Pre-test of online course on tuberculosis

This test is a part of an online course made by the Finnish Lung Health Association and St. Petersburg Scientific Research Institute on Tuberculosis and Lung Disease.

1. Which of the following factors contribute to the disproportionate burden of TB disease in minorities? (choose the one best answer)

A. Infection acquired in the country of origin in foreign-born minorities.

B. Unequal distribution of TB risk factors (e.g., HIV), contributing to increased exposure to TB disease or to an increased risk of developing TB disease once infected with M. tuberculosis.

C. Lower socioeconomic status and the effects of crowding.

D. A, B, and C are all correct.

E. Only A and B are correct

2. How is TB spread? (choose the one best answer)

A. From sharing eating utensils with an infected person.

B. From person to person through the air.

C. From insect bites.

D. From touching surfaces that are contaminated with M. tuberculosis.

3. The probability that M. tuberculosis will be transmitted depends on… (choose the one best answer)

A. Immune status of the exposed individual.

B. Infectiousness of the person with TB.

C. Proximity, frequency, and duration of exposure.

D. Environmental factors that affect the concentration of M. tuberculosis organisms.

E. A, B, C, and D are correct.

4. Which statements about infectiousness are true? (Choose the correct answer(s))

A. The infectiousness of a person with TB disease is directly related to the number of tubercle bacilli that he or she expels into the air.

B. Persons who expel few or no tubercle bacilli are just as infectious as those who expel many bacilli

5. Which of the following environmental factors do NOT increase the probability that M. tuberculosis will be transmitted? (circle the one best answer)

A. Exposure in small enclosed spaces.

B. Inadequate local or general ventilation that results in insufficient dilution or removal of infectious droplet nuclei.

C. Recirculation of air containing infectious droplet nuclei.

D. Improper specimen handling procedures that generate infectious droplet nuclei.

E. Negative pressure in an infectious TB patient’s room

6. A complete medical evaluation for TB disease includes which components? (Choose the correct answer(s))

A. Medical history

B. Physical examination

C. Test for M. tuberculosis infection

D. Chest radiograph

E. Bacteriologic examination of clinical specimens

F. All correct answers

7. TB disease most commonly affects which part of the body? (choose the one best answer)

A. Bone

B. Lungs

C. Kidneys

D. Brain

E. None of the above

8. A negative reaction for a Mantoux test or IGRA test excludes a person from having TB disease. (choose the one best answer)

A. True

B. False

9. When suspecting TB, which labroratory tests should be done to each patient?

A. Chest x-ray

B. Broncoscopy

C. HIV antigen blood test

D. Urine TB-culture x 3

E. Sputum culture x 3

F. Chest CT / HRCT

G. Tb-NhO

10. Positive (sputum )cultures for M. tuberculosis confirm the diagnosis of TB disease. However, in the absence of a positive culture, TB disease may also be diagnosed on the basis of clinical signs and symptoms alone.

A. True

B. False

11. Case Study – ”Igor”

Igor has symptoms of TB disease and a cavity on his chest radiograph, but all of his sputum smears are negative for acid-fast bacilli. Does this rule out the diagnosis of pulmonary TB disease for him? (choose the one best answer)

A. Yes, because his sputum smears are negative for acid-fast bacilli. Even though he has symptoms of TB disease and a cavity on his chest radiograph, his sputum smears have to be positive for acid-fast bacilli to indicate a diagnosis of pulmonary TB disease.

B. No, because he has symptoms of TB disease and his abnormal chest x-ray suggest that he does have pulmonary TB disease. Also, M. tuberculosis may grow in the cultures even though there are no acid-fast bacilli on the smear.

12. Which statement about the difference between LTBI and TB disease is true? (choose the one best answer)

A. Tubercle bacilli are in the body only with TB disease

B. Persons with LTBI cannot spread TB bacteria to others

C. Sputum smears and cultures are positive with LTBI but NOT with TB disease

13. Which of the following patient characteristics indicate LTBI, TB disease, or both? (Choose the one best answer. Answers may be used more than once)

A. Is NOT a case of TB.

B. LTBI

C. TB disease

D. Both LTBI and TB disease

Has a positive TB skin test or positive IGRA blood test result*

A. Is NOT a case of TB.

B. LTBI

C. TB disease

D. Both LTBI and TB disease

May spread TB bacteria to others*

A. Is NOT a case of TB.

B. LTBI

C. TB disease

D. Both LTBI and TB disease

Has TB bacteria in his/her body *

A. Is NOT a case of TB.

B. LTBI

C. TB disease

D. Both LTBI and TB disease

May require respiratory isolation*

A. Is NOT a case of TB.

B. LTBI

C. TB disease

D. Both LTBI and TB disease

14. The following persons have LTBI. Which persons have factors that put them either at an increased risk of progressing to TB disease? (Choose correct answer(s))

A. osteopenia

B. diabetes

C. child is 3 years old

D. HIV

E. Chemotherapy

F. Not A, but all the other answers

15. Case ”Sergei”

Sergei, a 30-year-old male, visits the Health Department for a tuberculosis test because he is required to have one before he starts his new job at the Childrens Hospital. He has a positive reaction to the test. He has no symptoms of TB and his chest x-ray findings are normal. Should Sergei be considered a case of TB? (choose the one best answer)

A. Yes, because he had a positive reaction to the tuberculosis test.

B. No, because he has TB infection, but no evidence of TB disease.

Should Sergei be considered infectious? (choose the one best answer)

A. Yes, the test indicates that he has TB infection. Therefore he is infectious.

B. No, because he has TB infection, but not TB disease. Therefore he is not infectious.

16. Case ”Natalya”.Natalya, a 45-year-old female, is referred to theHealth Department by her physician. She is obese, has high blood pressure, andhas heart problems. She reports that she has injected illegal drugs in the pastand also tested positive for HIV infection. What conditions does Natalya have that increase the risk that she will develop TB disease?(write ”yes” or ”no” and on the right side)

Increases the risk of developing TB (yes or no)

A. Obesity*

Increases the risk of developing TB (yes or no)

B. HIV*

Increases the risk of developing TB (yes or no)

C. High blood pressure*

Increases the risk of developing TB (yes or no)

D. Injection of iv-drugs*

Increases the risk of developing TB (yes or no)

E. Heart problems*

Increases the risk of developing TB (yes or no)

17. For all patients, the initial M. tuberculosis isolate should be tested for resistance to the first-line anti-TB drugs: isoniazid, rifampin, ethambutol, and pyrazinamide.

A. True

B. False

18. Which of the following statements is true about drug-resistant TB disease? (choose the one best answer)

A. Drug-resistant TB disease is transmitted in the same way as drug-susceptible TB disease.

B. Drug-resistant TB disease is NO more infectious than drug-susceptible TB disease.

C. Drug-resistant TB disease is easily treated with standard drug regimens.

D. A, B, and C are all correct.

E. Only A and B are correct.

19. Which of the following types of TB disease is caused by the organism M. tuberculosis? (choose the one best answer.)

A. Drug-susceptible TB

B. MDR TB

C. XDR TB

D. A, B, and C are all correct.

E. Only A and B are correct

20. What increases the risk of getting TB infection when exposed with drug-resistant TB? (You can choose more than one answer)

A. Exposure to a person who has known drug-resistant TB disease

B. Exposure to a person with TB disease who has had prior treatment for TB (treatment failure or

relapse) and whose susceptibility test results are not known

C. Exposure to a person with TB disease from an area in which there is a high prevalence of drug

21. Case ”Irina”.

In the health clinic you see Irina, a new patient. She complains of weight loss, fever, and a cough of 4 weeks’ duration. When questioned, she reports that she has been treated for TB disease in the past and that she occasionally injects heroin. What parts of Irina’s medical history lead you to suspect TB disease? (choose the one best answer)

A. Her symptoms of TB disease (weight loss, fever, and a persistent cough).

B. The fact that she has been treated for TB disease in the past.

C. Her history of injecting illegal drugs (heroin).

D. A, B, and C are all correct.

E. Only A and C are correct.

What diagnostic tests should be done on Irina? (choose the one best answer)

A. Sputum specimen collection for smear and culture.

B. Drug-susceptibility testing if culture is positive.

C. Chest radiograph because she has symptoms of pulmonary TB disease.

D. A, B, and C are all correct.

E. Only A and B are correct.

22. Inadequate treatment can lead to which of the following? (choose the one best answer)

A. Treatment failure

B. Relapse

C. Ongoing transmission

D. Development of drug resistance

E. A, B, C, and D are all correct.

23. The responsibility for successful treatment is assigned to which of the following? (choose the one best answer)

A. The patient

B. The health-care provider

C. The family of the patient

D. A, B, and C are all correct.

E. Only A and B are correct.

24. What should be included when educating a patient about TB treatment? (choose the one best answer)

A. How to take the medication

B. Adverse reactions to the medications

C. Consequences of not taking the medication correctly

D. TB infection control measures

E. A, B, C, and D are all correct.

25. What is DOT? (choose the one best answer)

A. A supervisor watches a health-care worker give a patient a bottle of prescribed 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.

26. Which of the following statements about DOT is true? (choose the one best answer)

A. Is the preferred core management strategy for treatment of TB disease.

B. Can reduce the development of drug resistance, treatment failure, or relapse after the

end of treatment.

C. Parents can always be relied upon to give DOT to their children.

D. A, B, and C are all correct.