RVCT Self-Study Posttest - Answer Key

Item 5 - Count Status Case Study - Manuel Manuel is diagnosed with TB in May 2008 after being evaluated at the health department in Laredo, Texas.. In July 2009, Manuel presents to heal

_ Your Name RVCT Self-Study Module

Posttest June, 2009 ANSWERS For question 1 circle the one best answer

1 How many reports does the RVCT form include?

A. One report: all the items on the RVCT form are reported at one time

B. Two reports: the RVCT and one Follow Up Report

X C. Three reports: the RVCT and two Follow Up Reports

D. Four reports: the RVCT and three Follow Up Reports

For questions 2 – 4 match the description with the RVCT item by writing in the number for the description on the line next to the item Choose the one best answer for each question What is the description for the 3 items listed below?

C _ 2. Item 1 Date Reported A. Date the reporting area sends the

RVCT to the counting authority

A _ 3 Item 2 Date Submitted B. Date that the counting authority verifies

the case as TB and includes it in the official case count

B _ 4. Item 6 Date Counted C. Date that a health department first

suspects that the patient might have TB

For questions 5 – 20 circle the one best answer for each question.

5 Item 5 - Count Status

What is needed to determine the count status?

A. That it is a verified case of TB

B. That the case is countable (if the case meets the surveillance definition)

C. Verified that it is not counted somewhere else

X D. A, B, and C are all correct

E. Only A and B are correct

6 Item 5 - Count Status

Case Study - Manuel

Manuel is diagnosed with TB in May 2008 after being evaluated at the health department in Laredo, Texas He successfully completes directly observed therapy on December 10, 2008

In July 2009, Manuel presents to health department again because

of cough and fever The clinician recognizes signs of TB disease

Manuel’s chest radiograph is consistent with TB disease An AFB

culture is positive for M tuberculosis complex and he is started on

anti-TB therapy again

Should Manuel’s new information be submitted and should his case be

countable for 2009 national surveillance?

A. Yes, his information should be submitted and

Yes, it should be counted in the 2009 national surveillance

X B. Yes, his information should be submitted and

No, it should NOT be counted in the 2009 national surveillance

C. No, his information should NOT be submitted and

No, it should NOT be counted in the 2009 national surveillance

Note for answer - CDC recommends that programs submit an RVCT for cases that recur

within 12 months after completion of therapy These cases are noncountable for area morbidity but will be used to assess program management burden In item 5 Count Status, select verified case: recurrent TB within 12 months Since TB recurred within 12 months after completion of therapy, do not select count as a TB case

7 Item 11 - Race

Case Study – Arnold

Arnold says that his father is Hawaiian and his mother is Filipino He says he is both of those races

Which of the following should you check for Arnold’s race?

A. American Indian or Alaska Native

B. Asian

C. Native Hawaiian or Other Pacific Islander

D. A, B, and C are all correct

X E. Only B and C are correct

Questions 8 – 9 refer to the Case Study – Carmelita

Case Study – Carmelita

Carmelita was born in Guatemala 10 years ago Her parents met each other in Guatemala and got married Carmelita’s mother was born in New York City and is a U.S citizen Her father is a citizen of Guatemala

8 Item 12 – Country of Birth

What should be entered for country of birth for Carmelita?

A. Yes, “U.S.-born,” country of birth United States

X B. Yes, ”U.S.-born,” country of birth Guatemala

C No, not “U.S.-born,” country of birth United States

D No, not “U.S.-born,” country of birth Guatemala

9 Item 14 – Pediatric TB Patients (<15 years old)

What should be entered for country of birth for the primary guardians of Carmelita?

X A. Mother, United States

Father, Guatemala

B. Mother, Guatemala

Father, Guatemala

Questions 10 – 11 refer to the Case Study – Rick

Item 15 - Status at TB Diagnosis

Case Study – Rick

Rick is diagnosed with pneumonia when he is admitted to the hospital on

July 3, 2009 TB disease is suspected and he starts taking TB therapy He

dies 1 week later on July 10, 2009, from complications due to diabetes

Upon autopsy, it is confirmed that Rick had TB

10 What should be entered for Rick’s Status at TB diagnosis?

X A. Alive

B. Dead

11 Was TB a cause of death?

X A. Yes, TB was a cause of death or a contributing condition to death

B No, TB was not a cause of death or not a contributing condition to death

C. It is unknown if TB was a cause of death

Note for answer: As TB was diagnosed at the time of death in addition to the admitting diagnosis of pneumonia, TB is included and considered as a (not the) possible cause of

death If a patient has TB disease when he/she dies, and TB is related to the cause of death, then select Yes, TB is a cause of death

12 This question includes the following 3 items:

Item 16 – Site of Disease

Item 22 A – Initial Chest Radiograph and Other Chest Imaging Study

Item 22 B – Initial CT Scan and Other Chest Imaging Study

Case Study - Hal

Hal is HIV positive and has miliary TB disease It appears on his initial

CT scan and his initial chest radiograph

In which Items would you record responses to indicate that Hal has

miliary TB?

A. Item 16 - Site of Disease

B. Item 22 A - Evidence of miliary TB

C. Item 22 B - Evidence of miliary TB

D. A, B, and C are correct

X E. Only B and C are correct

Questions 13, 14, 15, and 16 all refer to Item 18 – Sputum Culture and Case Study - Herman

Item 18 – Sputum Culture

Case Study – Herman

Herman is admitted to National Jewish Health hospital on July 12, 2009 and stays through July 28 During that time he is diagnosed with TB

The hospital laboratory released Herman’s sputum culture results to the health department on August 20 The results are as follows:

• Specimen collected on July 13 is positive

• Specimen collected on July 16 is positive

• Specimen collected on July 22 is negative

13 What should be entered for Herman’s sputum culture?

X A. Positive

B. Negative

C. Not done

D. Unknown

14 What should be entered for the date that Herman’s sputum was

collected?

X A. July 13

B. July 16

C. July 22

D. A, B, and C should all be entered

Note: July 13 was the date that the first positive sputum culture was collected

15 What should be entered as the Date Result Reported?

A. July 16

B. July 22

X C. August 20

Note: August 20 was the date that the laboratory released the report on the sputum

culture

16 What Reporting Laboratory Type should be selected?

A. Public Health Laboratory

B. Commercial Laboratory

X C. Other

Note: National Jewish Health hospital sometimes charges for services, but for the

purposes of the RVCT it is categorized as “Other.”

17 Item 21 – Nucleic Acid Amplification Test Result

Case Study – Ned

Ned is hospitalized for TB meningitis on November 13, 2009

Samples of his cerebral spinal fluid are collected 2 separate times over a 2-week period The rapid nucleic acid amplification (NAA) test results indicate that the 1st test was negative and the 2nd test

is positive

What would you select as Ned’s Nucleic Acid Amplification Test Result?

X A. Positive

B. Negative

C. Not Done

D. Unknown

E. Indeterminate

Note: If any NAA results are positive then the result entered should be positive, even if

multiple tests are negative

18 Item 23 - Tuberculin Skin Test (TST) Placed

Case Study - Ethyl

On May 28, 2009, Ethyl goes to the Tarrant County Health Department complaining of a persistent cough and fever Ethyl tells the nurse at the health department that she has recently been exposed to TB at the county jail where she works She also indicates that last year she had a Mantoux skin test performed at the jail and the result was positive The health care worker cannot find any documentation of the test result The health care worker then takes a sputum sample but does not perform a Mantoux skin test The sputum culture results indicate that Ethyl has TB disease

What would you select for Ethyl’s Tuberculin (Mantoux) Skin Test at

Diagnosis?

A. Positive

B. Negative

X C. Not done

D. Unknown

Note for answers: There is no medical documentation available for Ethyl’s previous TST

and a patient’s self-report is not acceptable for either a positive or negative TST result

Tarrant County Health Department did not perform a TST, so the answer is Not done.

19 Item 24 – Interferon Gamma Release Assay for Mycobacterium

tuberculosis at Diagnosis

Case Study - Minnie

The Magee County Health Department uses an interferon gamma release assay to test Minnie’s blood for TB infection

The test result indicates that M tuberculosis infection is likely

What would you select for Interferon Gamma Release Assay for M

tuberculosis at Diagnosis for Minnie?

(Circle the one best answer.)

X A. Positive

B. Negative

C. Not done

D. Unknown

E. Indeterminate

Note for answers: Minnie’s test result “M tuberculosis infection is likely” indicates that it

is positive The term “likely” is what is used in the RVCT instructions for item 24, and it is taken from the FDA –approved labeling for these tests

20 Item 25 – Primary Reason Evaluated for TB

Case study – Candace

Candace is a nurse at the Franklin County Nursing Home

During the annual employee screening for TB, Candace’s TST result is positive at 20mm She is subsequently diagnosed with

TB disease

What is the Primary Reason Evaluated for TB?

A. Targeted testing

X B. Health care worker

C. Employment/Administrative testing

Note: The instructions indicate the following:

• Health care workers (paid or unpaid) who may have a potential for exposure to M

tuberculosis complex are referred to as health care workers Health care worker

supersedes targeted testing or employment/administrative testing

• Targeted testing is for people who are considered at high risk for TB (e.g., foreign

born persons from areas with high rates of TB; persons who have HIV, diabetes, or other risk factors)

• Employment/administrative is for routine TST before employment or school If Candace had NOT been a health care worker at the hospital (e.g., cook, maintenance

worker) the primary reason she would have been evaluated would have been

employment/administrative testing

For questions 21 – 24 match the risk factor with the patient by writing the letter for the additional risk factor on the line next to the patient Choose the one best answer for each question.

Item 34 - Additional Risk Factors

What are the Additional Risk Factors for the following patients?

A _ 21 Eleanor’s husband is diagnosed with

MDR TB The health department contacts Eleanor and she is evaluated for

TB one month later Her test results indicate she has TB disease

A.

B.

C.

D.

E.

F.

G.

H.

I.

Contact of MDR TB patient

Contact of infectious

TB patient Missed contact Incomplete LTBI therapy

Post-organ Transplantation Diabetes Mellitus End-Stage Renal Disease

Immunosuppression (not HIV/AIDS) Other

D _ 22 Michelle starts LTBI therapy in May 2009.

In late July she decides to stop taking her medication because she doesn’t feel sick She now has TB disease

B _ 23 Juanita lives with her cousin In March

2009 her cousin is diagnosed with TB disease Juanita is tested during a contact investigation for her cousin and is also diagnosed with TB disease

E _ 24 In November 2009 Hilary has a heart

transplant; she is diagnosed with TB disease in 2010

For question 25 – 27 match the immigration status at first entry into the U.S with the patient Choose the one best answer for each question.

Item 35 - Immigration Status at First Entry to the United States

What is the Immigration Status at First Entry to the United States for the following patients?

First Entry into the U.S E _ 25 Sophia was born in Greece and is a

journalism major at Athens University in Greece In 2009 she vacations in Atlanta, Georgia, and visits the Martin Luther King Center

A.

B.

C.

D.

E.

F.

G.

H.

Not applicable (“U.S.-born”) Immigrant visa Student visa Employment visa Tourist visa Family/fiancé visa Refugee

Asylee or parolee

A _ 26 Elena was born in Romania where

her father was a citizen Her mother was a U.S citizen

B _ 27 Omar was born in Egypt and

entered the United States with permanent resident status

For question 28 circle the one best answer.

28 Item 42 – Moved

Case Study – Julio

In February 2010, Julio is screened at the El Paso Health Clinic for TB and given a chest radiograph and TST His tests

indicates that he has TB disease and is started on anti-TB treatment In June, he moves back to Juarez, Mexico, and continues TB care with the Juarez Departemento de Salud The

El Paso health official works closely with the Juarez health officials to transfer Julio’s records

What would you select for Item 42 Moved for Julio?

A. No, did not move during TB therapy

B. Yes, moved in state, out of jurisdiction

C. Yes, moved out of state

D. Yes, moved out of the U.S and indicate no for U.S transnational referral

X E. Yes, moved out of the U.S and indicate yes for U.S transnational referral

For questions 29 – 30 match the reason therapy extended for > 12 months with the patient Choose the one best answer for each question.

Item 45 – Reason Therapy was Extended for > 12 Months

What is the Reason Therapy was Extended for > 12 Months for the

following patients?

Extended > 12 months C _ 29 Marie, who is being treated for TB, and her

brother Donny travel to Salt Lake City, Utah, to attend their Uncle Andy’s funeral

Marie forgets to take her anti-TB medicine along on the trip Furthermore, she does not show up for DOT appointments for the next 6 weeks

A.

B.

C.

D.

E.

F.

Rifampin resistance Adverse drug reaction Non-adherence Failure

Clinical indications – other reasons Other

A _ 30 Geraldo’s initial drug susceptibility results

indicate that he has drug resistance to isoniazid and rifampin