Test 6

Tuberculosis: Texts

Text A

Tuberculosis

Tuberculosis is an infectious disease caused in most cases by a micro-organism called Mycobacterium tuberculosis.
The micro-organisms usually enter the body by inhalation through the lungs. They spread from the initial location in the
lungs to other parts of the body via the blood stream, the lymphatic system, the airways or by direct extension to other
organs.
• Pulmonary tuberculosis is the most frequent form of the disease, usually comprising over 80% of cases. It is the
form of tuberculosis that can be contagious.
• Extra-pulmonary tuberculosis is tuberculosis affecting organs other than the lungs, most frequently pleura, lymph
nodes, spine and other bones and joints, genitourinary tract, nervous system, abdomen or virtually any organ.
Tuberculosis may affect any part of the body, and may even become widely disseminated throughout the whole
body.
Tuberculosis develops in the human body in two stages. The first stage occurs when an individual who is exposed
to micro-organisms from an infectious case of tuberculosis becomes infected and the second is when the in-
fected individual develops the disease.

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 Text B

Diagnosis of tuberculosis

The most frequent symptoms of pulmonary tuberculosis are:

• persistent cough for 2 weeks or more: every patient presenting with this symptom should be designated a
tuberculosis suspect;
• sputum production, which may be blood-stained (haemoptysis), shortness of breath and chest pain;
• loss of appetite and loss of weight, a general feeling of illness and tiredness, night sweats and fever.
Any patient presenting with any of these symptoms should be suspected of having tuberculosis. If the patient is, or
was, in contact with a patient with infectious tuberculosis, such a person is even more likely to be suffering from
tuberculosis.
Symptoms of extra-pulmonary tuberculosis depend on the organ involved. Chest pain from tuberculosis pleurisy,
enlarged lymph nodes and sharp angular deformity of the spine are some of the presenting symptoms or signs of
extra-pulmonary tuberculosis.
Symptoms of extra-pulmonary tuberculosis depend on the organ involved. Chest pain from tuberculosis pleurisy,
enlarged lymph nodes and sharp angular deformity of the spine are some of the presenting symptoms or signs of
extra-pulmonary tuberculosis.

Tuberculosis cases are most likely to be found among:

• patients who present themselves on their own initiative at a health facility with symptoms suggesting
tuberculosis;
• those (especially children and young adults) living in the same household with smear-positive patients;
• those infected with HIV;
• those found to have an abnormality that has the appearance of tuberculosis when a chest radiograph has
been taken for clinical investigation of a sick patient.

Confirmation of the diagnosis:

There are several tests available to diagnosis TB. some of these are:
• Mantoux Test: This involves injecting a small amount of tuberculin into the skin in the lower part of the arm.
Then the person must return after 48 to 72 hours to have a trained health care worker look at their arm and
examine for hard area or swelling
• TB culture Test : Culture test involve studying bacteria by growing them on different substances. Bacteria
are usually contained in a sputum sample taken from suspected person.
• Chest X-ray: If a person has had bacteria which have caused inflammation in the lungs, an abnormal shadow
may be visible on an X-ray.

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 Text C

First line tuberculosis drugs and its dosage in adults

Drugs Daily dose Preparation Side effects

in mg/kg (range)

Isoniazid 4-6 Tablets(50,100,300 mg)

Aqueous IV/IM solution Burning sensation,
(100mg/ml) Vomiting,Jaundice,
Confusion

Rifampicin 8-12 Capsule(150,300mg) Anorexia, Nausea,

Aqueous IV solution Itching, Purpura,
shock

Pyrazinamide 20-23 Tablet(500 mg) Joint pain,

Jaundice,vomiting

Ethambutol 15-25 Tablet(100 and 400 mg) Visual Impairment

Streptomycin 12-18 IM Injection Dizziness

For drug-resistant TB, a combination of antibiotics called fluoroquinolones and injectable medications such as amikacin,
kanamycin or capreomycin are generally used for 20-30 months.

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 Text D

Tuberculosis: Lifestyle Management

• People with active TB disease should stay away from work and school until the doctor says it’s safe to return, in
order to avoid infecting others.
• Cover the mouth with a tissue when coughing and sneezing, then seal the tissue in a bag to throw it away.
• Make sure the patient’s room has adequate ventilation, so that the exhaled bacteria are carried away.
• People with active disease need to tell their doctor or health professionals about anyone they have had close
contact with, such as family, friends.
• Take all the medications on right time. If patient stop taking medications or skip some doses, the risk of developing
drug resistant TB is high.

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 Part A
Time: 15 minutes
Look at the four texts, A-D, in the separate Text Booklet.
For each question, 1-20, look through the texts, A-D, to find the relevant information.
Write your answers on the spaces provided in this Question Paper.
Answer all the questions within the 15-minute time limit. Your answers should be correctly spelt.

Tuberculosis: Questions

Questions 1-6

For each of the questions 1-7, decide which text (A,B, C or D) the information comes from. You may use any
letter more than once.

In which text can you find information about

1. Measures to prevent the spread of disease ____________________ __________

in household setting
2. Indicators of the disease ____________________ __________

3. How tuberculosis advances in individals ____________________ __________

4. Patients under risk ____________________ __________

5. Investigations to be done ____________________ __________

6. Tuberculosis treatment after exposure ____________________ __________

7. Mode of transmission of tuberculosis ____________________ __________

Questions 7-14

Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.
8. Which is the drug used for TB skin test?
_______ ______________________________________________ _______

9. What is the maximum dose of streptomycin per kilo of a patient’s weight?

_______ ______________________________________________ _______

10. Which bacteria causes tuberculosis?

_______ ______________________________________________ _______

11. How long does a patient have to take medication for drug-resistant TB?
_______ ______________________________________________ _______

12. Which type of tuberculosis spreads from infected person to others?

_______ ______________________________________________ _______

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13. What needs to be ensured to remove breathe out bacteria from a room?
__ ___ ______ ______ ____ ___________ ______ ______ ____

14. What threat follows the stoppage of TB medications?

__ ___ ______ ______ ____ ___________ ______ ______ ____

Questions 15-20

Complete each of the sentences, 15-20, with a word or a short phrase from one of the texts. Each answer
may include words, numbers or both.

15. The disease advances beyond the to affect various areas.

16. The signs of extra-pulmonary disease is based on the involved

17. Mantoux test checks for hard area and .

18. Inflammation of lungs as a result of presence of bacteria may be evident on .

19. is suspected on patients who visit the health sector on their own interest.

20. Four-drug regimen falls under _ tuberculosis drugs.

END OF PART A

THIS QUESTION PAPER WILL BE COLLECTED

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 Part B
In this part of the test, there are four short extracts relating to the work of health professionals. For questions
1-6, choose the answer (A, B or C) which you think fits best according to the text.

1. The regulatory statement instructs healthcare professionals to

A admit all patients to NSW public hospitals within 48 hours

B assess all patients in the Emergency Department for VTE
C initiate VTE prophylaxis for all patients identified to be at risk

Mandatory requirements
• All adult patients admitted to NSW public hospitals must be assessed for the risk of VTE within 24 hours
and regularly as indicated / appropriate.

• All adult patients discharged home from the Emergency Department who as a result of acute illness or
injury, have significantly reduced mobility relative to normal state, must be assessed for risk of VTE.

• Patients identified at risk of VTE are to receive the pharmacological and / or mechanical prophylaxis
most appropriate to that risk and their clinical condition.

• All health services must comply with the Prevention of VTE Policy.

• All Public Health Organisations must have processes in place in compliance with the actions summarised
in the VTE Prevention Framework (Appendix 4.1 of the attachment). A VTE risk assessment must be
completed for all admitted adult patients and other patients identified at risk, and decision support tools
made available to guide prescription of prophylaxis appropriate for the patients risk level.

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2. The treatment guidelines below recommend that

A all patients receive parathyroid hormone monitoring

B all patients receive 6-weekly monitoring
C all patients receive baseline blood tests

Medical monitoring guidelines for high risk patients on very low energy diets

Assessment Baseline 6 weeks Completion of

measures intensive phase

Electrolytes/Creatinine Yes If required Yes

Liver function tests Yes If required Yes

Fasting glucose Yes If required Yes

Cholesterol, triglycerides & HDL Yes If required Yes

Uric acid Yes If required Yes

Full blood count Yes If required Yes

Iron studies Yes If required Yes

Vitamin D Yes If required Yes

Calcium & Parathyroid hormone Yes If required Yes

(in patients on long term
anticonvulsants)

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3. The keys to safer food programme outlines the need to

A handle food products with care and hygeine

B educate and equip food handlers on safe practices
C eradicate probable causes of food borne disease

The Five Keys to Safer Food Programme

Diseases that people get from eating contaminated food are an important cause of illness, disability and
deaths around the world Foodborne diseases-especially those caused by bacteria, viruses, parasites and
fungi-are preventable, and education in safe food handling is a key measure for prevention, including to
contain antimicrobial resistance Five Keys to Safer Food Programme to assist Member States in promot-
ing safe food handling behaviors and educate all food handlers, including consumers, with tools easy to
adopt and adapt. The Five Keys to Safer Food explain the basic principles that each individual should
know all over the world to prevent foodborne diseases The five Keys to Safer Food are: (1) keep clean;
(2) separate raw and cooked; (3) cook thoroughly; (4) keep food at safe temperatures; and (5) use safe
water and raw material. . WHO’s objective is to target those who usually do not have access to food
safety education despite the important role they play in producing safe food for their comm unity (e.g.
rural women).

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4. The information handout informs that

A available reviews outline the steps to be taken

B a comprehensive system for safety is in place
C evaluations are done on the basis of many factors

Environmental Health Criteria

Environmental Health Criteria (EHC) documents provide international, critical reviews on the effects of
chemicals or combinations of chemicals and physical and biological agents on human health and the
environment.

Each EHC follows a standard outline or format, and you can expect to find a summary of the whole
document followed by information on identity, sources of exposure, environmental transport, distribution
and transformation, environmental levels and human exposure, kinetics and metabolism in laboratory
animals and humans, effects on laboratory animals and in vitro test systems.An overall evaluation and
conclusions for the protection of human health and the environment is found at the end of each document
together with needs for further research and details of previous evaluations by international bodies e.g.
IARC, JEFCA.
Two different series of Environmental Health Criteria (EHC) documents are available: (1) on specific
chemicals or groups of related chemicals; and (2) on risk assessment methodologies. Both are acces-
sible from the numerical listing below. In addition the EHCs on risk assessment methodologies are acces-
sible from the listing of all IPCS methodology publications and projects.

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5. The extract on randomised control trials on HIV infers

A presence of foreskin is a major precipitating factor

B circumcision performed by certain devices are safe
C immune systems are weak in males are uncircumcised

Male circumcision and HIV infection

A randomized controlled trial is the gold standard for scientific studies, and three such trials conclusively
determined that male circumcision reduces female-to-male HIV transmission by about 60% Responding
to this evidence, in March 2007, the World Health Organization and UNAIDS issued recommendations on
male circumcision and HIV prevention. The primary target cells through which HIV enters the body are
immune system target cells with CD4 receptors, including Langerhans cells. These cells are present in
high density in the epithelium of the inner foreskin and are close to the surface . The highly vascularized
foreskin mucosa and the mucosa at the frenulum are prone to tearing and bleeding during intercourse.
These microinjuries allow easy entry of HIV into the bloodstream. Important note about device-based
surgical methods In 2013, the World Health Organization stated that the male circumcision devices it
prequalifies are efficacious, safe and acceptable as additional methods of male circumcision for HIV
prevention among healthy men. Providers who perform circumcisions using device-based surgical meth-
ods should be appropriately trained and competent in these of the specific device.

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6. The display poster explains the referral process as

A shift of resources for precise treatment

B recommending facility for patient specific care
C determining specific care required for illness

The basics of the referral process

A referral is when a health care provider at one level of the health system—with insufficient resources (in
terms of drugs, equipment or skills) to manage a particular clinical condition or provide a certain ser -
vice—seeks the assistance of a more appropriate facility. This appropriate facility may be at the same or
a higher level than the referring facility but is able to assist in or take over the management of the client’s
condition or respond to the client’s needs.

Key reasons for deciding to refer either an emergency or a routine case include seeking:

• expert opinion regarding the client

• additional or different services for the client

• admission and expert management of the client or

• access to diagnostic and therapeutic tools.

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