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42 Cards in this Set
- Front
- Back
Which BUMED instruction provides guidelines for a tuberculosis control program of screening, preventive therapy, case identification and treatment, and contact investigation to control tuberculosis amoung members of the Navy, the Marine Corsp, and in other medical beneficiaries?
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BUMEDINST 6224.8 - Tuberculosis Control Program
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How many cases of tuberculosis occur annually in the United States?
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20,000
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How can morbidity and mortality from tuberculosis be reduced?
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By early identification and treatment of persons with tuberculosis disease.
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What is the most sensitive and specific test available for identifying those who are infected with Mycobacterium tuberculosis?
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The tuberculin skin test with purified protein derivative (PPD) administered by the Mantoux method.
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What bacterium causes tuberculosis?
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Mycobacterium tuberculosis
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What preventive therapy is the most effective measure to prevent the development of tuberculosis disease in a newly infected person?
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Isoniazid (INH)
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True or False. Preventive treatment totally eliminates the risk of tuberculosis.
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Fasle. Although preventive treatment reduces the risk of disease, it does not totally eliminate it.
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What term describes that the person has symptoms, signs, radiographic, or laboratory evidence of pulmonary, meningeal, miliary, or extrapulmonary tuberculosis?
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Active Disease
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What term describes that the person has no symptoms, signs, or radiographic evidence of active disease, but does have evidence of infection, as indicated by the presence of a positive tuberculin skin test?
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Tuberculosis infection
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True or False. For the purposes of the Tuberculosis Control Program, all individuals who have a positive tuberculin skin test are considered to have a tuberculosis infection.
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True.
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What method described a tuberculin skin test using a syring and needle to inject purified protein derivative (PPD) of tuberculin?
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Mantoux method
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What term described an area around the site of tuberculin injection that is raised and firm to the touch?
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Induration
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What term described a person with an area of induraton to a 5 TU tuberculin skin test when read 48 to 72 hours after administration?
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Tuberculin reactor
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What term describes a person with an area of induration of less than 5 mm to a 5 TU tuberculin skin test?
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Tuberculin non reactor
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What vaccines are made from live attenuated mycobacteria strains are commonly used in some countries in an attempt to prevent vaccines from becoming infected with tuberculosis?
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BCG (Bacillus Calmette-Guerin) vaccines
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What city and state is NAVENPVNTMEDU TWO in?
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Norfolk, VA
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What city and state is NAVENPVNTMEDU FIVE in?
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San Diego, CA
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What city and state is NAVENPVNTMEDU SIX in?
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Pearl Harbor, HI
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What city and state is NAVENPVNTMEDU SEVEN in?
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Naples, Italy
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What is the only approved tuberculin skin test material for the Mantoux test?
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The premixed Tween-80-stabilized intermediate strength PPD (5 TU equivalent).
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Why are multiple-puncture tuberculin tests (e.g., Tine or Monovac tests) not used except on the specific reccomendation of the area NAVENPVNTMEDU?
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They produce significant numbers of both false-positive and false-negative test results.
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What type of syring and needle is used for the administration of a Mantoux test?
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A disposable 1 ml tuberculin syring graduated in 0.1 ml intervals and fitted with a 25-guage 5/8 inch needle.
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What aspect of the forearm is the intradermal injection made?
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Volar
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How many hours after administration of a tuberculin skin test must it be examined?
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48 to 72 hours
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Who must read the tuberculin skin test?
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An MDR who is both trained and experienced in reading and interpreting tuberculin skin tests.
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How is the induration measured?
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In millimeters at its widest transverse diameter (across the arm).
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Where is the test result entered in the medical treatment record?
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SF 601 under SENSITIVITY TESTS
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How must the test result be entered in the medical record?
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Date, type of tuberculin and its strength, and the diameter of induration in millimeters, written by hand; do not use rubber stamps or automatic imprinting devices.
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How must the complete absence of induration be entered on the SF 601?
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"zero mm."
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What must be done if a person returns more than 72 hours after PPD application and the induration is zero to 14 mm?
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Make an entry of "not read" on the SF 601. Immediately aply a PPD test on the opposite arm.
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What must be done if a person returns more than 72 hours, (but before or on the 10th day), after PPD application and the induration is 15 mm or greater?
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The reaction is significant. Enter the induration and the time interval since test application on the SF 601. Manage the person as a tuberculin reactor per Evaluation and Preventive Therapy (Chemoprophylaxis) of Tuberculin Reactors.
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What must be done if a person returns more than 10 days after PPD application?
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Make an entry of "not read" on the SF 601 regardless of the size of any induration. Immediately apply a PPD test on the opposite arm.
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True or False. Do not under any circumstances report a skin test result as "zero mm" if the test was not read by a qualified MDR.
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True
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What medical conditions have been reported to increase the risk of tuberculosis?
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Silicosis, gastrectomy, jejeunoileal bypass, weight of 10 percent or more below ideal body weight, chronic renal failure, conditions requiring prolonged high-dose corticosteroid therapy or other immunosuppressive therapy, some hematologic disorders (e.g., leukemia and lymphomas) and other malignancies.
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What is the antibiotic regimen of choice for tuberculosis preventive therapy?
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INH in an oral daily dose of 300 mg for adults and 10 mg/kg (not to exceed 300 mg) for children.
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How long should tuberculin reactors with no risk factors for the development of tuberculosis disease receive INH therapy?
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6 months of continuous therapy with INH
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How long should tuberculin reactors with HIV infection and persons with stable abnormal chest radiographs consistent with past tuberculosis receive INH therapy?
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12 months of continuous therapy with INH
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What are contraindications to preventive therapy with INH?
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Previous history of INH-associated liver injury, history of a severe adverse reaction to INH, and acute or active liver disease of any etiology.
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True or False. Baseline liver function tests are not required for INH recipients under age 35.
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True, but they should be done if clinically indicated.
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What actions must be taken upon discovery of an active case of tuberculosis disease in the command?
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Initiate Disease Alert Report (MED 6220-3). Locate patient's close contacts. Screen contacts and screen again 3 months later. Maintain records of summary results. Clinically evaluate possible secondary cases for tuberculosis disease.
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Which hospitals are designated to act as contact points for pulmonary medicine or infectious disease consultation and patient transfer if needed?
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NAVHOSP Oakland,CA; NAVHOSP Portsmouth, VA; NAVHOSP San Diego, CA; and NAVHOSP Bethesda, MD.
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How is tuberculosis transmitted?
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By small airborne droplets or droplet nuclei from person to person in close contact or possibly through ventilation systems, such as on ships.
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