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Worksheets

ROUND 2

Total questions: 30

Worksheet time: 23mins

Name
Class
Date
1.

45 year old male was diagnosed to have TB and was initiated on ATT. On 12th day patient presented with complaints of fever with chills and myalgia. The possible cause for fever is-

a)

Isoniazid

b)

Rifampicin

c)

Ethambutol

d)

Streptomycin

2.

A patient presents with a 10 day history of high fever, cough and purulent sputum. A chest X-ray shows a dense consolidation in the RUL. The next step is-

a)

Obtain sputum specimens for AFB and start TB treatment

b)

Start a course of moxifloxacin

c)

Obtain sputum specimens for AFB and culture/sensitivity examination and start azithromycin

d)

Refer the patient to a TB hospital

3.

When should one suspect the possibility of drug-resistant TB

a)

When the patient has been treated for TB in the past

b)

when the patient is in contact with a patient who has drug-resistant TB

c)

when the patient has defaulted from treatment before the present illness

d)

All of the above

4.

You are seeing a 23 year old engineer who had sputum tested with GeneXpert, and the result was MTB detected, Rifampin resistance not detected, which of the following statements is true-

a)

This patient does not need to be tested for HIV infection because he denies risk factors of HIV

b)

This patient should not be tested for HIV infection because he is not from a population where HIV prevalence is elevated

c)

This patient should be tested for HIV infection because he has active tuberculosis

d)

None of the above

5.

You are seeing a patient in your clinic who was recently diagnosed with HIV. Which of the following is true about Tb screening-

a)

This patient does not need to be screened for active TB

b)

To screen them for active TB, you should ask about the presence of symptoms

c)

To screen them for active TB, you should obtain a CXR, even if they are asyptomatic; if any abnormality is present, further diagnostic evaluation for active TB in indiacted

d)

Both B and C

6.

Mohan is a 53 year old man who visits your office with a month of productive cough, loss of weight and night sweats. He has type II diabetes, sputum shows 2 plus AFB. You diagnose him with pulmonary TB and start him on ATT. As you start him on TB therapy, what counselling should you provide to counter potential medication side effects and to minimize drug interactions-

a)

Advise him that he should not worry if his urine or tears turn red-orange colour while on therapy

b)

Prescribe pyridoxine, 50mg by mouth daily

c)

Advice him to visit his diabetes doctor soon afterr starting TB therapy, due to risk of poorer blood sugar control while on TB therapy

d)

All of the above

7.

You see mohan again more than 6 weeks after starting TB therapy. His weight has dropped from 53kgs to 48 kgs, and he has evidence of temporal wasting. When you talk to him, he endorses ongoing fatigue and night sweats. You worry that he does not seem to be improving clinically after starting TB therapy. What should you do-

a)

Order a GeneXpert MTB/Rif test, line probe assay, or other drug susceptibility testing, if not sent already at the time of diagnosis

b)

Carefully screen for poor medication adherence using questions about his pill-taking

c)

Inquire about the quality of his diet and refer him to dietician

d)

All of the above

8.

On follow-up visits for the next 2 months, Mohan reports improved medication adherence, and his weight increased and symptoms improved. However, he misses his fifth month visit. You call him and mohan comes into your clinic one week later with his wife. He looks disheveled, does not make eye contact, and provides terse answers during your interview. He smells of alcohol. His wife notes that be becomes intermittently tearful at home and stopped going to work and stopped taking medications. what do you do-

a)

Screen for clinical depression using simple questions and consider referral to a mental health specialist

b)

Screen for alcohol use disorder using simple questions and consider referral to a mental health specialist

c)

Discuss Mohan's family and social support system with him and his wife

d)

All of the above

9.

Which of the following drugs should be given on an empty stomach for better bioavailability-

a)

Isoniazid

b)

Rifampicin

c)

Ethambutol

d)

Isoniazid and rifampicin

10.

Pyridoxine deficiency can occur due to treatment of which anti-TB drugs

a)

Rifampicin

b)

Isoniazid

c)

Ethambutol

d)

Pyrazinamide

11.

56 Year old chronic alcoholic was having constitutional symptoms and his sputum AFB was 2 plus, was initiated on ATT. On the 5th day of ATT treatment, patient noticed yellow discolouration of eye with high coloured urine, his liver function tests were also deranged. Which of the following ATT drugs can be used-

a)

Ethambutol

b)

Pyrazinamide

c)

P-amino salicylic acid

d)

INH

12.

A 35 year old married female presented to the emergency medicine department of a tertiary care hospital with complaints of abnormal behaviour characterised by agitation, excessive irrelevant talking, decreased sleep and appetite for the past 1 month. She had previous history of chronic cough with expectoration, fever with chills and rigors. Was diagnosed with TB and on ATT. which drug is likely to cause the above symptoms-

a)

INH

b)

Rifampicin

c)

Pyrazinamide

d)

Ethambutol

13.

which of the following statements is FALSE about chest X-rays for TB diagnosis-

a)

CXR's have good sensitivity, but poor specificity

b)

CXR's can help determine the severity of lung damage

c)

CXR's alone is sufficient to diagnose pulmonary TB

d)

CXR's can look similar in patients with old, inactive TB and those with currently active TB disease

14.

In a woman with infertility, suspected to have genito-urinary TB, which of the following specimens is important for diagnosis-

a)

Venous blood

b)

Menstrual blood

c)

Endometrial tissue

d)

sputum

15.

TB cannot occur in -

a)

Upper lobe

b)

Lingula

c)

RML

d)

None of the above

16.

A patient presents with a 10 day history of fever, cough and purulent sputum. A CXR shows a dense consolidation in the RUL. The next step is-

a)

Obtain sputum specimens for AFB and start TB treatment

b)

Start a course of moxifloxacin

c)

Obtain sputum specimens for AFB and culture/sensitivity examination and start Azithromycin

d)

Refer the patient to a TB hospital

17.

A 55 year old 40 pack year old smoker consults with you for a 2 month history of cough and blood tinged sputum. He reports that his sister had TB 10 years ago. The CXR shows a cavitary mass in the RUL. What is the next step-

a)

Obtain sputum AFB

b)

Send sputum for cytology

c)

Send patient for a bronchoscopy

d)

Start treatment with an antibiotic

18.

Which of the following is false regarding adverse reactions to TB drugs-

a)

Jaundice is a common adverse effect and is self-limiting

b)

Nausea is a common adverse effect, is usually self-limiting and can be treated with symptomatic management

c)

Joint pains are an adverse reaction to pyrazinamide and usually respond well to non-steroidal anti-inflammatory drugs

d)

The elderly and those with pre-existing liver disease are more susceptible to drug induced hepatitis

19.

Which of the following diagnostics tests is endorsed by WHO for extrapulmonary TB

a)

Interferon-gamma release assay - IGRA

b)

Tuberculin skin test

c)

Xpert MTB/RIF

d)

Serological TB tests- antibody

20.

What is the mechanism responsible for antibiotic resistance in Mycobacterium tuberculosis-

a)

Mutations in DNA gyrase gene

b)

Alterations in beta-lactamase

c)

Mutations in the catalase-peroxidase gene

d)

Alterations in RNA polymerase

21.

All of the following are the examples of selective media used for culture of Mycobacterium tuberculosis, except-

a)

Inspissated egg media

b)

Middlebrook 7H10/7H11 media with antibiotics

c)

Dubos media

d)

Middlebrook 7H10 media without antibiotics

22.

Which of the following statement is true about the tuberculin test and purified protein-

a)

The presence of intradermal skin induration is observed in 6 to 8 hours after being applied

b)

The redness of skin or erythema is also measured while reading the tuberculin test

c)

A positive tuberculin test means that a person was infected with M.tuberculosis in the past and continues to carry the viable organism

d)

A positive PPD test indicated that a person can never be infected with M.tuberculosis

23.

Which of the following bacteria causes lung infection and is the most common non-tuberculous mycobacterial infection associated with AIDS patients-

a)

M.avium complex

b)

M.leprae

c)

M.gordonae

d)

M.gastri

24.

A 16 year old boy from remote region in australia is presented to the hospital with a painless lesion on the left side of the neck, it first appeared about 2 months ago as a small lesion but turned into a bigger yellowish white papule as the days passed. Tissue sample was taken , gram staining and AFB done showed gram positive rods, after 4 weeks of incubation transparent colonies appeared on the culture media. Name the possible pathogen-

a)

M.ulcerans

b)

M.bovis

c)

M.avium

d)

M.leprae

25.

From the above question which of the following is the correct disease term related to the infection caused by the pathogen-

a)

Duodenal ulcer

b)

Leprosy

c)

Buruli ulcer

d)

Bairnsdale ulcer

26.

Mutations in KatG gene of Mycobacterium tuberculosis are responsible for resistance to-

a)

INH

b)

Rifampicin

c)

Pyrazinamide

d)

Streptomycin

27.

Tubercular granulomas are made up of-

a)

Organised aggregates of immune cells that surround foci of infected tissues

b)

Damaged tissue cells and bacilli only

c)

Fibrous and damaged tissue and bacilli only

d)

Necrotic tissue and damaged tissue and bacilli only

28.

Which one of the following is not a constituent of Lowenstein Jensen medium-

a)

Agarose

b)

Malachite green

c)

Mineral salts

d)

Asparagine

29.

Which one of the following is a non cultivable mycobacteria-

a)

M.tuberculosis

b)

M.bovis

c)

M.leprae

d)

M.avium intracellulare

30.

False negative mantoux test is observed in-

a)

Early tuberculosis

b)

Advanced tuberculosis

c)

Severe malnutrition

d)

All of the above