TB surveillance and Control

Question 1

what are the elements of an effective TB control program?

Answer 1

• TB screening
• Preventive therapy
• TB case ID
• TB patient management
• Contact investigation

Question 2

what skin test is used to test for TB

Answer 2

Tuberculin Skin Test (TST)

Question 3

what two ways can you test for a TB infection?

Answer 3

• TST

- Interferon Gamma Release Assay (IGRA)

Question 4

when can you use a QFT test?

Answer 4

• in all circumstances that a TST is used but NOT BOTH

Question 5

what bacteria can cause Active TB

Answer 5

Mycobacterium TB

Question 6

Latent TB:

Answer 6

• TB bacteria is alive but not reproducing and are inactive

- no symptoms

Question 7

what is Direct Observed Therapy

Answer 7

• way of ensuring patients take their medication

Question 8

what are the two meds given for TB?

Answer 8

• Isoniazid (INH)

- Rifapentine (RPT)

Question 9

what is the duration and dosage of INH and RPT?

Answer 9

• Oral weekly dose for 3 months

- 15mg per kg (900mg Max)

Question 10

what is an alternate regimen for INH and RPT?

Answer 10

• Rifampin (RIF) daily 10mg/kg (600mg max) for 4 months

Question 11

when is a TST required?

Answer 11

• initial entry to the military
• when screening requires it
• deemed to be at risk of TB
• clinically indicated my medical

Question 12

what do you document a periodic TB screening on?

Answer 12

• NAVMED 6224/8

Question 13

when do you perform periodic TB screening?

Answer 13

• at annual PHA

Question 14

when doing a TST when must it be read?

Answer 14

48-72 hours

Question 15

what is the purpose of a TB CXR?

Answer 15

• rule out active TB or fibrotic changes

Question 16

what is a positive induration for someone whos considered high risk?

Answer 16

5mm

Question 17

what is a positive induration for someone whos considered low risk?

Answer 17

10mm

Question 18

what is a positive induration for someone whos low risk?

Answer 18

15mm

Question 19

who is considered high risk for TB?

Answer 19

• recent close contact that has active TB
• person with fibrotic changes on CXR
• PT suspected to have TB

Question 20

who is considered medium risk for TB?

Answer 20

• recent immigrants (5 years) from high prevalence TB country
• healthcare workers exposed
• PT with clinical conditions that increase risk

Question 21

who is considered low risk for TB?

Answer 21

• person with no risk factors for TB

Question 22

what method is used for the TST?

Answer 22

Mantoux method

Question 23

how big should the wheal be for a TST?

Answer 23

6 to 10mm

Question 24

what form do you document a PPD on?

Answer 24

NAVMED 6230/4

- DD 2766

Question 25

how do you document the ppd result if they don’t come back?

Answer 25

“Not Read”

Question 26

what can cause false negative for the TST?

Answer 26

• immunosuppression due to TB infection

- general immunosuppression

Question 27

how often does someone on INH have to be evaluated?

Answer 27

Monthly

Question 28

what must be included in the INH Monthly evaluation?

Answer 28

• physician assessment to check for Active TB
• ask about drug reactions
• discuss when to DC medication
• discuss what to look out for
• document on NAVMED 6224/9

Question 29

what test do you need before putting someone on INH?

Answer 29

• Liver Function Test (LFT)

- SGOT/SGPT

Question 30

what are the two classes of AntiTB meds?

Answer 30

• Bactericial (INH, Rifampin)

- Bacteriostatic (Ethambutol, Streptomycin)