TUBERCULOSIS

BY: ARUN MANGATTU

 Tuberculin/PPD
• Tuberculin: Purified protein derivative
replaces the antigen old tuberculin
• Discovered by Von Pirquet ( 1907)
• Standard PPD-50,000 TU per mg
• One TU- .00002 mg PPD
• WHO advocates PPD –RT-23 with Tween 80
• Dosage : 1 TU, 5 TU, 250 TU
 Tuberculin test conversion
• An increase of 10 mm or more within a 2 year
period regardless of age
• Tuberculin test in use
Mantoux intradermal test : More precise test for
tuberculin sensitivity
Heaf test: Quick, easy, reliable, and cheaply,
preferred for testing large populations
Tine multiple puncture test: Unreliable, not
recommended
 Mantoux test
• Has limited validity due to lack of specificity
• 1 TU of PPD in 0.1 ml injected intradermally on
forearm
• Result read after 72 hours
Only indurations is measured
• >9 mm- Positive
• 6-9 mm-Doubtful
• <6 mm- Negative
• Percentage of Mantoux positive test in Indian if 20-40
years age group is 20-40 %
 Mentorship
1) The main virulence factor in TB pathogenesis
is:
A ) Bacteria's ability to survive inside the bronchi
B) Bacteria's ability to destroy the macrophage
C ) Bacteria's ability to destroy the pulmonary
tissue
D ) Bacteria's ability to survive inside the
macrophage
2) Cold abscess is present in:
A) Primary TB
B)Secondary TB
C)Not found in TB
D)Both A & B
3) Which of the following is true about primary
TB:
A )Symptomatic
B ) Localized
C ) Occurs in people who infected before
D) Has the ability to spread
4) GHON focus is generally located in:
A) upper part of the lower lobe
B) lower part of the upper lobe.
C) upper part of upper lobe
D) A and B
5) All the following are commonly used
epidemiological indices in TB except
A)Annual infection rate
B)Case rate
C)Incidence of new cases
D)X-Ray positivity rates
6) The most appropriate test to assess the
prevalence of tuberculosis infection in a
community is
• A) Sputum examination
• B) Mass miniature radiography
• C) Tuberculin test
• D) Clinical examination
7) The percentage of positive mantoux test in
Indian if 20-40 years age group is
• A) < 5%
• B)5-10%
• C) 20-30%
• D) > 50 %
8) The overall prevalence of TB infection in India
as per fourth round longitudinal survey was
• A) 20 %
• B) 30 %
• C) 40 %
• D) 50 %
• 9) Decrease in which of the following
parameters indicate the decrease in
tuberculosis problem in India
• A) Incidence of infection
• B) Prevalence of infection
• C) Incidence of disease
• D) Prevalence of disease
• 10) True about tuberculosis
• A) > 10 4 Bacilli are required for sputum
detection
• B) Monteux test can differentiate between
BCG and infection
• C) Can be grown on ordinary culture medium
• D) Drug sensitivity is tested by Schick test
• 11) One of the following is is known as
Tuberculin convesion index
• A) Incidence of infection
• B) Prevalence of infection
• C) Incidence of disease
• D) Prevalence of disease
• 12) Incidence of TB in a community is
measured by
A)Sputum smear+
B)Tuberculin test +
C)Sputum culture
D)Mantoux test
13) Which of the following is not false about
annual risk of TB
• A) It represents new cases of TB
• B) It is assessed by tuberculin conversion in
previously non vaccinated children
• C) ARI of 1%-75 new cases
• D) Current ARI in India is 1.7 %
14) McKewown’s theory states that reduced
prevalence of TB occurs due to
• A) Enhanced knowledge and awareness
• B) Medical advancement
• C) Behavior modification
• D) Social and environmental factors
15) Population of a village on 1st June 2021 is
16,500 , since 1st January 2021, 22 new cases
of TB were detected. Total registered cases
were 220. What is the incidence of TB
• A) 133 per 100,000
• B) 121 per 100,000
• C) 111 per 100,000
• D) 100 per 100,000
16) Decrease in which of the following
parameters indicate the disease in
tuberculosis problem in India
• A) Incidence of Infection
• B) Prevalence of infection
• C) Incidence of disease
• D) Prevalence of disease
17) Tuberculin test denotes
• A) Patients resistance to tuberculosis
• B) Previous or present sensitivity to tubercle
proteins
• C) Person is susceptible to tuberculosis
• D) Protective immune status of individual
against tuberculosis
• 18) World TB day theme 2022 was
• A) The clock is ticking
• B) Invest to end TB. Save Lives
• C)  It's time for action! It's time to End TB.  
• D) "It's time to End TB!"
• 19) India accounts for nearly____ of the
global incidence of TB
• A) 50%
• B) 25 %
• C) 20 %
• D) 33 %
World Health Organization’s 2022 Global TB
report.
• Around 10.6 million people across the world
were diagnosed with tuberculosis (TB) in 2021,
an increase of 4.5% from 2020
• 1.6 million patients died of the bacterial disease
• India accounts for 28% of 10.6 million TB cases
in 2021
20) Mycobacterium tuberculosis is a
a)Gram negative, non motile , acid fast bacilli
b)Gram positive , motile , acid fast bacilli
c) Gram positive , non motile , acid fast bacilli
d)Gram negative, ,motile, acid fast bacilli
• 21) Which of the following is a gold standard
for diagnosing TB
• A) Chest X-ray
• B) Blood culture
• C) Sputum culture
• D) Mantoux tes t
• 22) Mantoux test produces a positive reaction
after how many weeks of initial infection
• A) 2-10 weeks of initial infection
• B) 1 week
• C) 1-3 weeks
• D) Immediately after initial infection by
mycobacterium tuberculosis
• 23) A patient needs an intradermal injefction
for Mantoux test , but he currently has
bilateral forearm casts in place. Which of the
following would be the best alternative site
• A) Abdomen
• B) Lateral upper arm
• C) Medial upper arm
• D) Antecubital space
24) The first person who discovered
Mycobacterium tuberculosis was
(a) Louis Pasteur
(b) Robert Koch
(c) Edward Jenner
(d) None of the above
25) Which of these is the culture medium for
Mycobacterium tuberculosis?
• (a) Wilson blair medium
• (b) Löwenstein–Jensen medium
• (c) Mac Conkey’s medium
• (d) None of the above
26) This is the reason why diagnosing
tuberculosis is turning challenging
• (a) disease takes years to become active
• (b) symptoms are irregular, they appear and
then vanish
• (c) symptoms are not very obvious and
prominent always
• (d) both (b) and (c)
27) Diagnosis of tuberculosis is done by
• (a) Emulator and antiformin method
• (b) Concentration method
• (c) Petroff’s method
• (d) All of the above
28) Which of the following diagnostics tests is
intended for latent tuberculosis infection?
• a) Sputum smear microscopy
•  b) Polymerase chain reaction (PCR)
•  c) Interferon-gamma release assay (lGRA)
•  d) ELISAfor TB antibodies
• Interferon-gamma release assays (e.g., TB
Gold) are meant for the diagnosis of latent TB
infection.
• A 2011 World Health Organization (WHO)
policy discourages their use for active TB
diagnosis.
29) Which of the following tests are banned by
the government of India?
•  a) Sputum smear microscopy
•  b) Polymerase chain reaction (PCR)
•  c) Interferon-gamma release assay (lGRA)
•  d) Serological (antibody) TB tests
• The Indian Government has banned the use, sale
and import of all commercial serological
(antibody-detection) TB tests.
• This includes ELISA as well as rapid antibody tests.
• The ban applies to domestic as well as imported
serodiagnostics kits.
• The ban is based on a WHO policy that strongly
recommends against the use of serological,
antibody tests for TB.
• The International Standards for TB Care also
discourages the use of serological TB tests.
30) Advantages of culture for TB compared to
sputum microscopy alone include all of the
following EXCEPT:
•  a) Obtaining a positive culture can allow for
drug-susceptibility testing
•  b) Culture can allow for identification of non-
tuberculous mycobacterium species
•  c) Culture has a higher sensitivity than smear
microscopy for diagnosing TB
•  d) Culture, particularly by liquid media, can be
faster than smear microscopy
• Culture is not faster than smear microscopy
because even liquid culture needs 10 -14 days
for a result to be obtained.
• Sputum smear results are usually available
within 1-2 days.
• 31) Which of the following statements is FALSE
about chest X-rays for TB diagnosis:
•  a) Chest X-rays have good sensitivity, but poor
specificity
•  b) Chest X-rays can help determine the severity of
lung damage
•  c) Chest X-rays alone is sufficient to diagnose
pulmonary TB
•  d) Chest X-rays can look similar in patients with
old, inactive TB and those with currently active TB
disease
•  Chest X-rays alone is NOT sufficient to
diagnose pulmonary TB) It needs to be
followed by sputum testing.
• While chest X-rays have fairly high sensitivity
for pulmonary TB, its specificity is low. Many
lung conditions and infections can cause chest
X-ray abnormalities.
• So, all patients with chest X-ray abnormalities
must be investigated with sputum smears,
NAAT and/or culture.
• 32) What is the ideal location for sputum
collection?
•  a) Inside the doctor's clinic
•  b) Inside the laboratory
•  c) Outdoors or in a well ventilated area
•  d) The patient's bathroom with the door
closed
• Sputum expectoration can release infectious
aerosols, which are diluted in the open-air or
a well ventilated room and are inactivated by
UV light in the outdoors
• 33) Which of the following tests requires a
blood sample for the diagnosis of active
pulmonary TB?
•  a) Sputum smear microscopy
•  b) Liquid culture
•  c) Interferon-gamma release assay (IGRA)
•  d) None of the above
• There is no approved blood test for the
diagnosis of active pulmonary TB) IGRAs are
tested on blood but only give information on
latent TB infection, not active disease.
• 34) Which of the following constitutes a good
sample for sputum microscopy?
•  a) 5 ml of muco-purulent sputum
•  b) 5 ml of clear saliva
•  c) 2 ml of sputum in a washed food container
•  d) All of the above
• Sputum quality and quantity are essential
features of a good specimen for TB testing.
• Five ml of muco-purulent specimen collected
in a sterile laboratory approved container is
the ideal specimen for sputum microscopy for
TB
• 35) For a two year old child with suspected TB,
the best clinical specimen for pulmonary TB
diagnosis is:
•  a) Blood
•  b) Sputum
•  c) Gastric aspirate
•  d) Bronchoalveolar lavage (BAL)
• Young children cannot expectorate sputum
but it is often swallowed overnight. The best
specimen is, therefore, a series of two to
three consecutive, fasting gastric aspirates.
• 36) What is the minimum recommended
number and timing of specimens for the
diagnosis of pulmonary TB?
•  a) Three early morning sputum specimens
•  b) Two sputum specimens collected one
hour apart
•  c) Three sputum specimens taken on the
same day
•  d) One early morning sputum plus one blood
sample
• The minimum requirement for sputum testing
is two specimens taken one hour apart.
Previously three consecutive early morning
sputum samples were recommended but
research has shown that the 3rd sample does
not add much to the overall yield (and can
increase the risk of patient drop-out).
• 37) Which of the following specimens should
be rejected by the culture laboratory?
•  a) An unlabeled sputum specimen
•  b) A lymph node received in fixative
•  c) A specimen received without a request
form
•  d) All of the above
• Specimens that are unlabeled or do not have a
properly filled out form, are rejected by the
laboratory. Fixatives, such as formalin, will
inactivate any micro-organisms in a tissue
sample, therefore, making it unsuitable for
culture.
• 38) In a woman with infertility, suspected to
have genito-urinary TB, which of the following
specimens is important for diagnosis?
•  a) Venous blood
•  b) Menstrual blood
•  c) Endometrial tissue
•  d) Sputum
•  Endometrial issue for culture and
histopathology is critical for diagnosing
genito-urinary tract TB) Blood (venous or
menstrual) is not the appropriate sample as it
is very difficult to isolate M. tuberculosis or
detect MTB DNA in such samples.
• 39) Which of these statements is NOT true
about chest radiology for TB diagnosis?
•  a) Chest x-rays are highly specific for TB
•  b) All persons with radiographic abnormalities
suggestive of TB should have sputum specimens
submitted for microbiological examination
•  c) Treatment of TB purely on the basis of x-rays
can result in significant over-treatment
•  d) HIV infection can alter the radiological
appearance of TB
• Chest x-rays are not specific for TB) Many lung
infections and conditions can cause
radiological abnormalities.
• This is why all persons with radiographic
abnormalities suggestive of TB should have
sputum specimens submitted for
microbiological examination.
• Only microbiological examination can confirm
the diagnosis of TB).
40) The commonest radiologic finding in TB is:
•  a) Pleural effusion
•  b) Upper lobe consolidation with or without
cavities
•  c) Pericardial effusion
•  d) Lung nodule
•  Although TB can cause any of the radiologic
findings listed, upper lobe disease with or
without cavitation is the most common.
• 41) A patient presents with a 10 day history of high
fever, cough and purulent sputum. A CXR shows a
dense consolidation in the RUL. The next step is:
•  a) Obtain sputum specimens for AFB and start TB
treatment
•  b) Start a course of moxifloxacin
•  c) Obtain sputum specimens for AFB and
culture/sensitivity examination and start
azithromycin
•  d) Refer the patient to a TB hospital
•  CXR’s must be interpreted in the clinical
context.
• An acute presentation suggests acute
bacterial infection.
• Sputum specimens should be obtained before
starting conventional antibiotics.
Fluoroquinolones should be avoided if TB is at
all suspected as they will result in temporary
improvement because TB is sensitive to this
class of drugs, leading to delay in diagnosis.
• 42) A 55 year old 40 pack year smoker consults
with you for a 2 month history of cough and
blood tinged sputum (no fever). He reports that
his sister had TB 10 years ago. The CXR shows a
cavitary mass in the RUL. What is the next
step?
•  a) Obtain sputum AFB
•  b) Send sputum for cytology
•  c) Send patient for a bronchoscopy
•  d) Start treatment with an antibiotic
• Although TB must be suspected in anyone
with an upper lobe cavitary mass, in a heavy
smoker with a 2 month history of cough and
bloody sputum, in the absence of infectious
symptoms, lung cancer must be suspected) A
bronchoscopy can obtain specimens for AFB
but at the same time, can make the diagnosis
of cancer.
• 43) Langhans giant cells seen in
• A) TB
• B) leprosy
• C) sarcoidosis
• D) All the above
• 44) The causative of Tuberculosis produces
Tuberculin, it is a/an
(a) enzyme
(b) hormone
(c) endotoxin
(d) exotoxin
• 45) CBNAAT machines are used to detect
a. Drug Resistant Dengue
b. Drug Resistant TB
c. Zika Fever
d. Chikungunya
 46) At which place the disease Tuberculosis was
discovered?
• A. The Institute of hygiene, Berlin
B. University of British Columbia
C. California Institute of technology
D. At Geneva, Switzerland
47) What are the symptoms of the people
suffering from latent tuberculosis infection?
• A. Have no symptoms
B. Patient feel sick
C. Spread TB bacteria to others
D. Patients have a negative TB blood test.
• 48) The gold standard test for identification
and sensitivity is:
• A) Specimens
• B ) Direct microscopy of specimen
• C) Culture
• D) None of these
49) Which of the following is the classical CSF
finding seen in Tuberculous meningitis?
A. Increased protein, decreased sugar,
increased lymphocytes
B. Increased protein, sugar and lymphocytes
C. Decreased protein, increased sugar and
lymphocytes
D. Increased sugar, protein and neutrophils
• Correct answer : A. Increased protein,
decreased sugar, increased lymphocytes
50) The most common cause of tubal block in
lndia is
A. Gonorrhea infection
B. Chlamydia infection
C. Tuberculosis
D. Bacterial vaginosis