TUBERCULOSIS SURVEILLANCE AND CONTROL PROGRAM

Question 1

BUMEDINST 6224.8 Series

Answer 1

Tuberculosis Surveillance and Control Program

Question 2

What are the Elements of the TB Control Program

Answer 2

(1) Tuberculosis Screening
(2) Preventive Therapy
(3) Tuberculosis Case Identification
(4) Tuberculosis Patient Management
(5) Contact Investigation

Question 3

What is the method for Tuberculin Skin Test

Answer 3

Mantoux Method

Question 4

Approved materials for the tuberculin Purified Protein Derivative (PPD)

Answer 4

a) Tubersol – preferred product
b) Aplisol – alternate product

Question 5

What type of syringe and needle is used for the PPD

Answer 5

Disposable 1 ml tuberculin syringe
Fitted with a ¼ to ½ inch, 27 gauge needle with a short bevel

Question 6

What is Mycobacterium tuberculosis?

Answer 6

Bacteria that cause latent TB infection and active TB disease.

Question 7

What term
An illness in which TB bacteria are multiplying and attacking a part of the body, usually the lungs.

Answer 7

Active TB disease.

Question 8

What term
-A condition in which TB bacteria are alive but inactive in the body.
-People with latent TB infection have no symptoms, don’t feel sick, can’t spread TB to others, and usually have a positive skin test reaction.

Answer 8

Latent TB infection

Question 9

What term
-A vaccine for TB named after the French scientists who developed it, Calmette and Guérin.
-is rarely used in the United States, but it is often given to infants and small children in other countries where TB is common.

Answer 9

BCG

Question 10

Direct observed therapy (DOT)

Answer 10

(a) A way of helping patients take their medicine for TB.
(b) If you get DOT, you will meet with a health care worker every day or several times a week.

Question 11

Latent Tuberculosis Infection (LTBI) Treatment

Answer 11

Isoniazid (INH) and Rifapentine (RPT) in an oral weekly dose of 15 mg/kg (900mg max) of INH and RPT based off weight for 3 months.

Question 12

Initial screening (TB Testing) is done for?

Answer 12

-All personnel entering active duty.
-All individuals beginning employment as CIVMAR for the MSC
-When the person has past history of active disease, reaction to skin test, or a history of INH therapy

Question 13

When the person has past history of active disease, reaction to skin test, or a history of INH therapy.
What documentation must they provide?

Answer 13

1) Clinical evaluations
2) Hospitalizations
3) Diagnosis
4) Treatments

Question 14

Periodic screening (LTBI Screening)
for active duty is done when and documented on what?

Answer 14

(a) Annual screening during Periodic Health Assessment (PHA).
(b) Document on NAVMED 6224/8

Question 15

(LTBI Screening)
is documented on what form?

Answer 15

NAVMED 6224/8

Question 16

Chest radiograph is done to rule out_____ or ____
If clinically indicated

Answer 16

active TB or fiberotic changes.

Question 17

BCG stands for?

Answer 17

Bacillus Calmette Guerin

Question 18

Can you still administer TST for someone who previously received BCG immunization

Answer 18

Yes

Question 19

What risk type?
Induration of 5mm or greater is considered positive
-Recent close contacts of active TB disease patients.
-Persons with fibrotic or other changes on chest radiograph consistent with prior TB.
-Patients suspected of having active TB disease.

Answer 19

High Risk

Question 20

TB risk category
Induration of 10mm or greater.
-Recent immigrants (within 5 years) from high TB prevalence countries.
Healthcare workers and others at risk of occupational exposure to TB.
-Persons with clinical conditions that place them at increased risk.

Answer 20

Medium

Question 21

Risk factor
Induration of 15mm or greater
-Persons with no risk factors for TB

Answer 21

Low Risk

Question 22

How much intermediate strength PPD do you use

Answer 22

0.1 mL

Question 23

What is the angle of injection for PPD

Answer 23

5 to 15°

Question 24

how big is the wheal supposed to be when injecting PPD

Answer 24

6 to 10mm

Question 25

If the wheal is less than 6mm in diameter

Answer 25

he test should be administered
again

Question 26

Record PPD result on

Answer 26

DD form 2766 or NAVMED 6230/4

Question 27

what is the result NOT recorded as

Answer 27

1) Negative
2) Positive

Question 28

If person does not return

Answer 28

Record the result as “not read”, recall the person and apply TST on opposite arm

Question 29

When can you administer TST in relation to live attenuated vaccines

Answer 29

on the same day
At least four weeks after

Question 30

Prior to therapy, the reactor must be evaluated by an
_____ active TB disease.

Answer 30

Provider
MO, NP, PA, or IDC

Question 31

evaluation prior to INH

Answer 31

(a) Appropriate clinical history
(b) Physical exam
(c) Chest X-Ray
(d) Sputum Examination (only if radiographic shows signs of Active TB)
(e) Baseline liver function tests (SGOT/SGPT) and bilirubin. (on patients with elevated risk for liver disease)

Question 32

what is INH

Answer 32

Isoniazid

Question 33

what is RPT

Answer 33

Rifapentine

Question 34

Monthly Evaluation for IHN includes

Answer 34

(1) Physical assessment to check for indication of active TB.
(2) Counseling on potential adverse drug reaction
(3) Discuss when to discontinue medication(s).
(4) Discuss when to report for prompt medical evaluation.
(5) Document on NAVMED 6224/9.

Question 35

what are the liver enzymes

Answer 35

SGOT/SGPT

Question 36

Upon discovery of a suspected or confirmed case of active TB, the responsible medical department representative must notify the cognizant ______ and the ______ as soon as possible

Answer 36

NEPMU and the local health department

Question 37

Personnel who are enrolled in a contact investigation but are separating from the
service must be identified to the______ follow-up
testing.

Answer 37

e local public health department

Question 38

Personnel separating from the service will have to follow up with the _____ for medications

Answer 38

VA

Question 39

Treatment for active TB

Answer 39

-Chemotherapy is extremely effective and usually curative if the full course is taken.
-Antituberculous drugs are classified as bactericidal (Isoniazid, Rifampin, Pyrazinamide) and bacteriostatic (Ethambutol, Streptomycin)

Question 40

To prevent development of resistance e, clinical TB must always be treated with ________

Answer 40

at least two drugs that act through different mechanisms.

Question 41

alternate regimen is

Answer 41

Rifampin (RIF)
oral daily dose of 10 mg/kg (600mg max)
for 4 months

Question 42

Consider withholding INH if patient’s transaminase levels exceed

Answer 42

-three times the upper limit of normal if associated with symptoms
-five times the upper limit of normal if patient is asymptomatic

Question 43

When should the PPD be read

Answer 43

48 to 72 hours after the administration

Question 44

Record PPD result on

Answer 44

NAVMED 6230/4 or
DD Form 2766 and
enter into AHLTA, MRRS or SAMS

Question 45

active TB
Intensive phase (INH, RIF, EMB)

Answer 45

7d/wk for 56 doses, or 5d/wk for 40 doses.

Question 46

active TB
Continuation phase (INH, RIF)

Answer 46

7d/wk for 126 doses or 5d/wk for 90 doses

Question 47

BCG stands for?

Answer 47

Bacillus Calmette Guerin

Question 48

What are the Elements of the TB Control Program

Answer 48

(1) Tuberculosis Screening
(2) Preventive Therapy
(3) Tuberculosis Case Identification
(4) Tuberculosis Patient Management
(5) Contact Investigation