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Test 8: Tuberculosis infection prevention and control

  1. Tuberculosis is caused by the bacteria Mycobacterium tuberculosis which is transmitted by:
    • Airborne route
    • Droplet route
    • Contact transmission
    • Blood transmission.
  2. A recognised risk factor for the development of tuberculosis disease is:
    • Asian race
    • Female sex
    • Extremes of age (young infants and the elderly)
    • Frequent use of public transportation.
  3. Which of these people has the highest risk for developing tuberculosis disease?
    • An HIV patient on antiretroviral medications whose CD4 count has normalised
    • A diabetic 80-year-old female on steroids for her debilitating arthritis
    • A 65-year-old hypertensive male with acute heart attack in the ICU
    • A 28-year-old healthcare worker assigned to the TB ward wearing proper protection.
  4. Which of the following TB patients is the most infectious?
    • A well college student found to have suspicious TB infiltrates on a chest X-ray
    • A lady with TB of the spine
    • A boy with TB of the lymph nodes in his neck (draining fluid containing TB bacilli)
    • An elderly man coughing profusely (with a lung cavity from TB) who is not yet on treatment.
  5. The risk of TB transmission is determined by:
    • The degree and duration of TB exposure
    • Whether the patient had received the BCG immunisation in childhood
    • Whether the index case shared eating utensils with the exposed individuals
    • Whether the index case is a healthcare worker.
  6. Which of these areas in a hospital are considered high risk for TB transmission?
    • The cafeteria
    • The pharmacy
    • The operating theatres
    • The adult medical wards.
  7. What is the advantage of the sputum smear microscopy test for TB bacilli:
    • It is affordable even in resource-limited settings
    • It can detect patients with low levels of TB bacilli (pauci-bacillary disease)
    • It can differentiate easily between various types of mycobacteria
    • It can predict drug resistance.
  8. The term multidrug-resistant tuberculosis (MDR-TB) implies:
    • TB which is resistant to at least isoniazid and rifampicin
    • Resistance to all first line anti-TB drugs: isoniazid, rifampicin, pyrazinamide and ethambutol
    • Resistant to at least four classes of anti-TB drugs
    • Resistance acquired during the course of therapy.
  9. Which statement is true regarding drug-resistant TB (DRTB)?
    • DRTB is more infectious and communicable than the regular susceptible TB
    • DRTB is treated for the same number of months as the regular susceptible TB
    • DRTB patients convert to sputum smear-negative faster than susceptible TB
    • DRTB is more expensive and difficult to treat than drug susceptible TB.
  10. What are the ‘3Is’ of TB prevention?
    • TB-IPC; Intensified directly observed treatment, short-course (DOTS); Integrated contact tracing
    • TB-IPC, Isoniazid preventive therapy, Intensive training
    • TB-IPC, Isoniazid preventive therapy, Intensified case finding
    • TB-IPC, Isoniazid preventive therapy, Isolation rooms.
  11. Implementation of TB infection control in a healthcare facility is the responsibility of:
    • TB patients
    • The TB physicians
    • The hospital security workers
    • All healthcare workers.
  12. Which of these strategies is the most important in the hierarchy of TB infection control?
    • Leadership control
    • Administrative controls
    • Environmental controls
    • Respiratory controls.
  13. Environmental controls for TB:
    • Should provide healthcare workers with protective equipment
    • Should remove, replace, dilute or clean contaminated air
    • Should effectively treat patients with TB with correct anti-TB medications
    • Should provide clean and safe environments for patients with TB.
  14. Which type of ventilation is preferred in low-resource settings?
    • Natural ventilation
    • Mechanical ventilation
    • Mixed ventilation methods
    • Positive pressure ventilation.
  15. Natural ventilation:
    • Involves use of air-handling units to direct the movement of air in a room
    • Involves use of air-conditioners to recycle air in rooms
    • Involves supply and removal of air by electricity-dependent negative pressure systems
    • Involves natural draughts of fresh air from the outside environment.
  16. N95 respirators:
    • Have high filtering efficiency, preventing inhalation of over 95% of particulate aerosols
    • Should be worn only when within 1 metre of a TB suspect or confirmed case
    • Can filter out particles from 100–1000 microns in size
    • Should be worn by both patients and healthcare workers.
  17. N95 respirators:
    • Can be safely re-used over and over again up to one month
    • Should be worn by patients to reduce TB bacilli in the environment
    • Should be stored in dry envelopes marked with the healthcare worker’s name
    • Can still be used even if torn, as long as a fit test has been done.
  18. When should patients with infectious TB be required to wear a surgical mask?
    • When TB patients are in a closed or poorly ventilated area with other persons
    • When TB patients are in their own single rooms for long periods of time
    • When TB patients are allowed to go outdoors
    • When TB patients are sent home from the hospital.
  19. Healthcare workers in high-burden TB settings are:
    • At low risk of acquiring TB
    • At the same risk of acquiring TB as the general population
    • Protected from acquiring TB by the BCG vaccine
    • At significantly increased risk of acquiring TB from ongoing TB exposure.
  20. Patients newly diagnosed with TB should be advised that:
    • They must wear a surgical mask or face-cover outdoors
    • They may sleep in the same room with young infants
    • They should discard all tissues into a plastic bag and wash hands regularly
    • They can stop all preventive measures after two weeks of treatment for drug-resistant TB.