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October 2011 - HIV/TB: CPD questionnaires must be completed online via www.cpdjournals.co.za after submission you can check the answers and print your certificate.

PAEDIATRIC TB/HIV CO-INFECTION

1. True (A) or false (B):

Antiretroviral therapy reduces the incidence of TB in HIV-infected children.

2. True (A) or false (B):

The characteristic clinical features of TB, i.e. fever > 2 weeks, persistent cough > 2 weeks and failure to thrive in the preceding 3 months are less useful in HIV-infected than uninfected children.

3. True (A) or false (B):

South African policy is that all newborns should be vaccinated with BCG because of the high overall burden of TB.

THE PROGRESSION OF TB DIAGNOSIS IN THE HIV ERA

4. The GeneXpert (GX) MTB/RIF assay is (choose one):

A. A fully integrated, automated nucleic-acid-amplification test

B. Able to successful diagnose approximately 75% of smear-negative culture-positive TB

C. Able to provide a result within 2 hours

D. Going to replace smear microscopy as the frontline TB diagnostic tool in South Africa

E. All of the above.

5. Which one of the tests below can provide rapid drug susceptibility testing in a smear-positive patient with suspected MDR-TB in South Africa?

A. Mycobacterial growth in tube (MGIT) liquid culture GX assay

B. Genotype MTBDR plus assay

C. Microscopic observed drug susceptibility (MODS)

D. Either B or C.

6. True (A) or false (B):

The point-of-care urine LAM Ag rapid test offers potential as a 'rule-in' test for all TB patients.

A PRACTICAL APPROACH TO THE DIAGNOSIS AND MANAGEMENT OF PARADOXICAL TB-IRIS

7. Regarding the incidence of paradoxical TB-IRIS in HIV-infected TB patients who start ART, one of the following statements is correct:

A. Paradoxical TB-IRIS occurs in over 50% of such patients

B. A recent meta-analysis reported that paradoxical TB-IRIS occurs in approximately 5% of such patients

C. Paradoxical TB-IRIS is more common in patients who have higher CD4 counts prior to ART

D. A recent meta-analysis reported that paradoxical TB-IRIS occurs in approximately 15% of such patients

E. Paradoxical TB-IRIS is uncommon in patients with disseminated TB.

8. True (A) or false (B):

Prednisone should be started to treat paradoxical TB-IRIS as soon as the diagnosis is considered.

INTENSIFIED TUBERCULOSIS CASE FINDING AMONG HIV-INFECTED INDIVIDUALS

9. True (A) or false (B):

Individuals who do not report any of the following symptoms: current cough, fever, weight loss or night sweats, are unlikely to have active TB.

10. True (A) or false (B):

The WHO guidelines recommend that HIV-infected children with poor weight gain, fever, current cough or contact history with a TB case should be evaluated for TB.

TB AND HIV CO-INFECTION: WHEN TO START ART

11. True (A) or false (B):

Rifampicin is the anti-TB agent with the greatest potential for drug-drug interactions with non-nucleoside and protease inhibitor antiretrovirals.

12. True (A) or false (B):

Immediate ART (within 2 weeks) improves survival in patients with advanced AIDS.

INTO THE GREAT UNKNOWN - TREATING DRUG-RESISTANT TB AND HIV

13. True (A) or false (B):

In an HIV-infected patient who has MDR-TB, the time to start antiretroviral therapy is within two weeks of starting TB treatment.

14. True (A) or false (B):

XpertMTB is a new molecular diagnostic test for TB and does not require a bio-safety cabinet.

TB EPIDEMIOLOGY IN HIV-PREVALENT SETTINGS

15. True (A) or false (B):

Patients on antiretroviral therapy still have a substantially higher risk of developing TB disease compared with HIV-uninfected patients.

16. True (A) or false (B):

Point of care TB diagnostics is not one of the 2008 WHO STOP TB Partnership's basic strategies for improved HIV/TB services.

PHARMACOKINETIC INTERACTIONS BETWEEN ARVs AND

RIFAMPICIN-BASED TUBERCULOSIS TREATMENT

17. True (A) or false (B):

When starting a woman who has been taking rifampicin-based tuberculosis treatment for a month on antiretroviral therapy, nevirapine should be commenced at the usual starting dose.

18. True (A) or false (B):

A 4-year-old child is taking ritonavir-boosted lopinavir as part of his antiretroviral therapy regimen. He is diagnosed with pulmonary TB and started on rifampicin-based TB treatment. His dose of ritonavir-boosted lopinavir should be doubled for the duration of TB treatment.

THE PRINCIPLE OF CONTEXT IN FAMILY MEDICINE

19. True (A) or false (B):

According to Ian R McWhinney, to explore the exceptional potential in the consultation and to understand your patient fully you have to explore the context of the patient presentation.

20. True (A) or false (B):

The sub-system in terms of the family systems hierarchy includes the community, family and spouse.
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Publication:CME: Your SA Journal of CPD
Date:Oct 1, 2011
Words:724
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