Tuberculosis Control — MCQs
A patient presented with cough and evening rise of temperature since one month. Which among the following is the definitive diagnostic test for tuberculosis?
According to DOTS-PLUS guidelines 2013, which of the following statements about the treatment of multidrug-resistant TB is incorrect?
Basanti, a 29-year-old female from Bihar, presents with drug-sensitive tuberculosis. She delivers a baby. All of the following are indicated except:
XDR means extensive drug resistance to
Which of the following statements about the DOTS treatment for tuberculosis is correct?
A patient with cough was sputum AFB negative but chest X-ray was suggestive of TB. What should be the next step according to RNTCP?
Under NTEP, what is the honorarium given to a DOTS provider after the completion of treatment?
Regarding BCG vaccine, which of the following is untrue?
The online software used to monitor TB control program under RNTCP is:
Epidemic marker of TB?
Tuberculosis Control Indian Medical PG Practice Questions and MCQs
Question 1: A patient presented with cough and evening rise of temperature since one month. Which among the following is the definitive diagnostic test for tuberculosis?
- A. Gram's staining
- B. Culture (Correct Answer)
- C. Tuberculin testing
- D. Guinea-pig inoculation
Explanation: ***Culture*** - **Culture** of *Mycobacterium tuberculosis* from clinical specimens is considered the **gold standard** or **definitive diagnostic test** for tuberculosis - It allows for **species identification**, **comprehensive drug susceptibility testing (DST)** for first-line and second-line drugs, which is crucial for guiding treatment, especially in MDR-TB - Culture is essential for **confirming the diagnosis** when molecular tests are inconclusive and for **monitoring treatment response** - Though culture takes **2-8 weeks** (liquid media like MGIT is faster than solid media like LJ medium), it remains the reference standard *Gram's staining* - **Not effective** for *Mycobacterium tuberculosis* because its cell wall contains a high concentration of **mycolic acid**, making it impervious to the Gram stain - Mycobacteria appear as **gram-negative or gram-variable** "ghosts" with Gram staining - Specialized staining like **acid-fast stain (Ziehl-Neelsen or Auramine-Rhodamine)** is used to visualize the bacilli, but staining alone is **not definitive** - it only suggests mycobacterial infection *Tuberculin testing* - **Tuberculin skin testing (TST)** or Mantoux test detects a **delayed-type hypersensitivity reaction** to tuberculin purified protein derivative (PPD) and indicates **exposure or latent infection**, not necessarily active disease - Cannot distinguish between **latent TB infection (LTBI)** and **active TB disease** - A positive TST can result from **BCG vaccination** or exposure to **nontubercous mycobacteria (NTM)**, reducing specificity - Useful for **screening** but not diagnostic of active disease *Guinea-pig inoculation* - Historically used for **isolation and identification** of *Mycobacterium tuberculosis*, but is a **slow, expensive, and largely obsolete method** - Involves inoculating a susceptible animal with a suspect sample and observing for disease development over **6-8 weeks** - **Lower sensitivity** than modern culture and molecular methods, and raises ethical concerns - Replaced by faster techniques like **liquid culture systems** and **molecular diagnostics (CBNAAT/GeneXpert)**
Question 2: According to DOTS-PLUS guidelines 2013, which of the following statements about the treatment of multidrug-resistant TB is incorrect?
- A. Total duration 24-27 months
- B. Intensive phase 6-9 months
- C. Continuation phase - 2 drugs (Correct Answer)
- D. Intensive phase - 6 drugs
Explanation: ***Continuation phase - 2 drugs*** - According to DOTS-PLUS guidelines (2013), the continuation phase for multidrug-resistant TB (MDR-TB) should include at least **three to four effective drugs**, not two. - Using only two drugs in the continuation phase would be grossly inadequate and would likely lead to treatment failure and the development of extensively drug-resistant TB (XDR-TB). - This statement is **clearly incorrect** and represents a major deviation from standard treatment protocols. *Total duration 24-27 months* - According to DOTS-PLUS 2013 guidelines, the total treatment duration for MDR-TB is typically **18-24 months** (at least 18 months after culture conversion). - In complex cases, treatment may be extended beyond 24 months, though 24-27 months falls within acceptable parameters for difficult cases. - This statement is essentially correct for the upper range of treatment duration. *Intensive phase 6-9 months* - The intensive phase for MDR-TB treatment is indeed typically **6-9 months** or until culture conversion is documented. - This phase includes daily injectable agents and multiple oral drugs to rapidly reduce bacterial load. - This statement is **correct**. *Intensive phase - 6 drugs* - The 2013 DOTS-PLUS guidelines recommend an intensive phase regimen comprising **at least 4 effective drugs including an injectable agent**. - A 5-6 drug regimen may be used in complex cases or when drug susceptibility is uncertain. - While not the minimum standard, using 6 drugs is within acceptable practice, making this statement **generally correct**.
Question 3: Basanti, a 29-year-old female from Bihar, presents with drug-sensitive tuberculosis. She delivers a baby. All of the following are indicated except:
- A. Administer INH to the baby
- B. Withhold breast feeding (Correct Answer)
- C. Separate the baby from mother immediately
- D. Ask mother to ensure proper disposal of sputum
Explanation: ***Withhold breast feeding*** - For mothers with **drug-sensitive tuberculosis**, breastfeeding is **strongly encouraged** by WHO and CDC guidelines as the benefits far outweigh any theoretical risks. - Tuberculosis is **not transmitted through breast milk**, and the nutritional and immunological benefits of breastfeeding are crucial for the newborn. - With appropriate maternal treatment and **INH prophylaxis** for the baby, breastfeeding poses no significant risk and should **never be withheld**. *Administer INH to the baby* - **Isoniazid (INH) prophylaxis** for 6 months is the standard of care for newborns exposed to maternal tuberculosis. - This protects the infant from potential infection via respiratory droplets while the mother is receiving treatment. - After completing prophylaxis, BCG vaccination is given if tuberculosis is excluded. *Separate the baby from mother immediately* - **Immediate routine separation** is generally not recommended for drug-sensitive TB if the mother has been on appropriate treatment for at least 2 weeks and is clinically improving. - **Rooming-in is encouraged** with respiratory hygiene measures (mask wearing, hand hygiene, covering mouth when coughing). - Separation may be considered only for untreated or inadequately treated mothers, or those with multi-drug resistant TB. *Ask mother to ensure proper disposal of sputum* - **Proper sputum disposal** and adherence to respiratory hygiene are essential infection control measures. - This reduces environmental contamination and protects healthcare workers, family members, and the newborn from infectious aerosols. - This is a standard precaution for all tuberculosis patients regardless of drug sensitivity.
Question 4: XDR means extensive drug resistance to
- A. Minimum of 1 injectable drug
- B. H+R
- C. 1 Fluoroquinolone
- D. Fluoroquinolone + at least one Group A drug (bedaquiline/linezolid) (Correct Answer)
Explanation: ***Fluoroquinolone + at least one Group A drug (bedaquiline/linezolid)*** - **Extensively drug-resistant (XDR) tuberculosis** is defined by the WHO (2021) as TB with resistance to **rifampicin** (RR-TB baseline), plus resistance to any **fluoroquinolone** (levofloxacin or moxifloxacin), plus resistance to at least one additional **Group A drug** (bedaquiline or linezolid). - This represents the current standard definition emphasizing resistance to the most critical second-line oral agents. - XDR-TB is built upon **MDR-TB** (H+R resistance) with additional resistance patterns that make treatment extremely challenging. *Minimum of 1 injectable drug* - Injectable drug resistance (aminoglycosides, capreomycin) was part of the **old XDR-TB definition** (pre-2021) but is no longer required. - The WHO updated the definition to focus on more effective oral drugs rather than injectables. *H+R* - Resistance to **isoniazid (H)** and **rifampicin (R)** defines **multidrug-resistant (MDR) tuberculosis**, not XDR-TB. - MDR-TB is the foundation upon which XDR-TB is built, but it represents a less severe form of drug resistance. *1 Fluoroquinolone* - While fluoroquinolone resistance is a **necessary component** of XDR-TB, it is **not sufficient alone**. - XDR-TB requires fluoroquinolone resistance **plus** additional resistance to Group A drugs (bedaquiline or linezolid).
Question 5: Which of the following statements about the DOTS treatment for tuberculosis is correct?
- A. Case finding 80%, cure rate 85%
- B. Case finding 80%, cure rate 80%
- C. Case finding 70%, cure rate 75%
- D. Case finding 70%, cure rate 85% (Correct Answer)
Explanation: ***Case finding 70%, cure rate 85%*** - The **DOTS strategy** set a global target of detecting at least **70% of new sputum smear-positive TB cases** and curing at least **85% of these cases**. - Achieving these targets was considered crucial for controlling the spread of **tuberculosis** at a population level. *Case finding 80%, cure rate 85%* - While a **cure rate of 85%** is a key target of the DOTS strategy, the **case finding target was not 80%**. - Setting a higher case finding target might be desirable, but the **established goal** for DOTS was slightly lower to be more achievable. *Case finding 80%, cure rate 80%* - Neither the **case finding target nor the cure rate target** for DOTS was 80%. - The **cure rate target** was specifically emphasized as being higher to ensure effective treatment outcomes and prevent drug resistance. *Case finding 70%, cure rate 75%* - While **case finding 70%** aligns with the DOTS target, the **cure rate target was higher than 75%**. - A lower cure rate would indicate less effective treatment management, potentially leading to **treatment failures** and the emergence of **multidrug-resistant TB**.
Question 6: A patient with cough was sputum AFB negative but chest X-ray was suggestive of TB. What should be the next step according to RNTCP?
- A. Nucleic acid amplification test (Correct Answer)
- B. Tuberculin test
- C. Line probe assay
- D. Culture
Explanation: Nucleic acid amplification test - According to the and Revised National Tuberculosis Control Program (RNTCP) guidelines, if sputum AFB microscopy is negative but clinical suspicion and chest X-ray point towards TB, NAAT (Nucleic Acid Amplification Test) is recommended as the next confirmatory step [1]. - NAATs like CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) or TrueNat provide rapid detection of Mycobacterium tuberculosis and resistance to Rifampicin, aiding in early diagnosis and appropriate treatment initiation. Tuberculin test - The Tuberculin Skin Test (TST), also known as the Mantoux test, indicates past exposure to TB or latent infection, but it cannot differentiate between active disease, latent infection, or past treated infection [2]. - A positive TST in an adult with a suggestive chest X-ray still requires further investigation for active disease, as it does not confirm active pulmonary TB [2]. Line probe assay - Line Probe Assay (LPA) is a molecular test used for rapid detection of MDR-TB (multi-drug resistant TB) by identifying mutations associated with resistance to Rifampicin and Isoniazid. - While useful for resistance testing, it typically requires a positive culture or direct sputum sample with a higher bacterial load and is not the primary diagnostic test for initial confirmation of TB when sputum AFB is negative. Culture - Mycobacterial culture is the gold standard for TB diagnosis, providing definitive confirmation and enabling drug susceptibility testing (DST) [1]. - However, culture results can take several weeks (typically 3-6 weeks), which delays treatment initiation, making it a less immediate next step compared to rapid molecular tests like NAAT in cases of strong clinical suspicion.
Question 7: Under NTEP, what is the honorarium given to a DOTS provider after the completion of treatment?
- A. 150 INR
- B. 500 INR (Correct Answer)
- C. 1000 INR
- D. 250 INR
Explanation: ***500 INR*** - Under the **National Tuberculosis Elimination Programme (NTEP)**, a **DOTS provider** receives an honorarium of **INR 500** upon the successful completion of tuberculosis treatment for a **new TB patient**. - This incentive, revised from the earlier amount of INR 250, aims to recognize the crucial role of DOTS providers in ensuring treatment adherence and successful outcomes. - The increased honorarium reflects the government's commitment to incentivizing community participation in TB elimination. *150 INR* - This amount is **significantly lower than the stipulated honorarium** for a DOTS provider upon treatment completion under current NTEP guidelines. - The correct incentive for successful completion of treatment is INR 500 for new TB cases. *250 INR* - This was the **earlier honorarium amount** under the previous NTEP guidelines, which has since been **revised upward**. - Under the current NTEP incentive structure, the honorarium for treatment completion has been increased to INR 500. *1000 INR* - This amount is **higher than the designated honorarium** for a DOTS provider upon treatment completion under NTEP. - While this figure may apply to other incentive schemes or different milestones, the standard honorarium for new TB case completion is INR 500.
Question 8: Regarding BCG vaccine, which of the following is untrue?
- A. T.B. vaccine
- B. All of the options
- C. live vaccine
- D. Orally administered (Correct Answer)
Explanation: ***Orally administered*** - The **BCG vaccine** is not administered orally; it is typically given via an **intradermal injection**, usually in the upper arm. - Oral administration is a route used for some vaccines, but not for BCG. *T.B. vaccine* - The **BCG vaccine** is indeed a vaccine against **tuberculosis (TB)**, making this statement true. - It works by using a live, attenuated strain of *Mycobacterium bovis* to provide immunity against *Mycobacterium tuberculosis*. *All of the options* - Since the statement "Orally administered" is untrue, this option cannot be correct. - The BCG vaccine is not administered orally, which makes that specific claim false. *live vaccine* - The **BCG vaccine** is a **live attenuated vaccine**, meaning it contains a weakened form of the *Mycobacterium bovis* bacterium. - This characteristic allows it to stimulate a strong immune response, making this statement true.
Question 9: The online software used to monitor TB control program under RNTCP is:
- A. NIRBHAI
- B. NIKSHAY (Correct Answer)
- C. e-DOTS
- D. NISCHAY
Explanation: ***Correct Answer: NIKSHAY*** - **NIKSHAY** is the official **web-based patient management system** for monitoring the TB control program under the **Revised National Tuberculosis Control Programme (RNTCP)**, now known as the National Tuberculosis Elimination Programme (NTEP) - It serves as a comprehensive platform for **real-time case notification, treatment monitoring, and tracking of patient outcomes** - Enables **digital recording** of TB patient details, treatment regimens, and follow-up information across India *Incorrect: NIRBHAI* - This is not a recognized software platform associated with RNTCP or TB control monitoring - No official government health program uses this name for TB surveillance *Incorrect: e-DOTS* - While **DOTS (Directly Observed Treatment, Short-course)** is the core treatment strategy for TB, e-DOTS is not the comprehensive online monitoring software - e-DOTS may refer to electronic recording of DOTS adherence, but **NIKSHAY** is the overarching national platform *Incorrect: NISCHAY* - This is not a recognized software platform for RNTCP monitoring - Does not correspond to any official TB control initiative in India
Question 10: Epidemic marker of TB?
- A. Tuberculin test positivity rate
- B. Sputum AFB positivity rate (Correct Answer)
- C. Chest x-ray positivity rate
- D. None of the options
Explanation: ***Sputum AFB positivity rate*** - The **sputum acid-fast bacilli (AFB) positivity rate** directly indicates the number of individuals actively shedding viable *Mycobacterium tuberculosis* in their respiratory secretions. - This metric reflects the **infectious pool** within a community, making it a robust marker for assessing ongoing transmission and the epidemic status of tuberculosis. *Tuberculin test positivity rate* - The **tuberculin skin test (TST)** measures exposure to TB and latent infection, not active, infectious disease. - A high positivity rate indicates a high prevalence of **latent TB infection**, but doesn't differentiate between old exposure, cleared infection, or active disease, nor does it directly measure transmissibility. *Chest x-ray positivity rate* - **Chest X-rays** can identify pulmonary abnormalities consistent with TB, including active disease. - However, CXR findings are **non-specific** for TB and can be suggestive of previous infection or other lung conditions, making it less precise than sputum AFB for defining an active epidemic. *None of the options* - This option is incorrect because the **sputum AFB positivity rate** is a well-established and direct indicator of active TB disease transmission and epidemic activity.
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