What is it?
CONTACT INVESTIGATION
IMMIGRATION CLEARANCE
TB STUFF
Miscellaneous
100
Where is the abnormality in this image?
Right upper lobe
100
Name 3 factors for assigning a TB contact a high, medium, or low priority?
Index case factors: smear status, CXR status, drug resistance Contact factors: Age(less than 5), Immune status Environmental factors: indoor, car, ventilation. Intensity and Duration of exposure
100
What is the difference between class A TB and class B TB? Can you describe class B1, B2, and B3?
Class A TB is for immigrants with known active TB Class B1 TB pulmonary-no treatment or completed treatment Class B1 TB extra pulmonary Class B2 TB LTBI evaluation Class B3 TB contact evaluation
100
What does PAN sensitive/ susceptible TB mean and what usually happens when a patient is PAN sensitive
Pan-susceptible TB' is defined as TB caused by Mycobacterium tuberculosis (M. tuberculosis) strains that are susceptible to all first-line anti-TB drugs. In a normal case of PAN susceptible TB, the Ethambutol is discontinued, followed by Pyrazinamide after 60 doses (2 months) well tolerated without any missed doses.
100
Can sputum smear positive patients take public transportation to their appointments? Why or why not?
Typically not advised, because they are considered infectious and there is a risk of exposing other people to TB. It is also impossible to monitor patient compliance with isolation requirements while in public transportation. This is an enclosed vehicle and the driver should be wearing a mask per guidelines.
200
What is the problem in this picture?
Ethambutol is supposed to be 1600mg daily (4 tabs) but there are only 3 tabs (1200mg) in the pill box
200
True or false- A medium priority contact should have a QFT arranged by CDI within 10 working days
False, within 7 working days
200
What is the name of the CDC's system for alerting local health districts of TB immigration clients?
EDN, Electronic Disease Notification
200
What are the differences between the treatment for active TB versus Latent TB? Mention duration, medications used, adult versus child etc.
Active TB treatment duration is minimum of 6 months, could be longer depending on special circumstances such as resistance. Latent TB treatment varies: INH for 9 months, RIF for 4 months, INH & rifapentine for 12 wks.
200
What should you do if you were exposed to an infectious patient?
First, do not panic, keep calm. Inform your immediate supervisor right away and follow the necessary protocol for testing through Employee Health.
300
What is wrong in this picture?
Both patient and provider are not wearing their masks correctly
300
When interviewing a client, name at least 4 effective communication skills per CI skills course
Active listening Using appropriate nonverbal communication Using appropriate voice and tone Communicating at the case's level of understanding Giving factual information using reinforcement Summarizing important points from the conversation
300
True/False- Children under 10 y/o who receive a CXR should have both a posterior/anterior and lateral view ( this is specific for immigration clearance)?
True
300
Can we force active TB patients to take TB medicine? What happens if they refuse?
We cannot force them. However, we can enforce a health officer order to make them comply with the TB treatment guidelines. The patients who refuse could also be arrested and put in isolation if considered infectious and a threat to the society.
300
If a patient cannot swallow the TB pills, what other alternatives can be offered?
Cut in half, crush, crumble, or get order for suspension if appropriate
400
What is happening here?
CDI tracking down a contact
400
A contacts last exposure was on February 1st,which date can second round testing begin?
March 29, 8 weeks from last exposure
400
If an immigration patient does respond to initial letter, how long should CDI wait to send final notice?
10 business days
400
Can we force TB contacts to take preventive medicine for TB?
No we cannot force them. However, we are expected to provide extensive education regarding the benefits of preventive medicine and the risk for TB disease. CDIs are also expected to contact their PCPs regarding this as necessary.
400
When is a TB patient/contact considered lost to follow- up? What happens after?
A patient is considered lost to follow- up when all feasible efforts have been made to find patient to no avail. If patient is an active TB case, inform TB controller, the state, and the quarantine station at SF (if appropriate). If the patient is a contact, document appropriately and consult with supervisor and TB controller.
500
How do you know you have booked the wrong flight?
Your plane is in isolation.
500
A 5 y/o was exposed to TB at a day care by a 9 y/o index case who is smear neg/CXR abnormal non-cavitary. What priority (high/med/low) would you give the 5 y/o contact?
Low, 9 y/o not usually infectious
500
If immigrant has not completed TB evaluation and states they will be out of country for 6 months, what should CDI tell them?
Good bye and good luck, your case is closed
500
What is an Health Officer order? List possible scenarios where it could be used?
If an health officer determines that the public health or the health of any other person is endangered by a case of tuberculosis, or a suspected case of tuberculosis the health officer may issue any orders he or she deems necessary to protect the public health or the health of any other person, and may make application to a court for enforcement of such orders. Possible scenarios include those of Homelessness, Non compliance, mental illness
500
What is the rationale behind giving incentives to patients?
We offer incentives to increase the rate of compliance to treatment. Also, to assist them financially. When patients are happy, everyone is happy:-)
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