NTP III Flashcards
1
Q
What is the primary objective of tuberculosis preventive treatment (TPT)?
A
To prevent development of active TB by providing TB preventive treatment to eligible high-risk individuals.
2
Q
Which groups are targeted for isoniazid preventive treatment globally?
A
- People living with HIV
- Child household contacts less than 5 years old
3
Q
What are the new WHO guidelines regarding LTBI management issued in March 2018?
A
They recommended adopting shorter regimens like the three-month weekly rifapentine plus isoniazid regimen (3HP) and expanding target groups to all household contacts aged 5 years and older of bacteriologically confirmed PTB.
4
Q
Define ‘contact investigation’ in the context of TB.
A
A systematic process for identifying people with previously undiagnosed TB among the contacts of an index person with TB.
5
Q
What is a ‘household contact’ in TB terms?
A
A person who shared the same enclosed living space as the index person with TB.
6
Q
What does ‘latent tuberculosis infection (LTBI)’ mean?
A
A state of persistent immune response to stimulation by MTB antigens with no evidence of clinical manifestations of active TB disease.
7
Q
What is TB Preventive Treatment (TPT)?
A
Treatment offered to individuals who are at risk of developing active TB disease to reduce that risk.
8
Q
True or False: TST or IGRA is required for all individuals prior to TB preventive treatment.
A
False
9
Q
List the groups that do not require TST before TB preventive treatment.
A
- PLHIV
- Children < 5 years old who are household contacts of bacteriologically confirmed PTB
- Individuals aged 5 years and older who are household contacts of bacteriologically confirmed PTB with other TB risk factors.
10
Q
What should be done prior to initiating TB preventive treatment?
A
Exclude active TB by symptom and chest X-ray screening.
11
Q
Who should not receive preventive treatment?
A
Contacts of MDR-TB and RR-TB.
12
Q
What is the recommended regimen for TB preventive treatment under the program?
A
- 6 months of Isoniazid (6H)
- Weekly dosing with isoniazid and rifapentine for three months (3HP)
- Isoniazid and rifampicin daily (3HR) for children
- Rifampicin daily (4R) for adults.
13
Q
Fill in the blank: The abbreviation ‘PLHIV’ stands for _______.
A
People Living with HIV.
14
Q
What should be monitored during TB preventive treatment?
A
Regular clinical and laboratory follow-up for treatment monitoring.
15
Q
What is the significance of pyridoxine (vitamin B6) in TB treatment?
A
It is prescribed to individuals taking isoniazid who are at risk for peripheral neuropathy.
16
Q
In what situation is chest X-ray screening not required prior to TB preventive treatment?
A
For children < 5 years old.
17
Q
What are the options for treatment adherence and support mechanisms?
A
- Location: Home-, community-, or facility-based care
- Treatment supporter: family member, community partner, health-care workers
- Digital tools: video DOT/missed-call DOT.
18
Q
Who should be referred for further evaluation for active tuberculosis?
A
Those with TB signs and symptoms.
19
Q
What is the role of Form 4d and Form 5 in TB treatment?
A
To document and register the patient for TB preventive treatment.
20
Q
What is the importance of discussing social and financial needs with clients?
A
To enable adherence to treatment.
21
Q
What is the maximum duration for dispensing medicines?
A
One month.
22
Q
What forms must be accomplished for TB treatment?
A
Form 4d. TPT Treatment Card and Form 5. TB and TPT Patient Card.
23
Q
What should be done if a patient requires social or financial support?
A
Refer accordingly to other programs providing social protection.
24
Q
Which medications can be used in pregnant women?
A
Isoniazid and rifampicin.
25
What should be avoided in pregnant or breastfeeding women?
Rifapentine.
26
When should preventive treatment be deferred for pregnant women with HIV?
Until three months post-partum.
27
What should be given to infants whose breastfeeding mother is taking isoniazid?
Supplemental pyridoxine (vitamin B6).
28
What interaction occurs with rifampicin and rifapentine when taken with oral contraceptives?
Risk of decreased protective efficacy against pregnancy.
29
What should be advised to women on oral contraceptives while taking rifampicin or rifapentine?
Options include a higher dose of estrogen or another form of contraception.
30
What is the baseline liver transaminases threshold for initiating treatment with isoniazid and rifampicin?
More than three times the upper limit of normal (ULN).
31
When should preventive treatment be deferred in cases of acute hepatitis?
Until the acute hepatitis has been resolved.
32
How are isoniazid and rifampicin eliminated in patients with renal failure?
By biliary excretion.
33
What is the recommendation for patients with severe renal failure receiving isoniazid?
They should receive isoniazid with pyridoxine to prevent peripheral neuropathy.
34
Can rifampicin and rifapentine be co-administered with efavirenz?
Yes, without dose adjustment.
35
What should be done for a newborn whose mother has active TB disease?
Assess the newborn and refer if not well.
36
What is the follow-up schedule for patients after the initiation of treatment?
Two weeks after initiation and then at least monthly thereafter.
37
What should be monitored during follow-up visits?
Signs or symptoms of TB and adverse reactions.
38
What should be done if a patient develops active TB disease while on preventive treatment?
Stop TB preventive treatment and start treatment for active TB disease.
39
What tests are recommended monthly for individuals with abnormal baseline liver function tests?
Liver function tests (LFTs).
40
What should be done if liver transaminases exceed three times the ULN?
Discontinue treatment.
41
What should be explained to the patient regarding adherence?
The importance of adherence and completion at each encounter.
42
What is the definition of 'Completed' in treatment outcomes?
An individual who has completed the prescribed duration of treatment and remains well or asymptomatic.
43
What does 'Lost to follow-up' mean?
An individual who interrupted TB preventive treatment for two consecutive months or more.
44
What is the definition of 'Failed' in treatment outcomes?
An individual who developed active TB disease anytime while on TB preventive treatment.
45
What is the purpose of recording and reporting in TB control programs?
To ensure appropriate and effective care for patients and monitor program efficiency.
46
What is defined as Data Privacy?
Determining what data in an information system can be shared with third parties.
47
What is the retention period for paper-based records?
Seven years before properly being discarded.
48
What is the archiving period for electronic records?
20 years.
49
What is the ITIS?
The official electronic TB information system.
50
What ink color should be used for positive laboratory results?
Red ink.
51
What should be done for corrections in paper records?
Strike through incorrect information, correct it, and countersign with initials and date.
52
What is the standard notation for recording a patient's name?
Family name first in capital letters, followed by given name and name extensions.
53
What should be done with unused old paper forms?
Discard them as soon as new paper forms are available.
54
What should be done if patient records are lost?
Submit an incident report to the supervisor.
55
What is discouraged regarding the copying of records?
Copying of records in any forms, other than those mentioned in this MOP, is only allowed if approved by head of the facility or supervisor and with valid reason or purpose, e.g. back up record and decentralization.
56
What should be done if a patient record is lost?
Submit an incident report to the supervisor, exhaust efforts to find the missing record or device, and implement preventive measures.
57
What is ITIS used for?
ITIS serves as the backup tool for data and record recovery in case of catastrophic events such as fire, flood, or other natural disasters.
58
What must be done within 24 hours of discovering a violation of patient’s privacy?
Report to the facility head in writing and provide NTP Management Office a courtesy copy of this written report.
59
How long should paper-based records that are dormant or inactive be archived?
Five years in a separate storage space with lock.
60
What is the best method of disposing of confidential documents?
Shredding.
61
Who is responsible for ensuring accuracy and consistency of ITIS reports?
The physician or immediate supervisor.
62
What is required for an ITIS user account request?
Completion of the KMITS Service Request Form and submission to the ITIS Regional Administrator.
63
What happens to dormant ITIS accounts after six months of no login?
They are automatically inactivated.
64
What should be done to maintain ITIS security?
Keep account’s authentication details private and do not share accounts.
65
What should be encoded in ITIS at least once a week?
Screening information, treatment cards, laboratory results, and patient updates.
66
What is the purpose of palliative care according to the WHO?
To improve the quality of life for patients and their families facing life-threatening illness.
67
What must be ensured for patients with DR-TB?
Holistic management during treatment to attain treatment completion.
68
What are the end-of-life support measures for patients with TB?
* Relief of dyspnea
* Relief from pain and other symptoms
* Nutritional support
* Infection control measures
69
What is the scoring system for the CAGE questionnaire?
Item responses are scored 0 or 1, with a total score of 2 or greater considered clinically significant.
70
What is the confidentiality requirement when sharing patient data?
Observe confidentiality of records at all times to protect patient privacy.
71
What should be done when requesting access to patient data?
Course all requests through a formal letter stating the intended use of the data.
72
What is the maximum duration for archiving electronic records in ITIS?
20 years after the end of the most recent TB treatment episode.
73
What is the best practice for documenting records being disposed?
Document records being disposed in a logbook.
74
What should be provided to patients and families regarding TB management?
Counseling and education about TB disease.
75
Fill in the blank: The use of _______ is recommended when sharing patient data through the Internet.
confidentiality disclaimer
76
True or False: Sharing of external storage devices containing patient records is encouraged.
False
77
What is the requirement for validating cases and laboratory results in ITIS?
Validator must be different from the encoder.
78
What type of support should patients receive at the end of life?
Minimal suffering and support to maintain dignity.
79
What must be included in the KMITS Service Request Form?
* Change of ITIS version
* Change of access level
* Update of assignment or contact information
* Account deactivation
80
What are the responsibilities of the designated ITIS case validator?
Validate the encoded data.
81
What must be done if a report is overdue?
Send a letter to the PHO/CHO requesting reopening of the submission of report.
82
What should be monitored during routine data quality assessment?
Completeness, accuracy, and consistency of data.
83
What is the goal of palliative care in relation to DR-TB management?
To ensure quality of life and empower patients in their care.
84
What is the first step when a patient is suspected of having TB?
Request for bacteriologic test.
85
What symptoms indicate presumptive TB?
Cough of 2 weeks duration, unexplained fever of 2 weeks duration, night sweats of 2 weeks duration, unintentional and unexplained weight loss
## Footnote
If YES to at least 1, identify as presumptive TB and request for bacteriologic test.
86
What should be done if a patient has had a chest X-ray done in the past year?
Inquire about the result and determine if bacteriologic testing is needed
## Footnote
If NO, offer Chest X-ray screening.
87
What are primary risk factors for TB screening clients?
* Contacts of TB patients
* Those ever treated for TB
* People living with HIV (PLHIV)
* Elderly (> 60 years old)
* Diabetics
* Smokers
* Health-care workers
* Urban and rural poor (indigents)
* Those with other immune-suppressive medical conditions
## Footnote
These include conditions such as silicosis, solid organ transplant, autoimmune disorders, and more.
88
What is the presumptive TB yield rate for cough for ≥ 2 weeks at health facilities?
6%
## Footnote
This corresponds to 60 presumptive TB cases from 1,000 screened.
89
What is the presumptive TB yield rate for chest X-ray in risk groups in health facilities?
25%
## Footnote
This corresponds to 250 presumptive TB cases from 1,000 screened.
90
What is Xpert MTB/RIF?
An automated molecular assay that detects Mycobacterium tuberculosis and rifampicin resistance
## Footnote
Xpert Ultra is a newer generation with higher sensitivity.
91
What is the purpose of smear microscopy (SM) in TB diagnosis?
To diagnose TB cases, monitor treatment progress, and confirm cure in drug-sensitive TB
## Footnote
It is a conventional test used widely.
92
What is the tuberculin skin test (TST)?
A basic screening tool for TB infection using purified protein derivative (PPD)
## Footnote
It triggers a delayed hypersensitivity reaction in previously infected individuals.
93
What is the recommended treatment for pregnant women with TB?
Standardized treatment regimen of 2HRZE/4HR, with pyridoxine (vitamin B6) at 25 mg/day
## Footnote
Most anti-TB drugs are safe except streptomycin.
94
What is the risk associated with rifampicin and oral contraceptives?
Decreased protective efficacy against pregnancy
## Footnote
Women should consult clinicians about higher dose estrogen options or alternative contraception.
95
What should be done for patients with liver disease receiving TB treatment?
Do not use pyrazinamide; alternative regimens are needed
## Footnote
Options include 2SHRE/6HR or 9RE.
96
What is the adjustment for isoniazid dosing in patients with renal failure?
No change in frequency; 300 mg once daily or 900 mg three times per week
## Footnote
However, streptomycin should be avoided in these patients.
97
What are the interactions of rifampicin with anti-hypertensive medications?
Markedly reduces levels of calcium channel blockers and B-blockers
## Footnote
Minor clinical significance with ACE inhibitors.
98
What should be done if a patient has elevated ALT levels during TB treatment?
Interrupt treatment and modify regimen if ALT is more than three times the upper limit of normal
## Footnote
Refer to a specialist if needed.
99
What is the role of Digital Adherence Technologies (DAT) in TB treatment supervision?
Provides accurate, real-time data on patient treatment adherence
## Footnote
An example is 99 DOTS, which uses customized medication packaging with phone technology.
100
What effect do acids containing aluminum, calcium, or magnesium have on quinolones?
They may reduce absorption of quinolones.
101
What happens to serum levels of ciprofloxacin when used concurrently with didanosine?
Serum level of ciprofloxacin is reduced.
102
What is 99 DOTS?
A DAT that pairs customized medication packaging with basic phone call/SMS technology for patient treatment adherence.
103
How does the Smart pillbox work?
It combines a medication box with a sensor and mobile data connection to send dosing-event information in real-time.
104
What is Video-supported treatment (VOT)?
An Android app that utilizes video recording to monitor and support TB medication intake.
105
What should be advised to female patients at reproductive age regarding MDR-TB treatment?
Pregnancy should be avoided.
106
What methods of contraception are recommended during MDR-TB treatment?
* Depot medroxyprogesterone acetate (Depo Provera)
* Intra-uterine device
* Implants
107
When can treatment for pregnant patients with MDR-TB be deferred?
If clinically stable with minimal radiological disease, treatment may be deferred until the second trimester.
108
What drugs should be avoided during pregnancy due to potential teratogenic effects?
* Injectables
* Prothionamide
109
Which drug may be considered for individual women during pregnancy after weighing risks and benefits?
Bedaquiline.
110
What should mothers with sputum-positive MDR-TB do regarding breastfeeding?
Discontinue breastfeeding if possible.
111
What is the US-FDA classification for drugs with no risk in human studies?
Class A.
112
What is the recommended action for patients with mild to moderate renal insufficiency regarding Bdq and Dlm?
No adjustment necessary.
113
What is the formula to calculate creatinine clearance?
weight (kg) x (140 - age) x Constant / Serum Creatinine (umol/L)
114
What is the recommended dosage for Isoniazid in patients with creatinine clearance < 30 ml/min?
No adjustment necessary.
115
What should be done for patients with severe renal insufficiency regarding anti-TB drugs?
Use with caution and adjust dosing per patient’s creatinine clearance.
116
What is the recommended action for patients with mild hepatic impairment taking Bdq and Dlm?
No contraindication.
117
What should be monitored in patients with diabetes mellitus undergoing treatment for DR-TB?
Blood glucose control.
118
What is the role of surgery in MDR-TB and RR-TB treatment?
Elective partial lung resection may be used alongside a recommended MDR-TB regimen.
119
What are the signs and symptoms of peripheral neuropathy?
* Numbness
* Tingling
* Burning
* Pain in the feet or hands
120
What is the grading scale for the severity of peripheral neuropathy symptoms?
0 = Normal, 1 = Mild, 2 = Moderate, 3 = Severe.
121
What should be done for patients with Grade 2 peripheral neuropathy?
Stop Cs and Lzd; consider restarting Cs.
122
What is the action for patients with Grade 4 myelosuppression?
Stop Lzd immediately; consider hemotransfusion or erythropoietin.
123
What are the potential causes of myelosuppression during MDR-TB treatment?
* Linezolid
* AZT
124
What is the management strategy for patients with anemia due to myelosuppression?
Stop the causative drug immediately and monitor blood counts.
125
What possible anti-TB drugs can cause prolonged QT interval?
* Cfz
* Bdq
* Mfx
* Dlm
* Lfx
126
What are the storage temperature requirements for Epoetin alfa prefilled syringes?
Cold chain (2°– 8° C)
## Footnote
Epoetin alfa is to be stored within this temperature range to maintain efficacy.
127
What is the recommended dosing for Epoetin alfa?
150 IU/Kg three times a week or 450 IU/Kg once a week subcutaneously or intravenously
## Footnote
This dosing can vary based on patient needs.
128
Which drugs are possible causes of QT interval prolongation?
* Cfz
* Bdq
* Mfx
* Dlm
* Lfx
* Erythromycin
* Clarithromycin
* Quinidine
* Ketoconazole
* Fluconazole
* Antipsychotics
* Ondansetron
* Granisetron
* Domperidone
* Methadone
* Some antiretrovirals
## Footnote
This is not an exhaustive list; many drugs can impact the QT interval.
129
What should be checked if a patient has symptoms of cardiotoxicity?
An ECG
## Footnote
Symptoms include tachycardia, syncope, palpitations, weakness, or dizziness.
130
What formula is used to calculate the QTc interval?
QTcF = QT / RR^0.5
## Footnote
Fridericia’s formula is used for more accurate QT interval correction.
131
What does a QTcF of 450–480 ms indicate?
Grade 1 Mild Prolongation
## Footnote
This is the first level of severity for QT prolongation.
132
What is the action for Grade 3 Severe QT prolongation?
Stop the suspected causative drug(s) and hospitalize
## Footnote
Electrolytes should be repleted as necessary.
133
What electrolytes should be checked if a prolonged QT interval is detected?
* Serum potassium (K+)
* Ionized calcium (ionized Ca++)
* Magnesium (Mg++)
## Footnote
Abnormalities in these electrolytes are often related to injectable medications.
134
What is the management strategy for a patient with low potassium?
Urgent management with replacement and frequent repeat potassium testing
## Footnote
Testing is often daily or multiple times a day.
135
What is the first sign of optic neuritis?
Loss of red-green color distinction
## Footnote
This condition can lead to permanent vision loss.
136
Which drug is the most common cause of optic neuritis among TB drugs?
Linezolid
## Footnote
This typically occurs after four months of treatment.
137
What is the action for any grade of optic nerve disorder?
Stop Linezolid immediately
## Footnote
If there are any suspicions of optic neuritis, do not restart it.
138
What characterizes hepatitis in patients on anti-TB drugs?
Nausea, vomiting, jaundice, scleral icterus, tea-colored urine, pale stool, diminished appetite
## Footnote
These symptoms occur in the setting of elevated liver function tests.
139
What should be done for Grade 4 Life-threatening hepatitis?
Stop all drugs, including anti-TB drugs; measure LFTs weekly
## Footnote
Treatment may be reintroduced after toxicity is resolved.
140
What is the suggested management for hearing impairment due to anti-TB drugs?
Avoid aminoglycoside injectables in patients with baseline hearing loss
## Footnote
Hearing loss is often irreversible upon discontinuation of therapy.
141
What tests can be used to detect hearing loss?
* Audiometry
* Rinne’s test
* Weber’s test
## Footnote
These tests help diagnose types of hearing loss.
142
How should anti-TB drugs be reintroduced after hepatitis resolves?
In serial fashion every three to four days, starting with the least hepatotoxic drugs
## Footnote
Liver function tests should be monitored after each new exposure.
