Que. 1. In which year, TB was declared global emergency by WHO?

Ans. 1. 1993.

Que. 2. Where are MTB complexes generally found in the lungs?

Ans. 2. In the well aerated upper lobes of the lungs.

Que. 3. What is the route of transmission of TB?

Ans. 3. Primarily by airborne droplets. It spreads by speaking, sneezing & coughing.

Que. 4. Who are classified as great transmitters of TB?

Ans. 4. The great transmitters of TB are as follows –

• People with bad cough
• Smear positive patients
• Untreated patients
• Patients who have just started treatment
• Cases with poor response to treatment

Que. 5. Which are the major body parts involved by TB?

Ans. 5. TB affects primarily lungs but can involve any part of the body.

Que. 6. In which year was BCG campaign started?

Ans. 6. 1951.

Que. 7. In which year, was Directly Observed Treatment Short course (DOTS) using intermittent regimen started?

Ans. 7. 1993.

Que. 8. In which year, was Revised National TB Control Program (RNTCP) launched?

Ans. 8. 1997.

Que. 9. What the life time risk is among infected of getting the disease?

Ans. 9. 10 – 15%.

Que. 10. What is the per year risk of getting the TB disease amongst those co-infected with HIV?

Ans. 10. 10%.

Que. 11. What are the health determinants of risk of getting disease of TB?

Ans. 11. The Health determinants of risk of getting TB are as follows –

• Malnutrition
• Diabetes Mellitus
• Smoking
• Alcoholism

Que. 12. Which country has highest burden of Multi Drug Resistant (MDR) TB?

Ans. 12. India.

Que. 13. What are the factors responsible for the chances of getting infected with Mycobacterium tuberculosis?

Ans. 13. Factors responsible are –

• Duration of exposure
• Frequency of exposure
• Bacterial Load & virulence
• Immune status of an individual

Que. 14. How will you detect infection with M. Tuberculosis?

Ans. 14. By Tuberculin skin test (TST) or Monteux test and Direct IGRA test.

Que. 15. What do you mean by term A world free of TB?

Ans. 15. It means Zero TB deaths, Zero TB disease & zero TB sufferings.

Que. 16. What is the goal of The End TB Strategy?

Ans. 16. To end the global TB epidemic.

Que. 17. By when the A World Free of TB is to be achieved?

Ans. 17. 2035.

Que. 18. What were the highlights of National Tuberculosis Control Program (NTP), 1962?

Ans. 18. The Highlights of NTP were –

• Mostly X-ray based diagnosis
• Domiciliary treatment.
• Self-administered conventional Treatment regimens of 12-18 months

Que. 19. On review, which were the weaknesses found in NTP?

Ans. 19. The weaknesses found on review were as follows –

• Managerial Weaknesses
• Inadequate funding
• An over-reliance on X-ray for diagnosis
• Frequent interrupted supply of drugs
• Low rates of treatment completion

Que. 20. What do constitute primary complex in Tuberculosis?

Ans. 20. Primary Complex is constituted by –

• Sub pleural lung lesion
• Lymphangitis
• Hilar adenopathy

Que. 21. Which are the staff posted at TU?

Ans. 21. The staff posted at TU are as follows –

• Designated Medical Officer – TB Control (MOTC)
• Senior Treatment Supervisor (STS)
• Senior TB Lab Supervisor (STLS)

Que. 22. What were the components of DOTS strategy?

Ans. 22. The components of DOTS strategy were as follows –

• Strong political & administrative will
• Diagnosis based on sputum smear microscopy among chest symptomatic
• Intermittent short course directly observed treatment
• Uninterrupted supply of drugs maintained through patient wise boxes (PWS)
• Systemic monitoring and accountability

Que. 23. What were the goals of RNTCP?

Ans. 23. The goals of RNTCP are as follows –

• To decrease the mortality and morbidity due to TB
• To cut down the chain of transmission of infection until TB ceases to be a public health problem.

Que. 24. What were the objectives of the RNTCP?

Ans. 24. To achieve & maintain –

• Cure rate of at least 85% among newly detected smear-positive (infectious) pulmonary TB cases (PTB)
• Case detection of at least 70% of the expected new smear positive PTB cases in a community

Que. 25. What was the focus of RNTCP?

Ans. 25. Ensuring universal access to quality assured TB diagnosis and treatment services.

Que. 26. When & who conducted review of NTP?

Ans. 26. WHO & Swedish International development agency (SIDA) in 1992.

Que. 27. What are the causes of post primary TB?

Ans. 27. The causes of post primary TB are as follows –

• Endogenous reactivation of dormant tubercular bacilli acquired from a primary infection
• Exogenous re-infection.

Que. 28. When was stop TB Strategy launched?

Ans. 28. In 2006, by WHO.

Que. 29. What were the components of STOP TB STRATEGY?

Ans. 29. The components of STOP TB STRATEGY were as follows –

• Pursuing high quality DOTS expansion & enhancement
• Addressing HIV-TB, MDR TB & other challenges
• Contributing to health system strengthening
• Engaging all care providers
• Empowering patients & communities
• Enabling & promoting research

Que. 30. What were the objectives of National Strategic Plan (TB Free India) in 12^th Five-year plan (2012-17)?

Ans. 30. The objectives of NSP 2012-17 were as follows –

• To achieve 90% notification rate for all cases
• To achieve 90% success rate for all new & 85% for re-treatment cases
• To significantly improve the successful outcomes of treatment of DR TB cases
• To achieve decreased mortality & morbidity of HIV-associated TB
• To improve outcomes of TB care in the private sector

Que. 31. What are the principles of END TB STRATEGY?

Ans. 31. The principles of End TB Strategy are as follows –

• Government stewardship and accountability with monitoring and evaluation
• Strong coalition with civil city organizations and communities
• Protection and promotion of human rights, ethics and equity
• Adaptation of strategy and targets at country level with global collaboration

Que. 32. Whether State TB Cell (STC) is supported by State Training & Demonstration Centres (STDC)?

Ans. 32. Yes.

Que. 33. How many units does STCD has?

Ans. 33. STDC has 3 units –

• A training unit
• A supervision & monitoring unit
• An Intermediate Reference Laboratory (IRL)

Que. 34. What is the function of State Drug Store?

Ans. 34. It is responsible for effective management of drugs and other logistics.

Que. 35. What is the population covered by Tuberculosis unit (TU) in urban area?

Ans. 35. One lakh population.

Que. 36. What are the aims of Laboratory Services in NTEP?

Ans. 36. The aims of laboratory services are as follows –

• Provision of diagnostic services
• Maintaining quality through internal quality checks and external quality assurance

Que. 37. What are the pre-requisites for peripheral laboratory/DMC?

Ans. 37. The pre-requisites for DMC are as follows –

• Adequate Physical infrastructure
• Binocular Microscope
• Trained LT

Que. 38. How many NRLs are there in NTEP?

Ans. 38. Six.

Que. 39. What is the responsibility of NRLs?

Ans. 39. The responsibility of NRLs are as follows –

• External Quality Assurance of Lab Network in RNTCP
• Drug resistance surveillance
• Training & Research

Que. 40. What are the functions of IRLs?

Ans. 40. The functions of IRLs are given below –

• Monitoring & External Quality Assurance (EQA) of DMCs
• Facilities for Phenotypic tests – Culture & DST (Liquid & Solid Cultures)
• Facilities for genotypic tests – CBNAAT & LPA

Que. 41. What are the regulatory tools to effectively engage private sector?

Ans. 41. The regulatory tools are as follows –

• Standards for TB care in India
• Mandatory TB Notifications
• NIKSHAY
• Ban on sero-diagnostics
• Amendments in H1 drug schedule to control sale of ATT drugs

Que. 42. What are the advantages of public over private sector?

Ans. 42. The advantages of public over private sector are as follows –

• Free diagnosis
• Free Treatment
• Standardized regimens
• Referral & transfer system
• Supervision & Monitoring
• Accountability of treatment outcome

Que. 43. What are the advantages of private sector over public sector?

Ans. 43. The advantages of private sector over public sector are given below –

• Wider choices (>5 lac Practioners)
• Better Access
• Convenient timings
• Shorter distances
• Personal attention & care
• Projected discounts
• Faith & perception of better care.

Que. 44. Enumerate the pillars and components of End TB Strategy.

Ans. 44. The pillars and components of End TB Strategy are –

• Integrated, patient -cantered care and prevention
• Bold policies and support systems
• Intensified Research & Innovation

Que. 45. How many standards are developed for quality of TB care and control?

Ans. 45. 26 standards –

• 6 for diagnosis
• 5 for treatment
• 9 for public health
• 6 for social inclusions

Que. 46. What are the goals of End TB Strategy?

Ans. 46. The goals of End TB Strategy are –

• Reduction in no. of TB deaths compared with 2015 ———— 95%
• Reduction in TB incidence rates compared with 2015 ———- 90% (<10/Lakh)
• TB affected family facing catastrophic costs due to TB ——— 0%

Que. 47. Which is the part of the body generally not affected by TB?

Ans. 47. Nails & hairs.

Que. 48. What is the vision of NSP 2017-25?

Ans. 48. TB free India with zero deaths, disease and poverty due to TB.

Que. 49. What is the goal of NSP 2017-25?

Ans. 49. To achieve a rapid decline in burden of TB, morbidity and mortality while working towards elimination of TB in India by 2025.

Que. 50. What are the objectives of NSP 2017-25?

Ans. 50. The objectives are as follows –

• Find all drug sensitive TB & drug resistant TB Cases with an emphasis on reaching TB patients seeking care from private sector and underdiagnosed TB in high risk populations.
• Initiate and sustain all patients on appropriate treatment where as they seek care, with patient friendly and social support.
• Prevent the emergence of TB in susceptible populations.
• Build and strengthen enabling policies, empowered institutions, additional human resources and enhanced capacities and provide adequate financial resources

Que. 51. What are the key strategies in NSP 2017-25?

Ans.51. the Key Strategies in NSP 2017-25 are as follows –

• Private Sector engagement
• Active case findings
• Drug resistant TB Management
• Addressing social determinants like nutrition
• Robust Surveillance System
• Community engagement and multi-sectoral approach.

Que. 52. What are the expected outcomes in NSP 2017-25?

Ans. 52. The expected outcomes are as follows –

• 80% reduction in TB incidence (i.e. reduction from 211 per lakh to 43 per lakh)
• 90% reduction in mortality due to TB (i.e. reduction from 32 per lakh to 3 per lakh)
• 0% patients having catastrophic expenditure due to TB

Also to reduce estimated TB prevalence per lakh population to 65 per lakh.

Que. 53. When was CBNAAT & Line Probe Assay introduced in RNTCP?

Ans. 53. 2009.

Que. 54. How will you monitor response to treatment for MDR TB?

Ans. 54. By follow up culture on Liquid Culture (MGIT) system.

Que. 55. To whom is invariably MDR TB diagnosis offered?

Ans. 55. Invariably MDR TB diagnosis is offered to the following –

• All patients initiated on re-treatment
• Patients who remain smear positive on any follow up
• Failure of first line treatment
• Those at high risk such as contacts of MDR TB cases

Que. 56. Where are 6 NRLs located?

Ans. 56. Chennai, Bangalore, Delhi, Agra, Bhopal & Bhubaneshwar.

Que. 57. How many Intermediate Reference Labs (IRLs) are there in the country?

Ans. 57. 31.

Que. 58. What is the norm of population covered by one DMC in tribal, hilly, desert & difficult to reach area?

Ans. 58. 0.5 Lakh Population

Que. 59. When was Programmatic Management of Drug Resistant Tuberculosis (PMDT) services introduced in the country?

Ans. 59. 2007.

Que. 60. When was the complete geographic coverage of PMDT services in the country achieved?

Ans. 60. 2013.

Que. 61. What do you mean by presumptive pulmonary TB?

Ans. 61. A person with any of the symptoms and signs, suggestive of TB including cough >2 weeks, fever > 2 weeks, significant weight loss, haemoptysis and any abnormality in chest radiograph.

Que. 62. List the patients who should be screened regularly for signs & symptoms of TB.

Ans. 62. Those patients are –

• Contacts of microbiologically confirmed TB Patients
• PLHIV
• Diabetes
• Malnourished
• Cancer patients
• Patients on immune-suppressants or steroids

Que. 63. What do you mean by presumptive extra pulmonary TB?

Ans. 63. Refers to presence of organ specific sign & symptoms like Swelling of lymph nodes, pain & swelling in the joints, neck stiffness, disorientation etc and for constitutional symptoms like significant weight loss, persistent fever > 2 weeks and night sweats.

Que. 64. What do you mean by presumptive paediatric TB?

Ans. 64. Refers to children with persistent fever, &/or cough for more than 2 weeks, loss of weight / no weight gain &/or history of contact with infectious TB cases.

Que. 65. Name bactericidal 1^st line anti-tubercular drugs.

Ans. 65. Rifampicin, INH, Streptomycin & Pyrazinamide.

Que. 66. Name 1^st line bacteriostatic anti TB drugs.

Ans. 66. Ethambutol & Thioacetazone.

Que. 67. Name the only bactericidal drug active against persisters or dormant bacilli.

Ans. 67. Rifampicin.

Que. 68. Enumerate side effects of Rifampicin.

Ans. 68. Side Effects of Rifampicin are as follows –

• Nausea & Vomiting
• Red/orange discoloration of urine
• Gastritis
• Hepatotoxicity
• Influenza like illness
• Thrombocytopenia
• Nephrotoxicity

Que. 69. Enumerate the side effects of INH.

Ans. 69. Side effects of INH are as follows –

• GI Irritation
• Peripheral Neuropathy
• Blood dyscrasias
• Hyperglycaemia
• Liver damage

Que. 70. Enumerate side effects of Streptomycin.

Ans. 70. Vestibular Damage, Nystagmus & Renal damage.

Que. 71. What are the goals of TB treatment?

Ans. 71. The goals of TB treatment are as follows –

• To detect case fatality and morbidity by ensuring relapse free cure.
• To minimize & prevent development of drug resistance
• To render the patient non-infectious, break the chain of transmission and to decrease the pool of infection.

Que. 72. What are the types of TB based on anatomical site of TB?

Ans. 72.  Two types- 1) Pulmonary TB 2) Extra-pulmonary TB.

Que. 73. What do you mean by microbiologically confirmed TB case?

Ans. 73. Refers to presumptive TB patient with biological specimen positive for acid fast bacilli or positive for M. tuberculosis on culture or positive for tuberculosis through quality assured rapid diagnostic molecular test.

Que. 74. What do you mean by clinically diagnosed TB case?

Ans. 74. Refers to a presumptive TB patient who is not microbiologically confirmed, but has been diagnosed with active TB by a clinician on the basis of X-ray abnormality, histopathology or clinical signs with a decision to treat the patient with a full course of Anti TB treatment.

Que. 75. What is the definition of new case for TB in NTEP?

Ans. 75. A TB patient who has never had treatment for TB or has taken anti TB drugs less than one month is considered as a new case.

Que. 76. What do you mean by recurrent TB Case?

Ans. 76. A TB patient previously declared as successfully treated (cured/ treatment completed) and is subsequently found to be microbiologically confirmed TB Case.

Que. 77. What do you mean by previously treated patients?

Ans. 77. Those patients of TB who have received one month or more of anti TB drugs in the past.

Que. 78. Which are the methods for sputum smear microscopy (for AFB)?

Ans. 78. Two Methods –

• Zeihl – Neelson staining
• Fluorescent staining

Que. 79. Which are the methods available under NTEP for rapid molecular diagnostic testing?

Ans. 79. Two methods –

• Line Probe Assay (LPA) for MTB complex and detection of RIF & INH resistance.
• Nucleic Acid Amplification Test (NAAT) Xpert MTB/RIF testing using the Genexpert system.

Que. 80. Name the test used in place of skin test in low prevalence countries to detect TB infection.

Ans. 80. IGRAs test.

Que. 81. In which year, Government of India has banned the manufacture, importation, distribution & use of currently available commercial serological tests for diagnosis of TB?

Ans. 81. June 2012.

Que. 82. How much population does a TBHV cover in urban areas for supporting urban TB Control activities?

Ans. 82. One lakh urban population.

Que. 83. In daily regimen for treatment of drug sensitive TB (DS TB), what is the frequency of dosage?

Ans. 83. Single daily dose i.e. 7 days/week and for 4 weeks per month i.e. 28 days.

Que. 84. What is the dose of first line anti TB drugs in adults?

Ans. 84. Doses in adults are as follows –

Isoniazid ——————— 5 mg/Kg body weight

Rifampicin ——————- 10 mg/Kg body weight

Pyrazinamide ————— 25 mg/Kg body weight

Ethambutol —————— 15 mg/Kg body weight

Que. 85. What are the paediatric doses of first line anti TB Drugs?

Ans. 85. Paediatric doses are as follows –

Isoniazid ——————— 10 mg/ Kg body weight

Rifampicin ——————- 15 mg/ Kg body weight

Pyrazinamide ————— 30 mg/ Kg body weight

Ethambutol —————— 20 mg/ Kg body weight

Que. 86. In daily regimen for DS TB, fixed dose combinations (FDCs) are available for adults in which weight bands?

Ans. 86. Five weight bands are as follows –

• 25-34 Kg
• 35-49 Kg
• 50-64 Kg
• 65-75 kg
• Equal to or more than 75 Kg

Que. 87. In which conditions, tab Pyridoxine in indicated to prevent INH neuropathy in TB Patients?

Ans. 87. Pyridoxine is indicated in following TB cases –

• Alcoholics
• Malnourished persons
• Pregnant & Lactating women
• HIV infection
• Patients with Diabetes or chronic renal failure

Que. 88. How much incentive does TB patients of tribal and difficult area get?

Ans. 88. Rs 750/-

Que. 89. How much incentive does treatment supporter get to ensure completion of TB treatment?

Ans. 89. Category I ————– Rs 1000/- per patient

Category IV & V ——- Rs 5000/- per patient

Que. 90. Which category of TB treatment has been recently abolished?

Ans. 90. Category II.

Que. 91. In relation to nutritional support, which kind of services are usually offered to TB patients?

Ans. 91. All patients of active TB should receive –

• Assessment of their nutritional status
• Appropriate counselling based on their nutritional status at diagnosis & throughout their treatment.
• If malnutrition is recognised, its management.

Que. 92. Under NIKSHAY POSAN YOJNA how much incentive does a TB patient get for nutritional support?

Ans. 92. Rs 500/- per month.

Que. 93. Which are the highest priority contacts for active tracing?

Ans. 93. These are as follows –

• Persons with symptoms suggestive of TB
• Children aged less than 6 years old
• Contacts with Known or suspected immune compromised status, particularly HIV infection
• Contacts with Diabetes Mellitus
• Contacts with other high risks including pregnancy, smokers & alcoholics
• Contacts of patients with DR TB

Que. 94. Which is the treatment regimen for Drug sensitive TB?

Ans. 94.  2 HRZE + 4 HRE

Que. 95. What is the minimum load of tubercular bacilli per ml required to determine ZN/ Acid fast staining positive?

Ans. 95. 10,000 AFB/ml is required.

Que. 96. What are the uses of Culture & DST services in RNTCP?

Ans. 96. The uses are as follows –

• Isolation & identification of tubercle bacilli
• For diagnosis and management of drug resistant TB
• Diagnosis of TB in Pauci-bacillary TB -HIV & paediatric TB etc.
• For post treatment follow up and early detection of recurrence

Que. 97. What is the total turnaround time for C & DST?

Ans. 97. Up to 12 weeks

Que. 98. What is the time required for detection of tubercle bacilli by Culture & DST services?

Ans. 98. 2-8 weeks for detection.

Que. 99. In how many days, in MGIT 960 system of C & DST, positivity occurs?

Ans. 99. 4-21 days (Average 7-14 days)

Que. 100. What are the advantages of Line Probe Assay?

Ans. 100.  The advantages of LPA are as follows –

• Lower contamination rates than Culture
• Detects resistant genes for Rifampicin & Isoniazid
• Take 8 hours to get results

Que. 101. What is the norm for optimum utilization of CBNAAT?

Ans. 101. 10-12 tests per day.

Que. 102. What is the time taken by CBNAAT for diagnosis of TB?

Ans. 102. Two hours.

Que. 103. What is the sensitivity & specificity of CBNAAT in adults?

Ans. 103. 88% and 98% respectively.

Que. 104. What are the contents of Genexpert Dx system?

Ans. 104. The contents are as follows –

• Modules – Thermal & Optical system
• Cartridge
• Computer system – software, bar code scanner
• Printers &
• UPS

Que. 105. Name the information management system software used in NTEP.

Ans. 105. Nikshay.

Que. 106. How much incentive does a private sector doctor receive on notification and treatment completion of TB patients?

Ans. 106.  Total 1000/- Rs which includes 500/- Rs for private TB patient notification and Rs 500/- on treatment completion on giving outcome of patient.

Que. 107. What do you mean by annual risk of TB infection (ARTI)?

Ans. 107. It is proportion of individuals getting infected or re-infected with M. tuberculosis over a period of one year.

Que. 108. What does annual risk of TB infection reflect?

Ans. 108. Overall infectious pool in the community.

Que. 109. What will be course of action if high level resistance to INH is detected by the liquid culture?

Ans. 109. Omit INH.

Que. 110. What will be course of action if low level resistance to INH is detected by the liquid culture?

Ans. 110. Add High dose INH.

Que. 111. For which type of fluorescent microscopy is dark room required?

Ans. 111. Conventional fluorescent microscopy.

Que. 112. What are the advantages of LED FM?

Ans. 112. – Less expensive light source

• Dark room not required.
• Requires less power
• Able to run on batteries
• Longer life of bulbs
• No toxic products if broken.

Que. 113. For which type of diagnostic service, is there requirement of high biosafety level lab set up?

Ans. 113. Culture & DST services.

Que. 114. What is the minimum load of tubercular bacilli per ml required to determine solid culture & DST positive?

Ans. 114. 10-100 bacilli per ml.

Que. 115. For which type of diagnostic service, is there need for negative pressure environment?

Ans. 115. Liquid culture & DST services.

Que. 116. Whether Peripheral Health Institutions (PHIs) undertake TB case findings and treatment activities as part of general health services?

Ans. 116. True.

Que. 117. Which are the issues of concern in private sector under NTEP?

Ans. 117. The issues of concern in private sector are –

• Delay in diagnosis
• Over diagnosis of TB due to an overdependence on X-rays
• Use of multiple non-standard regimens for inappropriate duration
• Lack of mechanism to ensure the full course of treatment
• Lack of mechanism for public health actions
• Lack of mechanism to record treatment outcomes
• Lack of confidence in diagnosing paediatric TB

Que. 118. What are the disadvantages of private sector?

Ans. 118. The disadvantages of private sectors are as follows –

• Cost of clinical examinations /fees
• Cost of diagnostic tests
• Cost of drugs
• Irrational prescriptions
• Infrequent use of quality sputum test for diagnosis of TB
• No adherence tracking mechanism
• Fear of loosing patients if involved in NTEP

Que. 119. Before initiating treatment, on which counselling points should counselling of patients be done?

Ans. 119. Counselling points are as follows –

• Disease (Type & mode of spread)
• Treatment (dosage schedule, duration, common side effects & methods to prevent them).
• Treatment adherence
• Prevention of transmission of disease (Cough etiquettes, proper disposal of sputum)
• Screening of close contacts
• NPY

Que. 120. What is the turnaround time for DST by MGIT 960 systems?

Ans. 120. 21-28 days (up to 42 days).

Que. 121. What are the demerits of line probe Assay (LPA)?

Ans. 121. The demerits of Line Probe Assays are as follows –

• Skilled man power (training) is required
• Requirement of specialized equipment
• Dedicated space is required to avoid cross contamination between specimens
• Manual processing of equipment is necessary
• Complexity and no. of steps precludes its use in peripheral settings
• Do not perform well on Pauci bacillary specimens

Que. 122. How many tests can be performed in a day in manual format of LPA?

Ans. 122. 20 tests per day.

Que. 123. What do you mean by outcome – CURED – for drug susceptible TB patients?

Ans. 123. Microbiologically confirmed TB patients at the beginning of treatment, who was smear or culture negative at the end of the complete treatment.

Que. 124. What do you mean by Treatment Success as outcome?

Ans. 124. TB patients either cured or treatment completed are accounted in Treatment Success.

Que. 125. What do you mean by treatment outcome LOST TO FOLLOW UP?

Ans. 125. A TB patient whose treatment was interrupted for one consecutive month or more.

Que. 126. What are the causes of drug resistance for M. tuberculosis?

Ans. 126. The causes of drug resistance for M. tuberculosis are as follows –

• Genetic Mutations
• Man-made –
• Inadequate regimen
• Inadequate supply of drugs
• Poor quality of drugs
• Inadequate drug intake

Que. 127. Which are the specific strategies of treatment of DR TB in NSP 2017-25?

Ans. 127. The specific strategies are as follows –

• Decentralize DR TB Treatment
• Manage H mono/poly DR TB Patients
• Stronger MDR TB
• Newer drugs
• DST Guided treatment

Que. 128. What are the indications of CBNAAT?

Ans. 128. The indications of CBNAAT are as follows –

1. Presumptive TB – following patients –

• Paediatric age group
• PLHIV
• EPTB
• Smear negative but X-ray suggestive

1. All diagnosed TB patients preferably –

• Non-responders to treatment
• DR TB contacts
• Previously treated TB
• TB-HIV co-infection
• New TB patients (in Phased manner)

Que. 129. How much is the time required to get results by LPA?

Ans. 129. 72 hours.

Que. 130.How much is time required to get results by Solid LJ media?

Ans. 130. Up to 84 days.

Que. 131. How much is time required to get results by liquid culture (MGIT)?

Ans. 131. Up to 42 days.

Que. 132. What are the choices of drug resistance diagnostic technology?

Ans. 132. NAAT/LPA ——————- First Choice.

Liquid culture isolation & LPA DST ——- Second choice

Liquid culture isolation & Liquid DST —– Third choice.

Que. 133. What is the norm of population coverage by nodal DR TB centre?

Ans. 133. 1 per 10 million population.

Que. 134. On observation of which issues, will sputum specimen be rejected?

Ans. 134. On observation of following issues, specimen will be rejected –

• Unlabelled or mislabelled specimens
• Specimens sent without request form
• Name on specimens and request form do not match
• If the container is full up to the lid with the specimen
• Sample is not collected in appropriate container
• Specimen container breakage or leakage

Que. 135. Which are the materials required for packing the sputum specimen for transportation?

Ans. 135. The materials required for packing the specimen for transportation are –

• Falcon tubes
• 5% Phenol
• Adsorbent tissues
• Packaging kit
• Permanent marker pen.

Que. 136. What is the duration of treatment for the shorter MDR TB regimen?

Ans. 136. 9-11 months.

Que. 137. What are the facilities available at nodal DR TB centres?

Ans. 137. The facilities available at nodal DR TB Centres are as follows –

• 20-30 bedded tertiary care facility
• An airborne infection controls compliant ward
• Facilities for pre-treatment evaluations
• Facilities for Treatment initiations & follow up monitoring
• Management of adverse drug reactions
• Prevention and relief of physical & social suffering caused by the disease & its treatment
• Management of complications & comorbidities

Que. 139. Which regimens should be started ideally at district DR TB centres?

Ans. 139. The regimens that should be started ideally at district DR TB Centres are as follows –

• MDR/RR TB
• Shorter MDR regimen
• Conventional MDR TB Regimen
• H mono/poly Drug Resistant TB.

Que. 140. Which regimen should be ideally started at nodal DR TB centres?

Ans. 140. The regimen that should be started at Nodal DR TB centres are as follows –

• MDR/RR TB with additional resistance to any /all FQs or SLIs
• XDR TB
• Mixed pattern resistant TB
• Newer drug containing regimens
• Non-TB Mycobacterium (NTM) treatment

Que. 141. What are the advantages of decentralized test & treat approach under PMDT services?

Ans. 141. The advantages are as follows-

• Early & faster initiation of treatment of all diagnosed DR TB patients.
• Bringing care closer to the residence of majority of DR TB patients
• Significant reduction in catastrophic expenditure including loss of work hours and family income
• Rationally minimizing the need & duration of hospitalization
• Minimizing travel of patients, thereby transmission risks during travels
• Accountability of district management units.

Que. 142. In which conditions, may DDR-TBC change the regimen of DR-TB patients?

Ans. 142. In following conditions, DDR-TBC may change the regimen of DR TB patients –

• Additional laboratory confirmed resistance to 2^nd line drugs
• Severe adverse events known before treatment or doing follow up treatment
• Seriously ill patient with very low general condition or as evaluated by DDR – TBC any time before/during treatment and
• Patient with failing regimen or returning after treatment interruption of more than one month or emergence of any exclusion criteria for standard regimen.

Que. 143. What are the functions of Nodal DR TB Centres?

Ans. 143. The functions of nodal DR TB Centres are as follows –

• Pre-Treatment Evaluations (PTE)
• Counselling of patients & Family members
• Nikshay
• Travel enablers
• Follow up & management of adverse drug reactions
• Providing clinical decisions, referrals, management support & training to the districts
• Airborne infection control measures
• Nutritional assessment
• Mental Health
• Palliative care.

Que. 144. Which measures will you adopt for prevention of DR TB?

Ans. 144. The measures for prevention of DR TB are as follows –

• Sustain the highest quality care for drug sensitive TB patients
• Promote rational use of anti TB drugs
• Implement infection control measures

Que. 145. What do you mean by term Presumptive Drug Resistant TB?

Ans. 145. It refers to the following patients –

• TB patients found positive for any follow up smear examination during treatment with first line drugs including treatment failures
• Paediatric TB non-responders
• TB patients who are contacts of DR TB
• Previously treated TB patients
• New TB patients with HIV coinfection
• All notified new TB patients

Que. 146. What do you mean by vulnerable group?

Ans. 146. A vulnerable group is any group of people in which the prevalence or incidence of TB is significantly higher than in the general population. Vulnerable groups to be offered upfront CBNAAT.

Que. 147. During the course of a TB treatment schedule, when will you offer subsequent DST?

Ans. 147. One will offer subsequent DST in –

• Bacteriologically positive after intensive phase (IP) of a course of TB/DR TB treatment.
• Failure to respond to treatment as per NTEP guidelines
• Recurrence of TB diagnosed after a course of TB treatment
• For patients who are retrieved after lost to follow up
• For patients found to be HIV positive
• Any other reason as per treating physician advice

Que. 148. What is the most common cause of DR TB in children?

Ans. 148. Mainly due to primary transmission of DR TB to the children & less likely because of exposure to TB treatment.

Que. 149. Who are the presumed paediatric patients of DR TB?

Ans. 149. The presumed paediatric patients of DR TB are –

• Contacts of DR TB adult patients
• Children with recurrent TB
• Treatment after lost to follow up
• Treatment after failure
• Children living with HIV

Que. 150. On which points, will counselling be provided to DR TB patient on a DDR-TBC/NDR-TBC?

Ans. 150. The counselling points are as follows –

• Nature & duration of treatment
• Importance of adherence to treatment and need for complete and regular treatment
• Possible side effects of treatment
• Mechanism of transmission
• Consequences of irregular treatment or premature cessation of treatment.

Que. 151. Why is it advisable to involve close family members during the counselling?

Ans. 151. As family support is an essential component in the management.

Que. 152. Name 2^nd line fluoroquinolones involved in DR TB treatment.

Ans. 152. 2^nd line fluoroquinolones involved in DR TB treatment are as follows –

• Levofloxacin (Lfx)
• Moxifloxacin (Mfx)
• Gatifloxacin (Gfx)

Que. 153. Name 2^nd line injectable drugs involved in DR TB treatment.

Ans. 153. 2^nd line injectable drugs involved in DR TB treatment are as follows –

• Amikacin (Am)
• Capreomycin (Cm)
• Kanamycin (Km)
• Streptomycin (S)

Que. 154. What is the mechanism of action of Bedaquiline?

Ans. 154. It specifically targets mycobacterial ATP synthetase, an enzyme essential for supply of energy to Mycobacterium Tuberculosis bacilli.

Que. 155. What are the inclusion criteria for regimen containing Bedaquiline?

Ans. 155. Adults aged >18 years having pulmonary MDR TB.

Additional requirements –

• Non-pregnant females or females not on hormonal birth control methods are eligible.
• Patients with controlled arrhythmia can be considered after obtaining cardiac consultation.

Que. 156. What are the exclusion criteria for regimen containing Bedaquiline?

Ans. 156. The exclusion criteria for regimen containing Bedaquiline are as follows –

• Currently having uncontrolled cardiac arrhythmias that require medication
• Having any of the following QT/QTc interval –
• Marked prolongation of QT/QTc interval
• H/o additional risk factors for torsade de points e.g. heart failure, hypokalaemia, family history of long QT syndrome.

Que. 157. What are the indications of Bedaquiline containing regimens?

Ans. 157. The indications of Bedaquiline containing regimens are as follows –

• MDR/RR TB patients with resistance to any /all FQ or to any/all SLI.
• XDR TB patients
• Mixed pattern resistant TB patients
• Treatment of MDR TB + FQ/SLI resistance or XDR TB &
• MDR/RR TB patients with extensive pulmonary lesions or advanced disease with the risk of poor outcomes.

Que. 158. Which is the most common opportunistic infection amongst HIV infected individuals?

Ans. 158. M. tuberculosis.

Que. 159. What are the main reasons of attrition in successful treatment of TB?

Ans. 159. Death & lost to follow up during treatment.

Que. 160. What are the salient features of shorter MDR TB regimen?

Ans. 160. The salient features are as follows –

• Standardized shorter MDR TB Regimen with seven drugs and a treatment duration of 9-11 months
• Indicated conditionally in MDR TB or RR TB, regardless of patient age or HIV status.

Que. 161. What are the exclusion criteria for shorter MDR TB regimens?

Ans. 161. The exclusion criteria for shorter MDR TB regimen are as follows –

• Second line drug resistance (FQ &/or SLI drugs)
• Pregnancy
• EPTB
• Previous exposure for > 1 month to FQs or SLIs medicines

Que. 162. What is the treatment duration of shorter MDR TB regimen?

Ans. 162. 9-11 months.

Que. 163. What is the duration of conventional MDR TB regimen?

Ans. 163. 24-27 months.

Que. 164. What is the duration of H-mono/poly DR TB regimen & mixed pattern H mono/poly regimen?

Ans. 164. 9-12 months.

Que. 165. Which are the inclusion criteria for newer drugs delamanid containing regimen?

Ans. 165. The inclusion criteria for newer drugs delamanid containing regimen are as follows –

• Aged 6 to 17 years having pulmonary MDR TB
• For selected 7 states > 18 years age group.

Que. 166. What is the treatment duration of XDR TB regimen?

Ans. 166. 24-30 months.

Que. 167. What is the treatment duration of all oral longer regimen?

Ans. 167. 18-20 months.

Que. 168. What is the support provision in NTEP for airborne infection control?

Ans. 168. The support provisions are –

1) Practice of infection control measures

• Counselling
• Provision of spittoon, disinfectant, reusable masks & educated on their use.

2)Early detection & appropriate treatment

3) Supervision & monitoring while field visit

Que. 169. What are the weight bands for DR TB treatment?

Ans. 169. Five weight bands exist –

• <16 Kg
• 16-29 kg
• 30-45 Kg
• 46-70 Kg
• >70 kg

Que. 170. Which are the patient support activities available under NTEP?

Ans. 170. Patient support activities available under NTEP are –

• Patient travel reimbursement – Treatment initiation & all follow up visits
• ADR management
• Management of comorbidities
• Free diagnostics & drugs
• Treatment support – treatment supporter and monitor
• Patient counselling support
• Nikshay Poshan Yojana – Financial support of Rs. 500/- per month till the completion of treatment.

Que. 171. What are the components of DR TB patient counselling?

Ans. 171. The components of DR TB patient counselling are as follows –

• Nature & duration of treatment
• Importance of adherence to treatment and need for regular & complete treatment
• Possible side effects of drugs and consultation for the same
• Consequences of irregular treatment or premature cessation of treatment
• Family planning counselling for female patients
• Confidentiality & informed consent
• Patient may be given patient information booklet.

Que. 172. What will be course of action, if a patient interrupts treatment of DR TB less than one month during intensive phase?

Ans. 172. Resume IP treatment, however duration of treatment will be extended to complete IP. The follow up cultures will be done as per the revised schedule.

Que. 173. What will be the course of action, if a patient interrupts treatment for less than one month during continuation phase?

Ans. 173. Resume CP treatment, however duration of treatment will be extended to complete the CP. The follow up cultures will be done as per the revised schedule.

Que. 174. Which is the recommended regimen in NTEP for H mono /poly DR TB?

Ans. 174. (6) Lfx REZ.

Que. 175. What is the recommended shorter MDR TB regimen?

Ans. 175.  IP ———— (4-6) Mfx h km/Am Eto Cfz Z Hh E

CP————- (5) Mfxh Cfz Z E

Que. 176. What is the recommended all oral longer MDR TB regimen?

Ans. 176. (18-20) Bdq (6) Lfx Lzd Cfz Cs.

Que. 177. What is the recommended norm of collection of body fluids for CBNAAT?

Ans. 177. Spinal, pleural, pericardial, synovial, ascitic, bone marrow should be aseptically collected in a sterile container. Specimens should be transported to the laboratory as quickly as possible.

Que. 178. What is the recommended norm of collection of tissue samples for CBNAAT in NTEP?

Ans. 178. The aseptically collected tissues are placed in sterile containers preferably without fixatives or preservatives. If the specimen is to be shipped, it should be protected from drying by adding sterile saline.

Que. 179. What is the minimum volume of bronchial secretions to be collected for CBNAAT?

Ans. 179. 2-5 ml.

Que. 180. What is the minimum volume of bronchial alveolar lavage to be collected for CBNAAT?

Ans. 180. 20-50 ml.

Que. 181. What are the recommended norms of transporting gastric lavage for CBNAAT in NTEP?

Ans. 181. Gastric Lavage should be transported immediately to the lab and processed (not more than 4 hours) to prevent the killing action of the acid content in the gastric lavage on the tubercular bacilli. In the event of delay, the sample cannot be neutralized using 1-2 ml of sterile 10% sodium bicarbonate solution depending upon the volume of gastric aspirate.

Que. 182. What is the use of 4 FDC?

Ans. 182. It is given in intensive phase for the treatment of drug sensitive TB.

Que. 183. What is the use of 3 FDC?

Ans. 183. It is given in continuation phase for the treatment of drug sensitive TB.

Que. 184. Which are the key activities of National Tuberculosis Elimination Program (NTEP)?

Ans. 184. These key objectives are as follows –

• Active case finding
• Use of newer & shorter regimen
• Private sector engagement
• Financial & nutritional support to TB patients
• IT enabled surveillance, preventive & awareness measures

Que. 185. Which target of SDG does emphasize End TB Strategy?

Ans. 185. Target 3.3 of SDG.

Que. 186. When will be requirement of an additional STS?

Ans. 186. Additional STS is required in case of following services –

• If > 300 TB patients are registered annually in a TU in Public Sector.
• If > 50 private health establishments registered in a TU.
• If >200 private TB patients are notified in a TU in a year.

Que. 187. Which test can only be used for diagnosis of TB in HIV positive individuals with signs & symptoms of TB (Pulmonary/Extra-pulmonary) who have a CD4 cell count less than or equal to 100 cells/micro litre?

Ans. 187. Lateral flow urine lipoarabinomannan (LF- LAM) Assays.

Que. 188. What do you mean by C-Tb?

Ans. 188. C-Tb is the next generation skin test for detection of TB. It is unaffected by BCG vaccination status and hence can be used as a tool for latent TB diagnosis.

Que. 189. Which are the tools for diagnosis of TB in children?

Ans. 189. The tools for diagnosis of TB in children are as follows –

• Sputum Examination
• Chest X-ray
• CBNAAT
• Monteux test (TST)

Que. 190. Which is the tuberculin used in TST?

Ans. 190. PPT RT 23 with tween 80. More than 2TU are not used.

Que. 191. Which are the commonest manifestations of EPTB?

Ans. 191. Tubercular Lymphadenitis & Pleural effusion.

Que. 192. Which are the preferred diagnostic technologies for microbiological confirmation of EPTB?

Ans. 192. CBNAAT & Liquid culture.

Que. 193. Apart from CBNAAT & Liquid culture, which are the other useful tests for EPTB?

Ans. 193. Other useful tests for EPTB are as follows –

• FNAC & direct smear examination
• Excision/biopsy of specimen for histopathological examination
• Fluid for cytology, biochemical analysis and smear examination
• X-rays of involved organs
• USG for abdominal tuberculosis.

Que. 194. Why short course chemotherapy regimens of 6 months are preferred in treatment of tuberculosis?

Ans. 194. Short course chemotherapy regimens of 6 months are preferred because –

• Effective
• High cure rate
• Prevents emergence of drug resistance
• Minimizes relapses
• Improvement in treatment adherence
• Equally effective in pulmonary & extra-pulmonary TB

Que. 195. Which are the actions of anti-TB drugs?

Ans. 195. Three actions are as follows –

• Early bactericidal activity
• Sterilizing activity
• Ability to prevent emergence of drug resistance

Que. 196. When is steroid as an adjunctive therapy useful?

Ans. 196. In patients with TB pericarditis & meningeal TB with an initial high dose tapered gradually over 6-8 weeks.

Que. 197. When should Pyridoxine be given in paediatric TB cases?

Ans. 197. To all children receiving INH therapy irrespective of age group in doses of 10 mg per day.

Que. 198. When should the follow up sputum examination be done?

Ans. 198. The follow up sputum examination should be done –

• At the end of Intensive phase
• At the end of continuation phase
• At 6, 12, 18 & 24 months post treatment

Que. 199. What are the advantages of fixed dose combinations (FDCs)?

Ans. 199. The advantages of FDCs are as follows –

• Simplicity of treatment
• Increased patient acceptance
• Increased health worker compliance
• Easier drug management
• Reduced use of monotherapy
• Lower risk of emergence of drug resistance
• Easier to adjust dosages by body weight

Que. 200. What is the dose of INH for preventive therapy?

Ans. 200. 10 mg/KBW administered daily for minimum 6 months.

Que. 201. In which kind of EPTB, is surgery required?

Ans. 201. In following EPTB, surgery is required –

• Hydrocephalous
• Obstructive uropathy
• Constructive pericarditis
• Pott’s spine resulting neurological involvement

Que. 202. Which method can be used for contraception among TB patients?

Ans. 202. The methods used are –

• Barrier methods (Condoms/diaphragm)
• IUDs (CuT)
• Depot medroxy progesterone (Depo-Provera)

Que. 203. What do you mean by latent tuberculosis infection (LTBI)?

Ans. 203. LTBI is the presence of Mycobacterium tuberculosis in the body without sign & symptoms, or radiographic or bacteriologic evidence of TB.

Que. 204. What is the indication of Co-trimoxazole prophylaxis therapy (CPT)?

Ans. 204. For the prevention of opportunistic infections in HIV infected persons.

Que. 205. What is the dose of co-trimoxazole for adults under CPT?

Ans. 205. 960 mg (800+160) daily.

Que. 206. What are the contraindication of CPT?

Ans. 206. The contraindications of CPT are as follows –

• H/O serious drug allergy to sulpha drugs
• G6PD deficiency

Que. 207. What is the estimated burden of MDR/RR-TB cases in India?

Ans. 207. 9.1/lakh population.

Que. 208. What was the average success rate of conventional regimen of MDR TB?

Ans. 208. 49% (2014-17).

Que. 209. When was whole country covered by RNTCP?

Ans. 209. In 2006.

Que. 210. How much population does a designated microscopy centre (DMC) cover?

Ans. 210. Around one lakh population in plain areas & 0.5 lakh population in hilly & tribal areas.

Que. 211. How much population does a TB unit (TU) cover?

Ans. 211. 2 – 2.5 lakh population in plains.

Que. 212. How much population a state drug store cover?

Ans. 212. 50 million population.

Que. 213. Which is the nodal point of TB control activities in the district?

Ans. 213. District TB Centre (DTC).

Que. 214. What do you mean by Peripheral Health Institute (PHI)?

Ans. 214. PHI is a health facility manned by at least one medical officer.

Que. 215. Which lab does lead the lab networks in NTEP?

Ans. 215. National Reference Lab (NRL).

Que. 216. What is the planned rate of decline of TB incidence in NSP 2017-2025?

Ans. 216. 10 – 15 % annually.

Que. 217. What is the 3 tier system for NTEP lab networks?

Ans. 217. It is composed of – at national level NRLs, at state level IRLs & at peripheral level DMCs.

Que. 218. When, throughout the country, all diagnosed TB patients were put on daily regimen in public sector?

Ans. 218. 30^th October 2017.

Que. 219. What is the most sensitive activity of case finding strategy?

Ans. 219. Early detection of people with a high probability of having active TB (presumptive TB).

Que. 220. Why pyrazinamide is recommended in tubercular meningitis?

Ans. 220. As pyrazinamide achieves high level in CSF.

Que. 221. Which anti-TB drug should not be used in HIV patients?

Ans. 221. Thioacetazone.

Que. 222. Why miliary TB can be classified as pulmonary TB?

Ans. 222. As primary focus is in the lungs.

Que. 223. What will be the classification of pulmonary TB with extra-pulmonary TB?

Ans. 223. Pulmonary TB.

Que. 224. In which condition, sputum smear microscopy has limited sensitivity?

Ans. 224. Paediatric TB & PLHIV.

Que. 225. Whether Culture help in early diagnosis of TB?

Ans. 225. Culture requires 2-8 weeks to yield results & hence alone does not help in diagnosis of TB.

Que. 226. When should a patient receive results of sputum test?

Ans. 226. Within a day.

Que. 227. In daily regimen for treatment of drug sensitive TB, whether extension of Intensive phase (IP) should be done?

Ans. 227. Never (as per NTEP guidelines).

Que. 228. When will you extend continuation phase (CP) in daily regimen for DSTB?

Ans. 228. In daily treatment of DSTB, CP can be extended by 12-24 weeks in CNS TB, Skeletal TB & disseminated TB on clinical decision of treating physician.

Que. 229. Whether all TB patients must undergo HIV testing?

Ans. 229. Yes. It is necessary.

Que. 230. Where will you refer all HIV positive TB patients?

Ans. 230. All HIV positive TB patients, have to be referred to ART Centre for initiation of ART & Anti-TB drugs.

Que. 231. When will you advice sputum smear microscopy to a case of Pulmonary TB?

Ans. 231.  At the end of intensive phase and at the completion of treatment.

Que. 232. When will you provide post treatment follow up after completion of anti-TB treatment?

Ans. 232. At 6, 12, 18 & 24 months.

Que. 233. What do you mean by reverse contact tracing?

Ans. 233. In case of paediatric TB patients, reverse contact tracing is done for search of any active TB case in the household of the child.

Que. 234. What is the population covered by a culture & DST lab?

Ans. 234. 50 lakhs as per the NTEP norms.

Que. 235. On which method, molecular methods of diagnosis are based?

Ans. 235. Polymerase chain reactions & its modifications.

Que. 236. In line probe assay, how many tests can be done in manual format?

Ans. 236. 20 tests per day.

Que. 237. What is the burden of Extra-pulmonary TB?

Ans. 237. It is high, ranging from 15-20% of all TB cases in HIV negative patients.

Que. 238. What is the burden of EPTB in HIV positive patients?

Ans. 238. Accounts for 40-50% of new TB cases.

Que. 239. What is the norm of population coverage by each STLS?

Ans. 239. A population of 5 lakhs.

Que. 240. In which culture & DST method, there is higher chance of contamination?

Ans. 240. In liquid culture & DST method.

Que. 241. Which culture systems have high recovery rate in smear negative specimens?

Ans. 241. MGIT 960 systems.

Que. 242. Which type of testing is Rapid Molecular Drug Sensitive Testing (DRT)?

Ans. 242. Genotypic testing.

Que. 243. Which type of testing is Growth based drug susceptibility testing (DST)?

Ans. 243. Phenotypic testing.

Que. 244. Name the sputum collection sterile container used in NTEP?

Ans. 244. Conical falcon tube (50 ml).

Que. 245. What is the norm of provision of universal drug susceptibility testing (UDST)?

Ans. 245. NTEP is committed to provide UDST to all diagnosed and notified TB patients.

Que. 246. When will you provide travel enablers to DRTB patient & one attendant?

Ans. 246. During pre-treatment evaluation (PTE), initiation of treatment & follow up visits as per NTEP financial guidelines.

Que. 247. Whether mental health should be regularly monitored in patients receiving Cycloserine?

Ans. 247. Yes.

Que. 248. In which category of DR TB will you put a patient having R resistance?

Ans. 248. MDR TB.

Que. 249. How many specimens should be collected at CBNAAT site?

Ans. 249. Two. 1^st specimen for CBNAAT & 2^nd specimen for LPA (First line/second line).

Que. 250. What is the time taken by LPA test to provide results?

Ans. 250. 72 hours.

Que. 251. What type of drug resistance is detected by LPA test?

Ans. 251. 1^st line LPA —— R & H resistance

2^nd line LPA —— Fluoroquinolones & second line injectable drugs resistance.

Que. 252. What is bedaquiline?

Ans. 252. It is a new class of drug belonging to diarylquinoline. It is strong bactericidal. It is highly bound to plasma proteins & is hepatically metabolized. Bedaquiline has shown significant benefits in improving the time to culture conversion in MDR TB patients.

Que. 253. What is the indication of bedaquiline?

Ans. 253. It is indicated in adult MDR TB patients not eligible for the newly recommended shorter regimen.

Que. 254. On which regimen, all lab confirmed MDR/RR TB patients will be initiated?

Ans. 254. On the shorter MDR TB regimen with special precautions in pregnancy & EPTB patients.

Que. 255. Why will you not add formalin to tissue samples for CBNAAT?

Ans. 255. As it will kill tubercular bacilli present in specimen.

Que. 256. In children, which sample specimen will you use for microbiological confirmation by CBNAAT?

Ans. 256. Gastric lavage can be used.

Que. 257. What is contained in one tab of 4 FDC for DSTB patients?

Ans. 257. 75 mg H (INH), 150 mg R (Rifampicin), 400 mg Z (Pyrazinamide) & 275 mg E (Ethambutol).

Que. 258. What is contained in 3 FDC for DSTB patients?

Ans. 258. 75 mg H, 150 mg R & 275 mg E.

Que. 259. What is the role of chest X- Ray in NTEP?

Ans. 259. Chest X-ray is both screening & supportive tool for the diagnosis of smear negative pulmonary TB.

Que. 260. What is the role of tuberculin skin test (TST) in diagnosis of TB?

Ans. 260. TST using standard tuberculin is an adjunct tool in the diagnosis of TB among children.

Que. 261. Why demonstration of AFB in a smear from extra-pulmonary site is often difficult?

Ans. 261. Because of low bacillary load.

Que. 262. Why ethambutol is given separately to children?

Ans. 262. To monitor ophthalmic adverse reaction.

Que. 263. What is the role of TB preventive therapy (TPT)?

Ans. 263. It is given to prevent breakdown of TB infection to TB disease.

Que. 264. What are the characteristics of Latent TB Bacterial Infection (LTBI) cases?

Ans. 264. The characteristics of LTBI cases are as follows –

• LTBI cases cannot spread TB disease to others
• TST & IGRA results are usually positive
• Chest radiographs in LTBI are usually normal.

Que. 265. Which treatment regimen will be given to all new co-infected patients (HIV-TB)?

Ans. 265. Should be initiated on FDC of TLE single pill based regimen irrespective of Haemoglobin level or CD4 count.

Suggested Further Readings –

• Revised National TB Control Program, Technical & Operational guidelines for Tuberculosis control in India, by CTD, MOHFW, GoI, 2016 & 2019.
• Annual TB Report, by CTD, MOHFW, GoI, 2018 & 2019.
• PMDT Guidelines, by CTD, MOHFW, GoI, 2018 & March 2021.