Tuberculosis

Patients receiving treatment for TB disease should be carefully reevaluated if: 1. Their culture results do not become negative after 2 months of treatment 2. Their symptoms worsen after improving initially 3. Their culture results become positive after being negative 4. Their tuberculin skin test reaction does not become negative

A)1, 2, and 3 are correct

What should be done when a health care worker suspects that a patient has TB? 1. The patient should be isolated and placed in an AII room right away, if available. 2. The patient should be given a surgical mask and instructed to keep it on. 3. The patient should be given a diagnostic evaluation. 4. The patient should be tested for lung capacity.

A)1, 2, and 3 are correct

Which of the following are symptoms of TB disease? 1. Fever 2. Weight loss 3. Fatigue 4. Runny nose

A)1, 2, and 3 are correct

Why should patients receive a medical evaluation before receiving treatment for latent TB infection? 1. To identify any medical problems that may complicate treatment 2. To get a medical history to determine whether they have ever been treated for latent TB infection or TB disease previously 3. To exclude TB disease 4. To determine if the patient can pay for treatment

A)1, 2, and 3 are correct

Which TB medication can be associated with eye damage? A)Ethambutol B)Isoniazid C)Pyrazinamide D)Rifampin

A)Ethambutol

How can clinicians determine whether a patient is responding to treatment? 1. Do bacteriologic evaluations 2. Repeat tuberculin skin test 3. Do clinical evaluations 4. Use special urine tests

B)1 and 3 are correct

Which of the following factor(s) is/are considered when interpreting a skin test reaction as positive or negative? 1. The size of the induration at the site of injection 2. The size of redness at the site of injection 3. The person's risk factors for TB4. The gender of the person being tested

B)1 and 3 are correct

In what situation is two-step testing used? A)When testing HIV-infected patients B)When testing new employees in a TB testing program C)When any patient's first TST reaction is positive D)When country western dancing in Texas

B)When testing new employees in a TB testing program

For people with no risk factors for TB, what induration size is considered a positive reaction to the TST? A)5 or more millimeters B)10 or more millimeters C)15 or more millimeters

C)15 or more milliliters

The results of the chest x-ray alone can be used to confirm that a person has TB disease.

False

Multidrug-resistant TB is resistant to at least the drugs isoniazid and rifampin.

True

Sputum induction and other cough-inducing procedures performed on TB patients should be done in waiting rooms, if possible.

False

The presence of erythema (redness) at the site of the skin test injection indicates that a person has TB infection.

False

Treatment for latent TB infection should never be given to a person who has a negative TST or IGRA result

False

People who were recently infected with M. tuberculosis (within the past 2 years) are at increased risk that latent TB infection will progress to TB disease.

True

Which of the following is NOT a component for conducting a complete medical evaluation for diagnosing TB disease? A)Medical history B)Genotyping C)Test for TB infection D)Chest x-ray E)Bacteriologic examination

B)Genotyping

Which TB medication can be associated with peripheral neuropathy? A)Ethambutol B)Isoniazid C)Pyrazinamide D)Rifampin

B)Isoniazid

Which TB medication(s) can be associated with hepatitis? A)Ethambutol only B)Isoniazid, pyrazinamide, and rifampin C)Streptomycin only D)Rifampin only

B)Isoniazid, pyrazinamide, and rifampin

TB disease must be treated with several drugs to which the bacilli are susceptible.

True

What do laboratory personnel look for in a sputum smear? A)White blood cells B)Fast-moving bacilli C)Drug-resistant bacilli D)Acid-fast bacilli

D)Acid-fast bacilli

Extrapulmonary TB occurs in the lungs.

False

For patients with symptoms of TB disease, clinicians should wait for TST or IGRA results before starting other diagnostic tests.

False

People with symptoms of TB should NOT be evaluated for TB disease if they have a negative TST or interferon-gamma release assay (IGRA) result.

False

What precautions should a health care worker take when visiting the home of a TB patient who may be infectious? 1. Instruct the patient to cover their mouth and nose with a tissue when coughing or sneezing 2. Wear a personal respirator when visiting the home of an infectious TB patient or when transporting an infectious TB patient in a vehicle 3. When it is necessary to collect a sputum specimen in the home, collect the specimen in a well-ventilated area, away from other household members; if possible, the specimen should be collected outdoors 4. Wear surgical scrubs, gloves, and goggles

A)1, 2, and 3 are correct

Which of the following groups are more likely to be exposed to or infected with M. tuberculosis? 1. Contacts of people known or suspected of having infectious TB disease 2. People who live in, or have lived in, high-risk congregate settings (for example, homeless shelters or correctional facilities) 3. Health care workers who serve patients with TB disease 4. People who have unprotected sex

A)1, 2, and 3 are correct

Which of the statements about respirators and surgical masks are correct? 1. A user seal check is done each time a respirator is put on to ensure that the respirator is properly sealed. 2. Respirators are designed to protect a person by reducing the droplet nuclei breathed in (inhaled). 3. Surgical masks are designed to reduce droplets from being spread (exhaled) into the air by the person wearing them. 4. Healthcare workers working with persons with suspected or confirmed infectious TB should be given a surgical mask to wear to reduce the droplet nuclei breathed in (inhaled).

A)1, 2, and 3 are correct

What part of a patient's medical history should lead a clinician to suspect the possibility of TB disease? 1. Exposure to a person who has TB disease 2. Symptoms of TB disease 3. Previous TB infection or TB disease 4. Risk factors for developing TB disease

A)1, 2, and 3 are correct B)1 and 3 are correct C)2 and 4 are correct D)Only 4 is correct E)All are correct

What induration size is considered a positive reaction for people with HIV infection, contacts, and people who have chest x-ray findings suggestive of previous TB disease? A)5 or more millimeters B)10 or more millimeters C)15 or more millimeters

A)5 or more milliliters

Which of the following is NOT associated with using an IGRA? A)The booster phenomenon B)Blood samples must be processed within a specified timeframe C)Requires one patient visit to conduct the test D)BCG vaccination does not affect test results

A)The booster phenomenon

Why is it necessary to culture a specimen? A)To determine how long the person has had TB disease B)To determine whether the specimen contains M. tuberculosis C)To determine whether the person will recover from TB disease

A)To determine whether the specimen contains M. tuberculosis

Why are drug susceptibility tests done? 1. To determine which drugs will kill the tubercle bacilli that are causing disease in a particular patient 2. To see whether the patient is allergic to the drugs 3. To help clinicians choose the appropriate drugs for each patient 4. To determine which drugs the patient is receiving

B)1 and 3 are correct

What induration size is considered a positive reaction for children younger than 5 years of age, people who live or work in high-risk congregate settings, and people who have recently come to the United States (within the last 5 years) from areas of the world where TB is common? A)5 or more millimeters B)10 or more millimeters C)15 or more millimeters

B)10 or more milliliters

For people in the United States who have TB infection, but NOT HIV infection, what is the risk they will develop TB disease at some point in their lives? A)2% B)5% to 10% C)50% D)90%

B)5% to 10%

How often should patients be evaluated for signs and symptoms of adverse reactions during treatment for latent TB infection? A)Weekly B)At least monthly C)Only if symptoms of adverse reactions occur D)Every 3 months

B)At least monthly

How is TB spread? A)By sharing eating utensils with an infected person B)From person to person through the air C)By insects D)By touching surfaces that are contaminated with M. tuberculosis

B)From person to person through the air

Which statement is true about the purpose of treatment for latent TB infection? A)It is given to people who have latent TB infection to prevent them from testing positive on future tests for TB infection B)It is given to people who have latent TB infection to prevent them from developing TB disease C)It is given to people who have TB disease to prevent the disease from getting worse D)It is given to people who have TB disease to prevent them from becoming infectious

B)It is given to people who have latent TB infection to prevent them from developing TB disease

What are the common symptoms of hepatitis? A)Weight loss, night sweats, cough B)Nausea, vomiting, abdominal pain, fatigue, brown urine C)Tingling in the fingers, blurred vision, joint aches, orange urine D)Dizziness, hearing loss

B)Nausea, vomiting, abdominal pain, fatigue, brown urine

Which factor is generally associated with less infectiousness? A)Patient coughing, frequently and forcefully B)No acid-fast bacilli on the sputum smear C)Patient not receiving adequate treatment D)Cavity in the lung E)Patient undergoing a cough-inducing procedure

B)No acid-fast bacilli on the sputum smear

Which statement is TRUE about the difference between latent TB infection and TB disease? A)Tubercle bacilli are in the body with TB disease, but not latent TB infection B)Symptoms occur only with TB disease C)Latent TB infection is counted as a case but TB disease is not D)Sputum smears and cultures are positive with latent TB infection but not with TB disease

B)Symptoms occur only with TB disease

An abnormal chest x-ray is usually characteristic of: A)Latent TB infection B)TB disease (in the lungs) C)Both latent TB infection and TB disease

B)TB disease

Positive sputum smears and cultures are characteristic of: A)Latent TB infection B)TB disease C)Both latent TB infection and TB disease

B)TB disease

After TB has been transmitted, how long does it take for the body's immune system to mount a response detectable by a TST or IGRA? A)6 months or more B)7 to 10 days C)2 to 8 weeks D)24 hours

C)2 to 8 weeks

How long after receiving a TST should a patient's arm be examined for a reaction? A)Immediately B)24 hours C)48 to 72 hours D)3 weeks after the last exposure

C)48 to 72 hours

Directly observed therapy (DOT) means: A)A supervisor watches a field worker give a patient a bottle of pills B)A physician sees the patient once a month and counts the remaining pills in the medication bottles C)A health care worker or another designated person watches the patient swallow each dose of the prescribed drugs D)The nurse uses special urine tests to detect the presence of medicine in the patient's urine

C)A health care worker or another designated person watches the patient swallow each dose of the prescribed drugs

What are IGRA results based on? A)Amount of heparin in the sample B)The size of the induration at the site of the injection C)Amount of interferon-gamma (IFN-γ) released in response to the antigens and control substances D)Number of acid-fast bacilli present

C)Amount of interferon-gamma (IFN-γ) released in response to the antigens and control substances

What is the strongest risk factor for the development of TB disease in people with TB infection? A)Low birth weight B)Foreign birth C)HIV infection D)Unemployment

C)HIV infection

What site of the body is most common site for TB disease? A)Brain B)Kidney C)Lungs D)Lymph nodes

C)Lungs

How does being infected with both M. tuberculosis and HIV affect the risk for TB disease? A)People who are infected with both M. tuberculosis and HIV are much more likely to develop TB disease than people who are infected only with M. tuberculosis B)The risk of developing TB disease is 7% to 10% each year for people who are infected with both M. tuberculosis and HIV (if the HIV is not being treated). C)A person who has HIV infection can become infected with M. tuberculosis and then rapidly develop TB disease. D)All of the above

D)All of the above

The main goals of a TB infection-control program are to ensure early and prompt: A)Detection of TB disease B)Airborne precautions (e.g., isolation of people with known or suspected TB disease) C)Treatment of people with known or suspected TB disease D)All of the above

D)All of the above

What is the difference between primary and secondary drug resistance? A)Primary resistance is caused by person-to-person transmission of drug-resistant organisms. B)Secondary resistance develops during TB treatment. C)Secondary resistance can occur when the patient was not treated with the right TB drugs or the patient did not properly follow the prescribed treatment regimen. D)All of the above

D)All of the above

Which TB medication can be associated with orange discoloration of the urine? A)Ethambutol B)Isoniazid C)Pyrazinamide D)Rifampin

D)Rifampin

When can a TB patient be considered noninfectious? A)After receiving adequate treatment for 2 weeks or longer B)When symptoms have improved C)When the patient has 3 consecutive negative sputum smears from sputum collected in 8 to 24 hour intervals (at least one being an early morning specimen) D)When all of the above are true

D)When all of the above are true

Personal respirators should be used in: 1. TB airborne infection isolation (AII) rooms 2. Rooms where cough-inducing procedures are done 3. Ambulances transporting infectious TB patients 4. The homes of infectious TB patients

E)All are correct

What should be included in each patient's treatment plan? 1. A description of the treatment regimen 2. Methods of monitoring for adverse reactions 3. Methods of assessing and ensuring adherence to the treatment 4. Methods for evaluating treatment response

E)All are correct

Which of the following are improvements TB programs were able to make with increased federal, state, and other funds and resources that has contributed to a decrease in TB cases since 1993? 1. Promptly identify persons with TB 2. Start appropriate initial treatment for TB cases 3. Ensure patients complete treatment 4. Conduct contact investigations

E)All are correct

Which of the following factors contributed to the resurgence of TB cases between 1985 and 1992? 1. Inadequate funding for TB control and other public health efforts 2. The HIV epidemic 3. Immigration from countries where TB was common 4. Spread of TB in certain settings (e.g., correctional facilities and homeless shelters) 5. Spread of multidrug-resistant TB

E)All are correct

A person who has latent TB infection, but not TB disease, is infectious to others.

False

A health care or congregate setting's TB infection-control program should be based on a three-level hierarchy of control measures (i.e., administrative controls, environmental controls, and respiratory-protection controls).

True

Abusing drugs or alcohol can increase the risk that latent TB infection will progress to TB disease.

True

Airborne infection isolation (AII) rooms help prevent the spread of TB by being at negative pressure relative to other parts of the facility.

True

Drug resistance can develop when patients do not follow treatment regimens as prescribed

True

Drug susceptibility tests should be done when a patient is first found to have a positive culture for M. tuberculosis.

True

From 1993 through 2013, there was a steady decline in the number of TB cases reported annually in the United States.

True

The Mantoux tuberculin skin test (TST) is given by using a needle and syringe to inject 0.1 ml of 5 tuberculin units of liquid tuberculin between the layers of the skin (intradermally), usually on the forearm.

True

The current classification system for TB is based on the pathogenesis of TB.

True

The intensive phase of treatment for TB disease should include four drugs: isoniazid, rifampin, pyrazinamide, and ethambutol.

True

The results of the acid-fast bacilli (AFB) smear examination can be used to help determine the infectiousness of a TB patient.

True

Usually, only patients who have pulmonary or laryngeal TB are infectious.

True