NTP I Flashcards
(113 cards)
1
Q
What should TB care address beyond clinical service delivery?
A
The patient’s social and economic conditions that underlie the occurrence of TB disease.
2
Q
Define ‘individualized treatment and care plan’.
A
A personalized treatment plan mutually agreed upon by the health-care provider and the patient throughout the course of treatment.
3
Q
What components should be included in an individualized treatment and care plan?
A
- Literacy competency of the patient
- Nutritional support
- Co-morbid condition management
- Psycho-emotional support
- Familial and social support
- Financial support
4
Q
Who is a treatment supporter?
A
A person nominated by the patient and/or health-care provider to supervise the treatment of the patient.
5
Q
What is the purpose of nutritional support in TB care?
A
To enhance rapid healing and recovery or to provide nutritional advice for healthy eating habits.
6
Q
Define ‘co-morbid physical condition’.
A
A concomitant medical condition that may compromise or aggravate TB treatment.
7
Q
What is palliative care?
A
Care provided to patients in severe distress to affirm life and alleviate suffering.
8
Q
What does stigma in the context of TB refer to?
A
A disapproving renown or distinction perpetuated from misconceptions about TB disease and treatment.
9
Q
True or False: Discrimination in TB refers to the acknowledgment of patient rights.
A
False
10
Q
What should health-care workers (HCWs) respect throughout the continuum of TB care?
A
Patient autonomy and support self-efficacy.
11
Q
What should be maximized for patients in TB care?
A
Physical comfort, safety, and wellness.
12
Q
Define ‘systematic screening for active TB’.
A
Systematic identification of presumptive TB in a predetermined target group using rapid examinations.
13
Q
What is active case finding (ACF)?
A
Systematic screening implemented outside health facilities in high-risk populations.
14
Q
What is intensified case finding (ICF)?
A
Systematic screening in health facilities among all consults.
15
Q
What are the four cardinal signs and symptoms of TB?
A
- Cough lasting two weeks or longer
- Unexplained fever
- Unexplained weight loss
- Night sweats
16
Q
What is the primary screening tool for systematic screening in health facilities?
A
Symptom screening using the four cardinal signs and symptoms.
17
Q
What is the recommendation for screening by chest X-ray?
A
Recommended annually among all health facility consults.
18
Q
Who should be screened for TB co-infection?
A
All people living with HIV (PLHIV).
19
Q
What should happen if a patient has cardinal signs and symptoms for at least two weeks?
A
Identify as a presumptive TB case.
20
Q
What action should be taken for patients without cardinal signs/symptoms?
A
Offer chest X-ray screening if one has not been conducted in the past year.
21
Q
What does the National TB Prevalence Survey in 2016 indicate about symptom screening?
A
Screening using symptoms alone would have missed one-third to two-thirds of bacteriologically confirmed pulmonary TB cases.
22
Q
What is required before conducting an X-ray in a facility?
A
A written consent shall be taken and abdominal protective shield shall be used.
23
Q
What percentage of bacteriologically confirmed pulmonary TB cases would have been missed by screening for TB using symptoms alone, according to the National TB Prevalence Survey in 2016?
A
One-third to two-thirds.
24
Q
List the primary clients for chest X-ray screening if resources are limited.
A
- 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
- Those with other immune-suppressive medical conditions.
25
What should be done if chest X-ray is not available and high-risk patients exhibit signs and symptoms lasting less than two weeks?
The physician may decide to consider the patient a presumptive TB case.
26
What should all patients with chest X-ray findings suggestive of TB be identified as?
Presumptive TB.
27
How often should screening by chest X-ray be done for individuals?
Once a year.
28
When should PLHIV undergo screening by both chest X-ray and symptoms?
At the time of diagnosis of HIV/AIDS and annually thereafter.
29
What are the signs and symptoms for PLHIV that can indicate TB?
* Cough
* Unexplained fever
* Unexplained weight loss
* Night sweats.
30
What should be recorded for all presumptive TB identified?
Previous history of treatment and exposure to TB cases.
31
What is considered presumptive DR-TB?
Previous history of TB treatment, close contacts of a known DR-TB case, or a non-converter of DS-TB regimen.
32
What is the purpose of Form 1 in TB screening?
To record the patient in the Presumptive TB Master List.
33
What are the three main signs and symptoms suggestive of TB in children?
* Coughing/wheezing lasting two weeks or more
* Unexplained fever lasting two weeks or more
* Unexplained weight loss or failure to thrive.
34
What should be done for children who are close contacts of known TB cases?
Consider fatigue, reduced playfulness, decreased activity, not eating well, or anorexia lasting two weeks or more.
35
When is chest X-ray screening not routinely recommended for children?
Except for TB household contacts who are 5 years old and above.
36
What steps are involved in screening for extrapulmonary TB (EPTB)?
* Identify gibbus deformity
* Non-painful enlarged cervical lymphadenopathy
* Neck stiffness and/or drowsiness
* Pleural effusion
* Pericardial effusion
* Distended abdomen
* Non-painful enlarged joint
* Signs of tuberculin hypersensitivity.
37
What is the priority target population for active case finding in communities?
Urban and rural poor.
38
What should be done on the actual screening day?
Inform patients of the purpose of screening and the next steps if their chest X-ray is positive.
39
What is the recommended screening method for adults during annual screening?
Chest X-ray for ALL.
40
What is the rationale for using Xpert MTB/RIF over smear microscopy in ACF?
Xpert MTB/RIF is more sensitive and cost-effective than smear microscopy.
41
What should be done for all presumptive TB identified?
Ask about previous history of treatment and exposure to a TB case.
42
What is the definition of Active TB disease?
A presumptive TB case that is either bacteriologically confirmed or clinically diagnosed.
43
What does Pulmonary TB (PTB) refer to?
A case of tuberculosis involving the lung parenchyma.
44
What is Extrapulmonary TB (EPTB)?
A case of tuberculosis involving organs other than the lungs.
45
What is Bacteriologically confirmed TB (BCTB)?
A patient from whom a biological specimen is positive for TB.
46
What does clinically diagnosed TB (CDTB) refer to?
Diagnosis made by the attending physician based on clinical findings without bacteriological confirmation.
47
What does 'New' refer to in TB patients?
A patient who has never had treatment for TB or who has taken anti-TB drugs for less than one month.
48
What is a sputum sample positive for TB?
A sputum sample is positive for TB by smear microscopy, culture or rapid diagnostic tests (such as Xpert MTB/RIF, line probe assay for TB, TB LAMP).
49
What does Clinically diagnosed TB (CDTB) refer to?
CDTB refers to a patient for which the criterion for bacteriological confirmation is not fulfilled but diagnosis is made by the attending physicians based on clinical findings, X-ray abnormalities, suggestive histology and/or other biochemistry or imaging tests.
50
Define 'New' in the context of TB patients.
'New' refers to a patient who has never had treatment for TB or who has taken anti-TB drugs for less than one month.
51
What does 'Previously treated for TB' mean?
'Previously treated for TB' refers to a patient who had received one month or more of anti-TB drugs in the past.
52
Who is considered at high risk for multidrug-resistant tuberculosis (MDR-TB)?
Individuals previously treated for TB, new TB cases that are contacts of confirmed DR-TB cases, or non-converters among patients on DS-TB regimens.
53
What characterizes Rifampicin-resistant TB (RR-TB)?
RR-TB is characterized by resistance to rifampicin detected using phenotypic or genotypic methods, with or without resistance to other anti-TB drugs.
54
What is the desired turnaround time (TAT) for TB treatment initiation?
The desired turnaround time is five working days.
55
What is the primary diagnostic test for PTB and EPTB in adults and children?
A rapid diagnostic test (RDT), such as Xpert MTB/RIF, shall be the primary diagnostic test.
56
True or False: Smear microscopy can be used if Xpert MTB/RIF is not accessible.
True
57
What is the Tuberculin skin test (TST) used for?
The TST is used as an adjuvant when there is doubt in making a clinical diagnosis of TB in children.
58
What is considered a positive TST reaction in children?
An induration of at least 10 mm regardless of BCG vaccination status or 5 mm in immunocompromised children.
59
What should be done if sputum for bacteriological diagnosis of TB is contraindicated?
Massive hemoptysis is the only contraindication; blood-streaked sputum can still be examined.
60
Fill in the blank: The only contraindication to collecting sputum for bacteriological diagnosis of TB is _______.
massive hemoptysis
61
What is the role of the Tuberculosis Medical Advisory Committee (TB MAC)?
The TB MAC provides clinical expertise and guidance in the diagnosis and management of difficult TB cases.
62
What should be done if bacteriologic testing is negative or not available?
Patients shall be evaluated by the health facility physician who shall decide on clinical diagnosis based on best clinical judgment.
63
What is the procedure for collecting sputum specimens?
Prepare a sputum cup, instruct the patient to expectorate, collect 1ml for Xpert and 3–5 ml for smear microscopy.
64
What is a key requirement for the transport of sputum specimens?
Transport at cold temperature using cold packs inside the tertiary container.
65
What is the interpretation of 'T' in Xpert MTB/RIF results?
'T' indicates Mycobacterium tuberculosis detected, rifampicin resistance not detected.
66
What does 'N' indicate in Xpert MTB/RIF results?
'N' indicates Mycobacterium tuberculosis not detected.
67
What are the two types of microscopy used for smear microscopy?
Brightfield microscopy and fluorescence microscopy.
68
What is the advantage of fluorescence microscopy over brightfield microscopy?
Fluorescence microscopy has increased sensitivity and can be five times faster.
69
What does a positive smear microscopy result indicate?
At least one sputum smear is positive for AFB.
70
What should be done if the chest X-ray indicates shadows consistent with pulmonary disease?
A course of broad-spectrum antibiotics may be prescribed.
71
What is the follow-up procedure for patients with negative Xpert results but persistent symptoms?
Retrieve the chest X-ray result or refer for a chest X-ray if not yet done.
72
What is the recommended chest X-ray view for adults?
Chest X-ray PA upright view.
73
What is the approach to diagnosis of TB in children under 15 years old?
Ask to expectorate sputum or perform gastric lavage if available.
74
What type of chest X-ray views should be requested for children who cannot stand?
Anteroposterior and lateral view
## Footnote
This is to ensure proper imaging for diagnosis in pediatric patients.
75
What is the first step when presumptive TB is identified?
Request a chest X-ray if not done
## Footnote
A chest X-ray helps in evaluating potential pulmonary tuberculosis.
76
What does a positive result from Xpert MTB/Rif indicate?
MTB Positive
## Footnote
Indicates the presence of Mycobacterium tuberculosis.
77
What should be done if samples cannot be collected for TB testing?
Refer to a specialist center for further investigations
## Footnote
This is crucial for accurate diagnosis and management.
78
What are the clinical signs suggestive of TB in children under 10 years of age?
Persistent fever, weight loss, cough, and irritability
## Footnote
These symptoms are key indicators for further TB evaluation.
79
If chest X-ray findings are normal or uncertain, what is the follow-up protocol?
Follow up the child in two weeks
## Footnote
Consider giving one week of broad-spectrum antibiotics if not previously administered.
80
What does a positive Tuberculin Skin Test (TST) indicate?
May classify as clinically diagnosed TB
## Footnote
Especially if there is a known contact with a TB case.
81
What is the classification for a patient with bacteriologically confirmed rifampicin-resistant TB?
BC RR-TB
## Footnote
This classification is based on rapid diagnostic modalities like Xpert MTB/RIF.
82
What are the signs and symptoms of TB in children aged 10-18 years?
Persistent fever, adynamia, and expectoration (bloody sputum)
## Footnote
These symptoms differ from those in younger children.
83
What does DR-TB stand for?
Drug-resistant tuberculosis
## Footnote
This refers to TB that is resistant to standard anti-TB medications.
84
What should be done if the initial Xpert test shows MTB detected with rifampicin resistance?
Classify as drug-resistant TB (DR-TB)
## Footnote
Further testing may be required for treatment decisions.
85
What is the protocol for patients with indeterminate Xpert test results?
Recollect a fresh sputum sample and repeat the Xpert MTB/RIF test
## Footnote
Follow the second test result for treatment decisions.
86
What is the definition of bacteriologically confirmed multidrug-resistant TB (BC MDR-TB)?
Positive for MTB complex with resistance to at least both isoniazid and rifampicin
## Footnote
This classification is confirmed by an NTP-recognized laboratory.
87
How is clinically diagnosed multidrug-resistant TB (CD MDR-TB) defined?
A patient with negative MTB tests but with clinical deterioration and/or radiographic findings consistent with active TB
## Footnote
This includes cases where laboratory diagnosis was not done.
88
What should be done for presumptive extrapulmonary TB (EPTB) cases where body fluid samples cannot be obtained?
Give an antibiotic trial and follow-up after one to two weeks
## Footnote
This helps manage cases while awaiting further testing.
89
What is the importance of notifying patients diagnosed with active TB?
All patients diagnosed with active TB should be notified and registered
## Footnote
This is essential for tracking and treatment purposes.
90
What does the classification 'BC XDR-TB' stand for?
Bacteriologically confirmed extensively drug-resistant TB
## Footnote
This classification indicates resistance to multiple drugs, including fluoroquinolones.
91
True or False: If a child is clinically stable and has no risk factors for TB, they should be followed up in two weeks or one month.
True
## Footnote
This is part of the management protocol in non-suspicious cases.
92
Fill in the blank: If chest X-ray findings are strongly suggestive of TB, classify as _______.
clinically diagnosed TB
## Footnote
This classification is based on specific radiographic features.
93
What are the key chest X-ray findings indicative of TB?
* Markedly enlarged unequal hilar lymph gland
* Miliary mottling
* Large pleural effusion
* Apical opacification with cavitation
* Other findings like atelectasis, consolidation, reticular infiltrates
## Footnote
These findings warrant further investigation for TB.
94
What is the definition of case holding in tuberculosis treatment?
Case holding is the set of procedures that begins at diagnosis and continues to initiation of treatment and then throughout the treatment duration.
95
What activities are included in case holding?
* Treatment education for the patient
* Family members and treatment supporters
* Regular adherence counseling
* Provision of psychosocial support
* Medical management
96
What are the key components of medical management for tuberculosis?
* Assignment of the appropriate treatment regimen
* Monitoring of treatment response
* Monitoring and management of adverse events
97
What are the treatment objectives for drug-susceptible tuberculosis (DS-TB) and drug-resistant tuberculosis (DR-TB)?
* Cure or successfully treat DS-TB and DR-TB patients
* Treatment success rates of ≥ 90% for DS-TB and > 85% for DR-TB patients
98
Define 'New' in the context of TB Disease Registration Group.
New refers to patients who have never had treatment for TB or have taken anti-TB drugs for less than one month.
99
What does the term 'Retreatment' refer to in tuberculosis cases?
Retreatment refers to patients who have been treated before with anti-TB drugs for at least one month.
100
What is the definition of relapse in tuberculosis treatment?
Relapse refers to previously treated for TB and declared cured or treatment completed, but is presently diagnosed with active TB disease.
101
What does 'treatment adherence interventions' include?
* Social support (e.g., food, incentives, transportation)
* Psychological support
* Tracers (home visits or digital communication)
* Medication monitoring
* Staff education
102
What is Provider-initiated counseling and testing (PICT)?
PICT refers to HIV counseling and testing recommended by health-care providers to people attending health facilities.
103
What is the role of the Medical Advisory Committee (MAC) in tuberculosis management?
MAC is a case management committee composed of health-care providers with expertise in managing DR-TB who reviews and approves cases for empiric treatment.
104
What is standardized treatment in the context of tuberculosis?
Standardized treatment refers to a regimen that all patients in a defined group will receive, based on drug-resistance surveillance data.
105
What is an Individualized treatment regimen (ITR)?
ITR is a treatment regimen designed for an individual patient based on previous TB treatment history and individual DST results.
106
Define drug-susceptibility testing (DST).
DST refers to in-vitro testing using either phenotypic methods to determine susceptibility or molecular techniques to detect resistance-conferring mutations.
107
What is the intensive phase in tuberculosis treatment?
The intensive phase refers to the initial part of a standardized regimen which usually consists of four or more anti-TB drugs.
108
What does Isoniazid-resistant TB mean?
Isoniazid-resistant TB refers to MTB strains resistant to isoniazid and susceptible to rifampicin.
109
What is polyresistance in tuberculosis?
Polyresistance refers to resistance to more than one first-line anti-TB drug, other than isoniazid and rifampicin together.
110
What does Rifampicin-resistant TB (RR-TB) indicate?
RR-TB refers to MTB strains that are not susceptible to rifampicin and are eligible for treatment with MDR-TB regimens.
111
Define Multidrug-resistant TB (MDR-TB).
MDR-TB refers to MTB strains in which resistance to both isoniazid and rifampicin has been confirmed.
112
What are first-line TB drugs (FLD)?
First-line TB drugs refer to agents used to treat drug-susceptible TB: ethambutol, isoniazid, pyrazinamide, and rifampicin.
113
Fill in the blank: A second-line TB drug (SLD) is reserved for the treatment of _______.
[drug-resistant TB]
