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PREVMED TEST 3 > TB control > Flashcards

TB control Flashcards

1
Q

What are the 5 elements of TB control program?

A
  1. TB screening + testing
  2. EVAL + MGT. of LTBI patients
  3. TB contact investigation
  4. TB patient MGT.
  5. Reports
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2
Q

What are the 2 tests to identify individuals exposed to Mycobacterium TB?

A

Tuberculin Skin Test

Blood Assay for M. TB (BAMT)

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3
Q

What is the bacteria that causes TB?

A

mycobacterium tuberculosis

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4
Q

What are the 2 materials that are approved for performing TST?

A

Tuberculin PPD

Disposable 1ml tuberculin syringe

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5
Q

What is the preferred PPD product and PPD strength?

A

Tween-80-stabilized intermediate strength 5TU

Tubersol is preferred product

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6
Q

What is the alternate PPD product?

A

Aplisol

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7
Q

What syringe and needle size are used for tuberculin skin test?

A

1ml disposable syringe, 1/4 to 1/2in., 27 gauge needle with short bevel

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8
Q

What is used as a diagnostic aid for M. tuberculosis infection?

A

BAMT, QuantiFERON-TB Gold (QFT-G)

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9
Q

When should you use QFT-G?

A

diagnostic aid for M. TB
all circumstances in which TST is used
In place of, not in addition to a TST

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10
Q

Term: Bacteria present in latent TB infections and active TB patients

A

mycobacterium tuberculosis (spore forming)

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11
Q

Term: an illness in which TB bacteria are multiplying and attacking a part of the body, usually the lungs

A

active TB disease

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12
Q

Term: condition in which TB bacteria are alive but inactive in the body, have no symptoms, don’t feel sick, can’t spread TB to others, and positive STS

A

latent TB infection

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13
Q

Term: test often used to find out if you are infected with TB bacteria

A

TB skin test (TST)

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14
Q

Term: a new test that uses a blood sample to find out if you are infected with TB bacteria

A

TB blood test

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15
Q

Term: a vaccine for TB named after a French scientists who developed it, rarely used in US but given to infants/small children in TB common countries

A

BCG, Bacillus Calmette Guerin

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16
Q

Term: when you meet with a health care worker daily or several times per week to help patients take their medicine for TB

A

DOT, directly observed therapy

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17
Q

Term: test result that probably means you do not have TB infection?

A

neg TST

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18
Q

Term: test result that means you have a TB reaction and probably have TB infection

A

pos TST

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19
Q

What is the effective therapy and dosage to prevent the development of TB disease to LTBI patients?

A

INH 5mg/kg (300mg max) X9 months to accomplish 270 doses within 12 months

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20
Q

When should you use an alternate INH regimen?

A

in combination with DOT

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21
Q

What is the alternate INH regimen dosage?

A

15mg/kg (900mg max) twice weekly X9 months in combination with DOT only

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22
Q

How frequently should PPD testing be performed?

A

Initially entering AD or CIVMAR
Annually during PHAs
contact/outbreak/clinically indicated
Suitability screening

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23
Q

When does a person provide adequate documentation of hospitalizations, diagnosis, treatments, and clinical evaluations?

A

a person begins employment as CIVMAR for MSC
has a history of active or LTBI
has a reaction to TST
has a history of INH therapy

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24
Q

What is adequate medical documentation for persons with past, active, or reactive TST/INH therapy?

A

Include copies of pertinent medical records and
Physician statement on letterhead stationery
*if not then perform TST

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25
Q

When should a chest X-ray be performed during tuberculosis screening?

A

when clinically indicated or when ruling out active TB

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26
Q

Who do you contact if the rate of newly identified LTBI converters is more than one to two percent of personnel tested per year?

A

cognizant NAVENPVNTMEDU

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27
Q

What can be administered to people who have received BCG? And if positive what is the significance?

A

TST can be administered

individuals should be regarded as indicative of TB infection

28
Q

INH risk: induration of =/>5mm
recent close contact of active TB patients
fibrotic or other changes on chest X-ray with prior TB
Suspected of having active TB

A

pos TST, High risk

29
Q

INH risk: induration of =/>10mm
immigrants within 5yrs from high TB countries
Mycobacteriology lab personnel
clinical conditions that place them at increased risk

A

pos TST, medium risk

30
Q

INH risk: induration of =/>15mm and no risk factors for TB

A

pos TST, low risk

31
Q

INH risk: 15mm induration or greater

A

low risk

32
Q

INH risk: 10mm induration or greater

A

medium risk

33
Q

INH risk: 5mm induration or greater

A

high risk

34
Q

What is included in the initial evaluation with pos BAMT or TST?

A

appropriate clinical history, PE, chest X-ray, baseline liver function tests + bilirubin

35
Q

When should you perform a baseline liver function test (SGOT/SGPT) + bilirubin

A

patients with elevated risk for liver disease or INH-induced hepatoxicity

36
Q

Prior to therapy, who must evaluate a person with pos BAMT or TST to rule out what?

A

MO, NP, PA, or IDC

r/o active TB

37
Q

What are the requirements for INH therapy during monthly evaluations?

A

PE to check for signs of hepatitis or adverse effects
counseling on adverse drug reaction
discuss when to d/c meds
discuss when to report for prompt medical evaluation

38
Q

How often do you follow up for INH preventive therapy?

A

Monthly and annually

39
Q

What are the requirements for non-compliance extended doses of INH therapy?

A

Examine to r/o active TB if interrupted >2 months
administer at least 270 doses of INH within 12 months
15mg/kg (900mg max) twice weekly with DOT

40
Q

When should you consider withholding INH in regards to blood levels? and why?

A

patient’s transaminase levels exceed 3-5X the upper limit of normal
INH may increase the liver enzyme (SGOT/SGPT) levels

41
Q

What is the purpose for TB contact investigation?

A

initiated upon discovery of an active TB to prevent further propagation

42
Q

What are the procedures for suspected or confirmed case of active TB?

A

CO notifies cognizant NEPMU + local hlth dept. ASAP
NEPMU conducts investigation w/ medical + IAW CDC
If separating from service be ID to local public hlth

43
Q

Who is responsible for ensuring contact investigation is initiated rapidly?

A

CO/OIC of individual

44
Q

Who are reports provided to when conducting TB contact investigations?

A

cognizant NEPMU provides copies to CMD, cognizant FLEET/TYCOM surgeon, and NMCPHC

45
Q

Within how long should you submit an MER for suspicious or confirmed TB diagnosis?

A

within 24hrs

46
Q

When should you submit a second MER?

A

when active TB is either ruled in or out

47
Q

What are the method is preferred for administering PPD tests?

A

Mantoux method

48
Q

What is the standard method to screen for exposure to tubercle bacilli?

A

Mantoux method

49
Q

How much tuberculin is administered for PPD test and strength?

A

0.1 ml intermediate strength PPD

50
Q

How do you administer tuberculin for PPD test?

A

intradermal 0.1 ml intermediate strength PPD (5tu) on volar aspect of forearm, bevel up, clean/dry site, inject outer layer of epidermis, so that a tense pale wheal 6-10 mml appears on skin

51
Q

why should you repeat a PPD test if the wheal is <6 mm when initially administering? where should you administer it?

A

needle may have been inserted too deeply
adequate dose wasn’t administered
at least 2in from original site or opposite arm

52
Q

When should you interpret PPD results after administering it?

A

examined by trained MDR, 48-72hrs after administration

53
Q

How do you measure/record PPD induration results?

A
  • @nearest whole mm + widest transverse diameter
  • ignore redness
  • move fingertips across reaction
  • use mm ruler to measure at its widest point
  • record lower reading between marks
54
Q

What forms are used to record PPD results?

A

NAVMED 6230/4 or

NAVMED 6230/5

55
Q

What is recorded when there is an absence of induration for PPD results?
what about failure to read results?
and what should not be recorded?

A

0 mm or zero mm
not read, no show >72hrs apply on opposite arm
don’t record as neg/pos

56
Q

What happens if individual returns or does not return >72hrs from original administration of PPD?

A

recall the individual record as “not read” and apply TST on opposite arm

57
Q

If live attenuated virus vaccines are given how long do you wait until administering PPD?

A

same day as parenteral live attenuated virus vaccine

or 4wks after live attenuated vaccines

58
Q

What are some symptoms that are related with active tuberculosis disease?

A

weakness, weight loss, fatigue, fever, loss of appetite, chills, and night sweats, other symptoms bad cough, chest pain, dyspnea, hoarseness, and hemoptysis

59
Q

What is the treatment for active TB patients?

A

Chemotherapy, INH daily 300mg for adults, 10-20mg/kg for children X6-9 months

60
Q

what are the 2 classifications of anti-tuberculous drugs?

A

bactericidal (isoniazid, rifampin, pyrazinamide)

bacteriostatic (ethambutol, streptomycin)

61
Q

what are the 3 bactericides for anti-tuberculous drugs?

A

isoniazid
rifampin
pyrazinamide

62
Q

what are the 2 bacteriostatic anti-tuberculous drugs?

A

ethambutol

streptomycin

63
Q

what are some complications for patients with active TB disease?

A

extrapulmonary TB infection
adverse effects,
INH associated HEP
superinfections/resistance to tx

64
Q

What is BUMEDINST 6224.8 Series 8B, 21FEB13?

A

TB control program

65
Q

What is the instruction for Tuberculosis Control Program?

A

BUMEDINST 6224.8

PREVMED TEST 3 (4 decks)

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