Download National Tuberculosis Control Program Ultimate Exam and more Exams Technology in PDF only on Docsity!
Program Ultimate Exam
Question 1. Which component of the Mycobacterium tuberculosis cell wall is primarily responsible for its acid-fast staining property? A) Peptidoglycan B) Mycolic acids C) Lipoarabinomannan D) Arabinogalactan Answer: B Explanation: Mycolic acids are long fatty acids that confer the high lipid content of the cell wall, making the bacilli retain carbol-fuchsin dye after acid-alcohol decolorization (acid-fast). Question 2. The primary mode of transmission of Mycobacterium tuberculosis is: A) Direct skin contact B) Ingestion of contaminated milk C) Inhalation of droplet nuclei ≤5 μm D) Blood transfusion Answer: C Explanation: TB spreads when infected individuals expel droplet nuclei that remain suspended and are inhaled by susceptible persons. Question 3. Which of the following best describes a latent TB infection (LTBI)? A) Active disease with positive sputum smear B) Presence of viable bacilli without clinical symptoms or radiographic lesions C) Tuberculous meningitis D) Multidrug-resistant disease
Program Ultimate Exam
Answer: B Explanation: LTBI indicates that the host harbors viable Mycobacterium tuberculosis but shows no signs or symptoms; it can reactivate later. Question 4. The first major policy shift that transformed India’s TB control from a vertical program to a public-private partnership model was: A) Launch of NTP in 1962 B) Introduction of RNTCP in 1997 C) Adoption of DOTS in 1993 D) Initiation of NTEP in 2020 Answer: C Explanation: The Directly Observed Treatment, Short-course (DOTS) strategy introduced in 1993 marked the shift toward a standardized, partnership-based approach. Question 5. According to the WHO End TB Strategy, which of the following is NOT one of the three pillars? A) Integrated, patient-centered care and prevention B) Bold policies and supportive systems C) Intensified research and innovation D) Universal health coverage for all diseases Answer: D Explanation: The three pillars are (1) patient-centered care and prevention, (2) policies and systems, and (3) research and innovation; universal health coverage is a broader health goal. Question 6. In the National Strategic Plan (NSP) 2025-2027, the target for the Treatment Success Rate (TSR) for drug-sensitive TB is: A) ≥75 %
Program Ultimate Exam
Question 9. Which of the following groups is NOT considered a high-risk population for TB screening under the NTEP? A) Persons living with HIV B) Household contacts of confirmed TB cases C) School teachers without known exposure D) Individuals with uncontrolled diabetes mellitus Answer: C Explanation: Teachers without known exposure are not automatically high-risk; the other groups have documented increased susceptibility. Question 10. The GeneXpert MTB/RIF assay provides results for: A) Only sputum smear microscopy B) Detection of Mycobacterium tuberculosis and rifampicin resistance within 2 hours C) Full drug susceptibility profile for all first-line drugs D) Quantitative bacterial load measurement Answer: B Explanation: GeneXpert is a rapid NAAT that detects MTB DNA and mutations conferring rifampicin resistance. Question 11. Which culture medium is classified as a liquid system for Mycobacterium tuberculosis growth? A) Löwenstein-Jensen (LJ) B) Middlebrook 7H10 agar C) Mycobacterial Growth Indicator Tube (MGIT) D) Stonebrink medium Answer: C
Program Ultimate Exam
Explanation: MGIT is a liquid broth system that reduces time to detection compared with solid media. Question 12. Line Probe Assay (LPA) is primarily used for: A) Detecting Mycobacterium bovis only B. Rapid identification of mutations conferring resistance to first-line drugs (INH, RIF) C. Quantifying bacterial load in sputum D. Determining susceptibility to second-line injectables Answer: B Explanation: LPA detects specific gene mutations associated with resistance to isoniazid and rifampicin, enabling early MDR-TB diagnosis. Question 13. In pediatric TB, which sample collection method is recommended when a child cannot expectorate sputum? A) Bronchoalveolar lavage under general anesthesia B) Induced sputum after hypertonic saline nebulization C. Urine culture D. Stool microscopy Answer: B Explanation: Induced sputum is a safe, non-invasive method to obtain respiratory specimens from children. Question 14. The most common extrapulmonary TB manifestation in immunocompetent adults is: A) Tuberculous meningitis B) Skeletal (Pott’s disease) C) Lymph node TB (cervical)
Program Ultimate Exam
A) Resistance to isoniazid and rifampicin only B) MDR-TB plus resistance to any fluoroquinolone C) MDR-TB plus resistance to any second-line injectable D) MDR-TB plus resistance to both a fluoroquinolone and a second-line injectable Answer: B Explanation: Pre-XDR-TB is MDR-TB with additional resistance to at least one fluoroquinolone, but not yet to a second-line injectable. Question 18. The BPaLM regimen for MDR-TB includes all of the following drugs EXCEPT: A) Bedaquiline B) Pretomanid C) Linezolid D) Ethambutol Answer: D Explanation: BPaLM consists of Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin; Ethambutol is not part of this regimen. Question 19. Which adverse drug reaction is most commonly associated with linezolid in the BPaLM regimen? A) Ototoxicity B) Peripheral neuropathy C) Visual disturbances D) Hyperuricemia Answer: B Explanation: Linezolid can cause peripheral neuropathy and myelosuppression; neuropathy is a frequent dose-limiting toxicity.
Program Ultimate Exam
Question 20. The DOTS strategy emphasizes which of the following components? A) Self-administered therapy without supervision B) Direct observation of each dose by a trained provider C) Use of injectable drugs for all cases D) Treatment only in tertiary hospitals Answer: B Explanation: DOTS requires that a health worker or trained individual observes the patient taking each dose to ensure adherence. Question 21. Digital adherence tools (DATs) such as 99DOTS primarily aim to: A) Replace all in-person DOT visits B) Provide real-time adherence data through SMS or mobile apps C. Deliver anti-TB drugs directly to homes D. Perform remote radiographic interpretation Answer: B Explanation: DATs capture patient-reported dose intake via mobile technology, allowing program managers to monitor adherence remotely. Question 22. The Ni-kshay portal is used for: A) Ordering BCG vaccine stocks only B) Real-time case notification, treatment monitoring, and reporting in the NTEP C. Conducting tele-consultations for TB patients D. Managing only drug-resistant TB data
Program Ultimate Exam
C. Only for patients on second-line TB drugs D. Only for children under 5 years Answer: B Explanation: CPT reduces opportunistic infections in HIV-positive individuals with CD4 ≤ 350 or clinical stage III/IV. Question 26. Bidirectional screening for diabetes mellitus (DM) and TB is recommended because: A) TB drugs cure diabetes B) Diabetes increases the risk of developing active TB and TB can worsen glycemic control C. Diabetes patients are immune to TB D. Screening is mandatory only for research purposes Answer: B Explanation: DM triples the risk of TB and TB infection can destabilize blood glucose, justifying mutual screening. Question 27. Which of the following lifestyle factors most strongly predicts poor TB treatment outcomes? A) Regular physical exercise B) Tobacco smoking C. High protein diet D. Daily consumption of citrus fruits Answer: B Explanation: Smoking impairs immune response and is associated with higher rates of treatment failure and relapse.
Program Ultimate Exam
Question 28. The 6H regimen for TB preventive treatment (TPT) consists of: A) Six months of daily isoniazid B) Six weeks of daily rifampicin C. Three months of weekly isoniazid-rifapentine D. Six months of daily ethambutol Answer: A Explanation: 6H is a standard TPT regimen delivering isoniazid 300 mg daily for six months. Question 29. The newer short-course TPT regimen 3HP includes: A) Three months of daily isoniazid and pyrazinamide B) Three months of weekly isoniazid plus rifapentine C. Three weeks of daily rifampicin only D. Three months of daily levofloxacin Answer: B Explanation: 3HP delivers isoniazid (15 mg/kg) and rifapentine (10 mg/kg) once weekly for 12 doses over 3 months. Question 30. Ni-kshay Poshan Yojana provides: A) Free diagnostic X-ray for all TB patients B) Monthly financial assistance of INR 500 for nutritional support during treatment C. Direct cash transfer to private hospitals only D. Housing loans for TB-affected families Answer: B Explanation: Poshan Yojana offers INR 500 per month to eligible TB patients to improve nutrition and adherence.
Program Ultimate Exam
Explanation: TSR includes both cured patients and those who completed treatment without bacteriological confirmation. Question 34. In the NTEP, a “lost to follow-up” (LTFU) case is defined as: A) Patient who dies during treatment B. Patient who interrupts treatment for ≥2 months and is not found after tracing C. Patient who completes treatment but is not evaluated for cure D. Patient who transfers to another district without notification Answer: B Explanation: LTFU refers to treatment interruption of ≥2 months with unsuccessful tracing. Question 35. Which of the following is the most appropriate first-line regimen for a newly diagnosed child (weight 12 kg) with drug-sensitive pulmonary TB? A) HRZE for 2 months, then HR for 4 months, using pediatric FDCs per weight band B. HRZE for 6 months continuously C. HRE for 2 months, then HR for 4 months D. Only rifampicin and isoniazid for 6 months Answer: A Explanation: Pediatric dosing follows weight-band FDCs with a 2-month intensive phase (HRZE) followed by 4 months continuation (HR). Question 36. Which diagnostic algorithm is recommended for a presumptive TB patient who is HIV-positive and unable to produce sputum? A) Chest X-ray only B. Urine LAM assay plus GeneXpert on any available specimen
Program Ultimate Exam
C. Sputum smear microscopy after induction D. No testing; start empirical treatment Answer: B Explanation: Urine lipoarabinomannan (LAM) is highly sensitive in HIV-positive patients with low CD4, and GeneXpert can be performed on alternative specimens. Question 37. The principal advantage of fluorescence microscopy over Ziehl-Neelsen staining is: A) Ability to detect drug resistance B. Higher sensitivity and faster reading time C. No need for a microscope D. It can differentiate Mycobacterium species Answer: B Explanation: Fluorescence microscopy (LED-FM) increases detection sensitivity by ~10 % and reduces slide-reading time. Question 38. In the management of TB meningitis, which drug is essential because it penetrates the cerebrospinal fluid (CSF) well? A) Ethambutol B) Isoniazid C. Streptomycin D. Pyrazinamide Answer: B Explanation: Isoniazid achieves therapeutic concentrations in CSF, making it a cornerstone of TB meningitis therapy.
Program Ultimate Exam
Answer: B Explanation: WHO defines “cured” as having two negative bacteriological results in the final month and the preceding month. Question 42. In the context of TB surveillance, a “cluster” refers to: A) A group of patients with identical drug susceptibility patterns identified within a defined time-space window B. All TB cases reported in a calendar year C. Patients who have completed treatment successfully D. A set of laboratory reagents used together Answer: A Explanation: Clusters indicate possible transmission events and are investigated for outbreak control. Question 43. Which of the following is an indicator used to monitor the performance of the TB program’s contact investigation? A) Percentage of household contacts screened within 6 weeks of index case notification B. Number of GeneXpert machines installed per district C. Average time taken to process a culture report D. Ratio of private to public sector TB notifications Answer: A Explanation: Timely screening of contacts is a key metric for active case finding and prevention. Question 44. The “DOT” component of DOTS can be satisfactorily performed by which of the following? A) Only a qualified physician
Program Ultimate Exam
B. Any trained community volunteer, family member, or health worker who directly observes dose intake C. The patient alone, as long as a video is recorded D. Only a pharmacist at a registered pharmacy Answer: B Explanation: DOT allows flexibility; any trained individual can observe the patient taking medication. Question 45. Which pharmacokinetic property of rifampicin necessitates daily dosing rather than weekly dosing? A) Very long half-life (>48 h) B. Induction of hepatic enzymes leading to decreased levels with intermittent dosing C. Poor oral absorption D. High renal excretion Answer: B Explanation: Rifampicin induces hepatic enzymes, causing sub-therapeutic levels if given intermittently; daily dosing maintains effective concentrations. Question 46. In a patient receiving bedaquiline as part of the BPaLM regimen, which cardiac monitoring is essential? A) Baseline and monthly ECG for QTc prolongation B. Daily blood pressure measurement C. Weekly liver function tests only D. No monitoring required as bedaquiline is cardioprotective Answer: A Explanation: Bedaquiline can cause QTc prolongation; ECG monitoring is mandatory.
Program Ultimate Exam
Answer: C Explanation: DOTS-Plus was introduced to provide standardized care for multidrug-resistant TB. Question 50. Which laboratory test is most suitable for monitoring treatment response in a patient with extrapulmonary lymph node TB? A) Serial sputum smear microscopy B. Fine-needle aspiration cytology (FNAC) with GeneXpert on the aspirate C. Urine culture D. Serum erythrocyte sedimentation rate (ESR) alone Answer: B Explanation: FNAC provides tissue for bacteriological confirmation and can be used with GeneXpert to assess response. Question 51. The term “catastrophic health expenditure” in TB patients refers to: A) Any out-of-pocket spending on TB drugs B. Expenditure exceeding 10 % of household’s total consumption or 40 % of non-food expenditure C. Costs covered entirely by the government D. Spending on complementary and alternative medicine only Answer: B Explanation: WHO defines catastrophic health expenditure as spending that exceeds these thresholds, leading to financial hardship. Question 52. Which of the following is the correct order of steps for sputum sample collection under the NTEP guidelines? A) Instruct patient to cough deep, collect first specimen in the morning, label, and transport within 24 h
Program Ultimate Exam
B. Collect sputum at any time of day, no labeling required C. Only collect after bronchoscopy D. Collect only if the patient has a fever Answer: A Explanation: Early morning sputum yields higher bacillary load, proper labeling and timely transport are essential for accurate results. Question 53. In the NTEP, “Programmatic Management of Drug-Resistant TB (PMDT)” includes which of the following activities? A) Only providing second-line drugs without monitoring B. Comprehensive care: DST, individualized regimen, ADR monitoring, and adherence support C. Treating all DR-TB patients with the same fixed-dose regimen D. Referring all DR-TB cases to tertiary centers only Answer: B Explanation: PMDT is a holistic approach encompassing diagnosis, treatment, monitoring, and support for DR-TB. Question 54. Which factor is considered a major barrier to TB case detection in the private sector? A) Excessive use of GeneXpert machines B. Lack of mandatory notification and under-reporting C. Over-staffing of private clinics D. High patient awareness Answer: B Explanation: Private providers often do not notify TB cases to the public system, leading to gaps in surveillance.
