Quiz 3: Diagnosis of childhood tuberculosis

Please choose the one, most correct answer to each question or statement.

1. The clinical diagnosis of tuberculosis in children:
   • Is usually easy to confirm
   • Can be confirmed with a few special investigations
   • Is confirmed only when other infections have been excluded
   • Usually cannot be confirmed
2. What is used in a Mantoux skin test?
   • Live TB bacilli
   • Tuberculin
   • Serum from a patient with tuberculosis
   • Serum from a patient who has been cured of tuberculosis
3. The Mantoux skin test is done:
   • Intravenously
   • Intramuscularly
   • Subcutaneously
   • Intradermally
4. When should a Mantoux skin test be read?
   • Immediately
   • At 24 hours
   • Between 48 and 72 hours
   • After five days
5. A Mantoux skin test is positive when:
   • The area of induration is 0 to 4 mm.
   • The area of induration is 2 to 5 mm in HIV-infected children.
   • The area of induration is 10 mm or more in children without immunosuppression.
   • The area of redness is 15 mm or more.
6. What does a positive Mantoux skin test indicate?
   • The child has tuberculosis
   • The child is immune to tuberculosis
   • The child is malnourished
   • The child has been infected with TB bacilli
7. A negative Mantoux skin test is unreliable in:
   • Boys
   • Older children
   • Children with HIV infection
   • Children with mild undernutrition
8. How is a sputum sample obtained in a young child?
   • By asking the child to cough.
   • By gastric aspirate.
   • By suctioning the nose
   • By collecting saliva
9. Do sputum samples usually contain many TB bacilli in children with tuberculosis?
   • Always
   • Usually they do
   • Usually they do not
   • Never in children
10. How can staff protect themselves against TB infection when collecting sputum?
    • Receive BCG immunisation
    • Take a short course of INH
    • Wear a N95 respirator
    • Keep all the windows closed
11. The recommended initial laboratory test for confirming tuberculosis is:
    • smear microscopy
    • Line probe assay
    • Xpert MTB/RIF ultra
    • TB culture
12. How long does it take to get a sputum culture result with liquid culture medium?
    • Less than one week
    • One to two weeks
    • Two to three weeks
    • More than one month
13. What is the most sensitive test on sputum for TB bacilli?
    • Staining the smear
    • Xpert MTB/RIF ultra
    • A Heaf test
    • Culture
14. A chest X-ray is:
    • Essential to diagnose tuberculosis
    • Very useful in diagnosing tuberculosis in children
    • Only useful in adults with tuberculosis who have lung cavities
    • No longer needed with modern sputum tests
15. The commonest chest X-ray finding in children with tuberculosis is:
    • Enlarged hilar lymph nodes
    • The primary infection in the lung
    • Consolidation of the upper lobe of a lung
    • Bronchiectasis
16. Many small spots throughout both lungs on a chest X-ray suggests:
    • Primary TB infection
    • Pleural effusion
    • Miliary tuberculosis
    • Patchy bronchopneumonia
17. Fine needle aspiration is useful when diagnosing tuberculosis in:
    • The spleen
    • Enlarged lymph nodes
    • The lung
    • The spine
18. When should a lumbar puncture be performed?
    • Only in children with disseminated tuberculosis
    • If spinal tuberculosis is suspected
    • To confirm a clinical diagnosis of tuberculous meningitis
    • If the Mantoux skin test is positive in an infant
19. When should children with tuberculosis be screened for HIV?
    • All children suspected of having tuberculosis must be screened
    • Only in infants
    • Only in sexually active adolescents
    • Screening for HIV is not necessary
20. What test should be used when diagnosing HIV infection in a child under 18 moths of age with tuberculosis?
    • Rapid HIV test
    • ELISA HIV test
    • HIV Western blot test
    • HIV PCR test