, is true

Spiral

Information Gathering, Community Mapping, and Checking Resources (such as the internet) are all examples of:

Strategies to learn more about cultures

Which is not true of TB?

The 20% rise in TB cases seen between 1985 and 1992 was due solely to the HIV epidemic.

Kasowitz's Law States

The longer the duration of untreated syphilis infection before pregnancy in mother, the less likely the fetus will be infected.

Internet Partner Services refers to:

The process of using the internet to conduct or enhance the process of notifying a person of their potential exposure to an infectious disease

Which statement is not true regarding Hepatitis testing?

There is no reliable test available for Hepatitis C.

Change in pace, jumping around in speaking, stalling, and contradictions are:

Things you would listen for in a patient to indicate a problem may exist

Which of the following is a definition for assertiveness?

To claim or maintain one's rights or position without compromising the rights of others

Which of the following organisms are not associated with PID?

Treponema pallidum

Which of the following statements about secondary syphilis is true?

Typically there is a latent period of several weeks between the disappearance of the chancre of primary syphilis and the signs and symptoms of secondary syphilis

Which of the following would be a good example of a verification question?

What concerns you most about talking to me about your partner?

Which of the following is not a reason for conducting a Re-interview?

Which of the following is not a reason for conducting a Re-interview?

Which of the following resources should be part of your community referral directory?

Which of the following resources should be part of your community referral directory? a) Resources for Immunizations b) Resources for STD/HIV Testing c) Resources for Food Pantry/Food Assistance d) Resources for Housing e) All of the above

Which of the following is an example of a passive referral?

You give the patient a card with the name/phone number of the agency and encourage him/her to call to schedule an appointment when s/he has time.

What is the interview period for PID?

a) 60 days prior to the onset of symptoms through the date of treatment

In addition to identifying partners to ensure they are given the opportunity to be tested and/or treated for STD/HIV, assessing the patient's need for supportive services and helping him/her to access those referrals is also your responsibility. Which of the following services might a patient need?

a) A referral for ongoing medical evaluation and treatment. b) A referral for prenatal care. c) A referral for substance abuse. d) A referral for mental health services. e) A referral to Rape Crisis

Which of the below are common types of referral forms used by a community based organization (CBO) or AIDS Service Organization (ASO)?

a) Appointment reminder cards b) Formal referral form

HIV rapid tests:

a) Are believed to increase the number of HIV-infected persons who learn they are infected

Which of the following statements regarding HIV and Chlamydia co-infection is true?

a) Because of the inflammation of the urethra and cervix caused by Chlamydia, women with Chlamydia are more at risk for contracting HIV than women without a chlamydial infection.

The interview period is:

a) Calculated to provide a time frame in which to elicit the names of sex partners, in order to provide testing and treatment/counseling

Which statement about Chlamydia trachomatis is true?

a) Chlamydiae are classified as bacteria containing cell walls and cell membranes. b) Like viruses, chlamydiae grow intracellularly, but unlike viruses, chlamydiae contain both DNA and RNA. c) Chlamydiae are "obligatory intracellular parasites" and survive only by a replication cycle that results in the death of the infected host.

Identify the tasks in the Post Interview Analysis:

a) Compute critical period, complete forms, and complete any remaining record searching on the index patient

Which of the following are the 6 Principles of Investigation

a) Confidentiality, organization, promptness, thoroughness, communication and creativity and flexibility.

Which is true about Hepatitis transmission?

a) Hepatitis A is transmitted by the fecal oral route and can spread through close physical contact or contaminated food. b) Hepatitis B is transmitted through contact with infectious blood, often through sex. c) Hepatitis C is transmitted through infected blood, often through injection drug use. d) Hepatitis D is transmitted through infectious blood and is acquired with HBV. e) Hepatitis E is transmitted through the oral fecal route and is often spread through contaminated water.

Which of the following is true regarding hepatitis?

a) Hepatitis refers to any viral infection of the liver, regardless of which viral family caused it. b) Hepatitis can result from both infectious and non-infectious causes. c) There are five major hepatitis viruses, three of which are prevalent in the US.

Which outcome(s) below may result from PID?

a) Infertility b) Ectopic Pregnancy c) Chronic Pain

Drug resistant TB

a) Is caused by M. tuberculosis organisms that are resistant to at least one of the first line TB treatment drugs. b) Can be transmitted from person to person or develop during TB treatment when the patient did not follow the treatment as prescribed. c) Can be mono-resistant or poly-resistant.

PID is diagnosed by

a) Laboratory tests b) A bi-manual exam c) Clinical signs and symptoms

Which groups are considered more likely to be exposed to or infected with M. tuberculosis?

a) Low-income groups with poor access to health care, including homeless people. b) People who live or work in high-risk residential settings (for example, nursing homes, homeless shelters, or correctional facilities). c) People who have come to the United States within the last 5 years from areas of the world where TB is common (for example, Asia, Africa, Russia, Eastern Europe, or Latin America).

Hepatitis A vaccine and hepatitis B vaccine are recommended for which of the following?

a) Men who have sex with men b) Users of injection drugs c) Persons with chronic liver disease

Which

a) PID is an infection of the upper reproductive tract (uterus, fallopian tube, ovaries) in women. b) Women have increased risk of getting PID during menstruation.

As presented in the module, which of the partners in the following scenario should be referred for examination and possible treatment? On October 24, a Partner Services provider interviewed a 19-year-old male who was referred to the clinic and diagnosed with asymptomatic Chlamydia. The patient identified three female sex partners.

a) Partner A is 18 years old. The patient states he had sex with her at least twice a week for the past two months b) Partner B is 19 years old. The patient states he had sex with her only once at a Labor Day weekend picnic Review The referral of sex partners can be accomplished through the Partner Services Provider or by self-referral. All sex partners during the 60 day period before symptoms appeared or before clinical evaluation or treatment should be referred for examination and treatment. Only Partners A and B fell in this window period

Diseases associated with HIV in the industrialized world include:

a) Pneumonia b) Meningitis c) Cervical cancer d) Diarrhea

What is the interview period for HIV when there is a test history?

a) Six months prior to the last negative test date

Which is true about a good cluster candidate?

a) Steady partners and partners of more than one infected person are good choices for Cluster Interviews.

Proper documentation should include which of the following information.

a) The date, time, and each specific action you took. b) The responses of other people and commitments made by anyone. c) Recommendations for future action. d) Expectations you held. e) All of the above.

Primary Disease Intervention includes:

a) The process of preventing disease by treating persons who may have been exposed to an infection but who, have not yet developed signs or symptoms of disease. c) Persons who have been exposed to infection and at the time of examination are negative or unknown, but offered preventive treatment so the disease can be aborted before it develops. Wrong

Secondary Disease Intervention is:

a) The process offering prompt and accurate medical examination and treatment to prevent further complications. c) The process of stopping the spread and complications of a disease. Wrong

When using e-mail for Internet Partner Notification, the email message should include the following information, except:

a) The type of exposure they had

Which of the following best explains why individuals treated for Chlamydia have high chlamydial infection rates several months after treatment.

a) They do not complete the proper drug therapy. b) They may be reinfected by existing partners who are infected and not identified and treated. c) They may become reinfected by new partners who are infected.

Which of the following are symptoms of viral hepatitis?

a) Vomiting b) Abdominal pain c) Grey-colored bowel movements d) Joint pain e) Jaundice

Which of the following women are at risk for developing PID?

a) Young, sexually active women who do not practice safe sex b) Women infected with N. gonorrhoeae c) Women who use an IUD (intrauterine device)

Which of the following statements about the female reproductive and genitourinary tract is true?

a) Younger women are more susceptible to Chlamydia bacteria than older women b) The cervix is shaped like a small donut, with a hole in the center called an os c) The cervix of younger women is lined with more of the tissue, columnar epithelium, that the Chlamydia bacteria targets

Which of the following statements about Chlamydial infection in men is true?

acute epididymitis

Which of the following are recommended in CDC's STD Treatment Guidelines for Chlamydia screening among women?

all women should be screened annually with risk factors & men and women should be re-tested after 3 months of treatment

The critical period for primary syphilis is:

b) 3 months prior to the onset of symptoms up to and including the date of adequate treatment

The cluster interview format is different from an original interview format in the following ways:

b) An exposure, rather than infection, is discussed. Wrong c) The medical history is shortened in the Cluster Interview.

Which of the following are not tests for Gonorrhea?

b) Darkfield Microscopy

Which of the following statements is a potential consequence of Chlamydia in women if left untreated?

b) Pelvic Inflammatory Disease c) Transmission of disease to baby at delivery if the woman becomes pregnant

Which is not true of Latent TB Infection (LTBI) and TB disease?

b) People with latent TB infection (LTBI) often have TB symptoms.

How is TB transmitted?

b) Person to person through the air

When leaving a referral note for someone who you are searching for in the field, it is best to

b) Prepare the note before you go into the field

Select the components of the Medical History:

b) Sexual orientation, current gender, HIV status The components of Medical History include: symptoms and duration, medical tests in the interview period, STD/HIV history, antibiotics in the past year, drugs used, alcohol use, pregnancy/pre-natal care, HIV status, Injection drug use, anti-retroviral therapy, sex at birth, current gender, and institutionalizations.

Which of the following is a breach of confidentially as it relates to partner services?

b) Sharing only the gender (not name) of the index patient when notifying the partner (e.g. , he wanted you to know)

Which is not true of treatment for TB disease?

b) The initial treatment of TB disease should only include rifampin. Additional drugs are added if no response to treatment is noted.

Although local policies and morbidity trends will determine how STD/HIV cases are prioritized for field investigation, in general, which of the following criteria would be considered as a first priority.

b) The potential for preventing the development of symptomatic disease by preventively treating persons who may be incubating the disease.

Why is the visual case analysis used?

b) To compare social/epidemiologic and clinical/medical information known about the index patient, with known information about the natural course of their syphilis infection.

Which is the primary purpose of case management?

b) To systematically pursue, document, and analyze medical and epidemiologic case information to identify opportunities to develop and implement timely disease intervention plans.

Which of the below examples is an open-ended question you could ask to help identify a patient's support system?

b) Who do you count on when you need support?

Select the most applicable advantages for reaching individuals by phone

c) Can reach more people via the phone than by going out into the field and avoid unnecessary conflict with parents, partners or roommates.

Two complications of a Chlamydial infection in a newborn are:

c) Conjunctivitis and pneumonia

Which of the following is not an example of a psychological problem or issue?

c) Dysfunctional relationships

Which is the correct order for gathering information when using the Name First Method to elicit partners?

c) Foundation, names of partners, exposure, locating, clustering, descriptive

Use the Visual Case Analysis Chart to answer the question. Based on the ghosted spread/source lesions, who is more likely to be the source to John Scott's syphilis infection.

c) Jane because her ghosted source lesion occurs at the time they were having sex, lesion sites were compatible and it fits the basic assumptions.

Which is not true about HIV tests?

c) P24 antigen tests can detect early infection and late stage infection, but not latent infection.

When clustering, ask about people who are:

c) People with symptoms of disease d) People who engage in risky behavior

Which is true about HIV transmission?

c) Sexually transmitted diseases, and especially sexually transmitted diseases that cause ulcers such as syphilis or chancroid, can greatly facilitate HIV transmission. d) Prenatal testing and antiviral prophylaxis have almost eliminated perinatal transmission in the United States.

When notifying a partner of their exposure to an STD or HIV, which of the following statements would be the most appropriate response.

c) Since all this information is confidential, all I can say is that we got this information from someone who has this disease and exposed you. They wanted you to know so you could get the appropriate medical services needed.

The critical period is:

c) The most likely time frame in which a patient could have been infected based on personal symptoms and medical history

What is the main goal of the Cluster Interview?

c) To find out more about a related index patient from an uninfected person who knows them.

Expedited Partner Therapy (EPT) is:

d) A process where partners of infected persons are treated before clinical evaluation

Which of the below key elements are not commonly included in a community referral resource directory?

d) Board of Directors e) Mission Statement

What are the three disease intervention functions performed by partner services providers during case management

d) Interviewing, Field Investigation, Case Analysis

What is the preferred treatment regimen for latent TB Infection (LTBI)?

d) Isoniazid daily for 9 months

Which of the following are not complications of Gonorrhea in men?

d) Pelvic Inflammatory Disease

Which of the following is not an STD motivator?

d) Resistance to treatment

Which of the following sections is not true of the Re-interview format?

d) Risk reduction should focus on developing a new plan for the patient.

When coaching for a self-referral, which of the following items is not discussed:

d) Why the partner should not blame the index patient?

Gonorrhea cannot be transmitted by

deep throat kissing

Which of the following is not known to be a causal factor of PID?

spermicide