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Management of Tuberculosis in Prison Populations

Epidemiology, Transmission, and Natural History

1. Transmission of M. tuberculosis depends on:

A. The length of time and frequency of the exposure.

B. The degree of contagiousness of the infected person.

C. The environment and airflow in which the exposure occurred.

D. All of the above.


2. The majority of persons who become infected never develop active TB.

A. True

B. False


3. The most significant risk factor for latent TB infection is:

A. Injection drug use.

B. Country of origin.

C. Being a resident or employee in congregated settings such as prisons and jails, health care facilities, and homeless shelters.

D. Being a known contact of an active TB case.


Screening

4. Early detection and isolation of inmates with suspected pulmonary TB disease is critical to preventing widespread TB transmission.

A. True

B. False


5. A CXR using lead shielding should be performed after the first trimester for all pregnant women, even women who are at higher risk for developing active TB disease.

A. True

B. False


6. A negative TST rules out the possibility of active TB.

A. True

B. False


7. All of the following are exceptions for a baseline TST being obtained on new intakes to the BOP, except for:

A. The inmate has documentation of a prior positive TST while incarcerated within BOP.

B. The inmate has a history of a severe reaction to a TST, which is considered a positive TST reaction.

C. The inmate is in holdover status.

D. The inmate provides a credible history of treatment of LTBI.


8. Which of the following is a contraindication to tuberculin skin testing?

A. Pregnancy

B. Bacillus calmette-guerin vaccination

C. Both (A) and (B)

D. None of the above


9. The TST results should always be documented:

A. In millimeters

B. As positive or negative

C. Either (A) and/or (B)

D. None of the above


10. Which of the following have a higher risk of developing TB disease in the two years following infection and are considered high priority for LTBI treatment?

A. TST reactors

B. TST convertors

C. TST adaptors

D. TST resistors


11. Interferon-Gamma Release Assays test for:

A. TB infection

B. Active TB disease

C. Both (A) and (B)

D. None of the above


Latent Tuberculosis Infection (LTBI)

12. All inmates with a positive TST or IGRA should:

A. Be clinically evaluated.

B. Have a CXR to rule out active TB.

C. Be considered for treatment of LTBI.

D. All of the above.


13. The BOP has adopted the 12-week, 12-dose regimen of isoniazid and rifapentine as the standard BOP treatment for LTBI, to be utilized unless there are contraindications for its use.

A. True

B. False


14. Which of the following is used for treatment of latent TB infection?

A. Rifampin

B. Rifabutin

C. Rifapentine

D. All of the above


15. The 12-week INH-RPT is contraindicated for HIV-infected inmates on antiretroviral therapy.

A. True

B. False


16. Treatment for LTBI should ordinarily be discontinued under which of the following circumstances?

A. Liver transaminases exceeding three times the upper limit of normal, if the inmate has symptoms of hepatitis.

B. Liver transaminases exceeding three times the upper limit of normal, if the inmate is asymptomatic.

C. Liver transaminases exceeding five times the upper limit of normal, if the inmate has symptoms of hepatitis.

D. Liver transaminases exceeding four times the upper limit of normal, if the inmate is asymptomatic.


Diagnosis of Active Tuberculosis Disease

17. Which of the following rules out active TB?

A. A negative TST or IGRA.

B. Negative AFB smears from sputum or bronchoscopy specimens.

C. Negative AFB cultures in persons with abnormal CXRs consistent with TB.

D. None of the above.


18. Presentations of extrapulmonary TB are all of the following, except for:

A. Epididymitis

B. Renal disease

C. Vomiting and diarrhea

D. Meningitis


Treatment of Tuberculosis Disease

19. Standard 4-drug “RIPE” treatment consists of rifampin, isoniazid, pyrazinamide, ethambutol, plus:

A. Vitamin B12

B. Vitamin B6

C. Vitamin A

D. Vitamin K


20. A physician consultant with expertise in TB treatment should be consulted for which of the following TB cases?

A. Failure of sputum cultures to convert to negative, following two months of therapy.

B. Resistance to rifampin, with or without resistance to other drugs.

C. HIV co-infection, drug intolerance, pregnancy, or other situations requiring deviation from a standard treatment regimen.

D. All of the above.


21. Culture-negative pulmonary TB is not considered to be a form of active TB and therefore does not need to be reported to the health department.

A. True

B. False


22. Antiretroviral therapy regimens should be assessed with particular attention to potential pharmacokinetic interactions with:

A. Rifamycins

B. Isoniazid

C. Pyrazinamide

D. Ethambutol


23. Very high rates of relapse have been reported in patients who present initially with cavitation on chest radiograph and whose sputum cultures remain positive after two months of treatment, therefore, it is recommended that the continuation phase (RIF and INH) in such patients be extended an additional:

A. 1 month

B. 2 months

C. 3 months

D. 4 months


24. A Snellen (visual acuity) and Ishihara (red-green color vision test) should be performed prior to initiating treatment with:

A. Rifamycins

B. Ethambutol

C. Pyrazinamide

D. All of the above


Contact Investigations

25. When an inmate identifies a child of _____ as a community contact, a health department referral should be made immediately because of the potentially life-threatening consequences of undetected TB in a young child.

A. 8 years and younger

B. 6 years and younger

C. 4 years and younger

D. 2 years and younger


26. Which of the following inmates should be isolated in an airborne infection isolation room?

A. Symptomatic inmates

B. Asymptomatic inmates

C. Both (A) and (B)

D. None of the above


Infection Control Measures

27. It is the responsibility of all correctional facility staff to identify inmates with _____ and refer them to Health Services.

A. HIV infection

B. A chronic cough

C. LTBI

D. All of the above


TB Program Management

28. Particular attention should be focused on ensuring which of the following of the TB exposure control plan?

A. TB suspects are isolated and evaluated for contagious TB.

B. Annual tuberculin skin testing of inmates is timely and data are evaluated, to detect unrecognized transmission of M. tuberculosis.

C. TB case reports and referrals are made to health authorities as appropriate.

D. All of the above.


Appendix 1. Tuberculosis Risk Factors

29. All of the following are risk factors for TB infection, except for:

A. Foreign born from high-incidence countries.

B. Injection drug users.

C. Those with diabetes mellitus.

D. Close contacts to infectious TB cases.


Appendix 3c. Treatment of LTBI: Baseline and Ongoing Monitoring

30. Which of the following is an adverse reaction that needs to be monitored at baseline / ongoing screening for INH monthly treatment?

A. Nausea / vomiting

B. Diarrhea

C. Dizziness

D. Fever or chills


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