Tuberculosis Control Program BUMEDINST 6224.8

Question 1

What is the Tuberculosis Control Program instruction?

Answer 1

BUMEDISNT6224.8

Question 2

How many cases of tuberculosis occur annually in the United States?

Answer 2

20,000

Question 3

What is the most sensitive and specific test available for identifying those who are infected with Mycobacterium tuberculosis?

Answer 3

The tuberculin skin test with purified protein derivative (PPD) administered by the Mantoux method.

Question 4

What bacterium causes tuberculosis?

Answer 4

Mycobacterium tuberculosis

Question 5

What preventive therapy is the most effective measure to prevent the development of tuberculosis disease in a newly infected person?

Answer 5

Isoniazid (INH)

Question 6

True or False. Preventive treatment totally eliminates the risk of tuberculosis.

Answer 6

False. Although preventive treatment reduces the risk of disease, it does not totally eliminate it.

Question 7

What term describes that the person has symptoms, signs, radiographic, or laboratory evidence of pulmonary, meningeal, miliary, or extra pulmonary tuberculosis?

Answer 7

Active Disease

Question 8

What term describes that the person has no symptoms, signs, or radiographic evidence of active disease, but does have evidence of infection, as indicated by the presence of a positive tuberculin skin test?

Answer 8

Tuberculosis infection

Question 9

True or False. For the purposes of the Tuberculosis Control Program, all individuals who have a positive tuberculin skin test are considered to have a tuberculosis infection.

Answer 9

True.

Question 10

What method described a tuberculin skin test using a syringe and needle to inject purified protein derivative (PPD) of tuberculin?

Answer 10

Mantoux method

Question 11

What term described an area around the site of tuberculin injection that is raised and firm to the touch?

Answer 11

Induration

Question 12

What term described a person with an area of indurations to a 5 TU tuberculin skin test when read 48 to 72 hours after administration?

Answer 12

Tuberculin reactor

Question 13

What term describes a person with an area of induration of less than 5 mm to a 5 TU tuberculin skin test?

Answer 13

Tuberculin non reactor

Question 14

What vaccines are made from live attenuated mycobacteria strains are commonly used in some countries in an attempt to prevent vaccines from becoming infected with tuberculosis?

Answer 14

BCG (Bacillus Calmette-Guerin) vaccines

Question 15

What city and state is NAVENPVNTMEDU TWO in?

Answer 15

Norfolk, VA

Question 16

What city and state is NAVENPVNTMEDU FIVE in?

Answer 16

San Diego, CA

Question 17

What city and state is NAVENPVNTMEDU SIX in?

Answer 17

Pearl Harbor, HI

Question 18

What city and state is NAVENPVNTMEDU SEVEN in?

Answer 18

Naples, Italy

Question 19

What is the only approved tuberculin skin test material for the Mantoux test?

Answer 19

The premixed Tween-80-stabilized intermediate strength PPD (5 TU equivalent)

Question 20

Why is multiple-puncture tuberculin tests (e.g., Tine or Monovac tests) not used except on the specific recommendation of the area NAVENPVNTMEDU?

Answer 20

They produce significant numbers of both false-positive and false-negative test results.

Question 21

What type of syringe and needle is used for the administration of a Mantoux test?

Answer 21

A disposable 1 ml tuberculin syringe graduated in 0.1 ml intervals and fitted with a 25-guage 5/8 inch needle.

Question 22

What aspect of the forearm is the intra-dermal injection made?

Answer 22

Volar

Question 23

How many hours after administration of a tuberculin skin test must it be examined?

Answer 23

48 to 72 hours

Question 24

How is the indurations measured?

Answer 24

In millimeters at its widest transverse diameter (across the arm).

Question 25

Where is the test result entered in the medical treatment record?

Answer 25

SF 601 under SENSITIVITY TESTS

Question 26

How must the test result be entered in the medical record?

Answer 26

Date, type of tuberculin and its strength, and the diameter of induration in millimeters, written by hand; do not use rubber stamps or automatic imprinting devices.

Question 27

How must the complete absence of induration be entered on the SF 601?

Answer 27

“Zero mm.”

Question 28

What must be done if a person returns more than 72 hours after PPD application and the induration is zero to 14 mm?

Answer 28

Make an entry of “not read” on the SF 601. Immediately apply a PPD test on the opposite arm

Question 29

What must be done if a person returns more than 72 hours, (but before or on the 10th day), after PPD application and the induration is 15 mm or greater?

Answer 29

The reaction is significant. Enter the induration and the time interval since test application on the SF 601. Manage the person as a tuberculin reactor per Evaluation and Preventive Therapy (Chemoprophylaxis) of Tuberculin Reactors

Question 30

What must be done if a person returns more than 10 days after PPD application?

Answer 30

Make an entry of “not read” on the SF 601 regardless of the size of any induration. Immediately apply a PPD test on the opposite arm.

Question 31

True or False. Do not under any circumstances report a skin test result as “zero mm” if the test was not read by a qualified MDR

Answer 31

True

Question 32

What medical conditions have been reported to increase the risk of tuberculosis?

Answer 32

Silicosis, gastrectomy, jejeunoileal bypass, weight of 10 percent or more below ideal body weight, chronic renal failure, conditions requiring prolonged high-dose corticosteroid therapy or other immunosuppressive therapy, some hematologic disorders (e.g., leukemia and lymphomas) and other malignancies.

Question 33

What is the antibiotic regimen of choice for tuberculosis preventive therapy?

Answer 33

INH in an oral daily dose of 300 mg for adults and 10 mg/kg (not to exceed 300 mg) for children

Question 34

How long should tuberculin reactors with no risk factors for the development of tuberculosis disease receive INH therapy?

Answer 34

6 months of continuous therapy with INH

Question 35

How long should tuberculin reactors with HIV infection and persons with stable abnormal chest radiographs consistent with past tuberculosis receive INH therapy

Answer 35

12 months of continuous therapy with INH

Question 36

What are contraindications to preventive therapy with INH?

Answer 36

Previous history of INH-associated liver injury, history of a severe adverse reaction to INH, and acute or active liver disease of any etiology.

Question 37

True or False. Baseline liver function tests are not required for INH recipients under age 35.

Answer 37

True, but they should be done if clinically indicated

Question 38

What actions must be taken upon discovery of an active case of tuberculosis disease in the command?

Answer 38

Initiate Disease Alert Report (MED 6220-3). Locate patient’s close contacts. Screen contacts and screen again 3 months later. Maintain records of summary results. Clinically evaluate possible secondary cases for tuberculosis disease

Question 39

Which hospitals are designated to act as contact points for pulmonary medicine or infectious disease consultation and patient transfer if needed

Answer 39

NAVHOSP Oakland,CA; NAVHOSP Portsmouth, VA; NAVHOSP San Diego, CA; and NAVHOSP Bethesda, MD.

Question 40

How is tuberculosis transmitted?

Answer 40

By small airborne droplets or droplet nuclei from person to person in close contact or possibly through ventilation systems, such as on ships