Exercise Workbook April 2021

TRAINING FOR
HEALTH WORKERS
PROVIDING TB
SERVICES
EXERCISE WORKBOOK
PHILIPPINES 2021
NATIONAL TUBERCULOSIS CONTROL PROGRAM
ADVANCING CLIENT CENTERED CARE AND EXPANDING

SUSTAINABLE SERVICES FOR TB (ACCESS TB)
1
2
Exercise 1: Classifying Drug – resistant TB Based on Drug Susceptibility Test 4
Exercise 2: Identifying Presumptive TB 5

Exercise 3: Screening Presumptive TB 9
Exercise 4: Filling out the TB Laboratory Specimen Receiving Form 14
Exercise 5: Filling out the Presumptive TB Masterlist 15
Exercise 6: Classifying TB Cases 17
Exercise 7: Updating the Presumptive TB Masterlist and giving feedback to
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the referring unit
Exercise 8: Assigning Appropriate Treatment Regimen and Monitoring of

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Treatment
Exercise 9: Determining Appropriate Treatment Regimen 24
Exercise 10: TB in Special Situations 30
Exercise 11: Determining Appropriate Treatment Regimen Dosage 32
Exercise 12: Filling – out the DR-TB Treatment Card and DR-TB Register 36
Exercise 13: Monitoring Treatment Response 43
Exercise 14: Recording Supervised Treatment 50
Exercise 15: Management of Adverse Events 53
Exercise 16: Active Drug Safety Monitoring and Management 55
Exercise 17: Determining Treatment Outcome 59
Exercise 18: Practicing Interpersonal Communication and Counseling 65
Exercise 19: Patient-Centered Care 66
Exercise 20: Use of Stock Cards 68

Exercise 21: Dispensing of NTP Products 76
Exercise 22: Recording and Reporting for PMDT 78

Exercise 23: Infection Control 80
Exercise 24: TB Preventive Treatment 83`
3
INSTRUCTIONS: Indicate the classification of TB disease based on drug susceptibility
testing for the items shown in the presentation.
Resistance Pattern Answer
1. H-resistant
2. H Z E-resistant
3. R-resistant
4. R Z E-resistant
5. H R-resistant
6. R Lfx Mfx-resistant
7. H R Z E-resistant
8. H R Lfx-resistant
9. H R Z E Lfx-resistant
10. H Z Lfx -resistant
11. H R Z E Lfx Mfx Bdq Lzd -resistant
4
INSTRUCTIONS: Identify which of the following is a presumptive TB case. Determine
and classify which registration groups they belong.
Case 1
Patient HDL, 34 years old, who took only 3 months of Regimen 1 treatment last year,
was referred to your treatment facility. She complains of persistent cough for the last
4 weeks with back pain, hemoptysis, and weight loss.
Presumptive TB: YES NO

IF YES: DSTB DR-TB
Registration Group:
Case 2
Patient JSP is 61 years old and having cough for 10 days. He came to your clinic with
complains of chest pain, difficulty of breathing and fever for 3 days with TB treatment
history of Regimen 1 and declared cured. His chest x-ray result showed fibroreticular
infiltrates in the visualized lung areas with an intervening cavity seen in the right upper
lobe due to PTB.

IF YES: DSTB DR-TB
Registration Group:
Case 3
Patient OCM, a 4 year old boy was brought to your facility. The child has been
experiencing cough for three weeks, unexplained fever for 2 weeks and loss of
appetite. The child has no history of any TB treatment and could not expectorate.
Chest x-ray result revealed bilateral upper PTB.

IF YES: DSTB DR-TB 󠆸
Registration Group:
5
Case 4
Patient GYM is a 34 year old housewife. She lives with her husband and 3 children in
an apartment. She came to the clinic because of enlarged cervical lymphadenopathy,
non-painful, 7 days of fever, cough and back pain and with no history of TB treatment.
Upon interview, you found out that her husband is a confirmed MDR-TB Patient.

IF YES: DSTB DR-TB
Registration Group:
Case 5
Patient RJH was recently diagnosed with pulmonary TB after completing 6 months of
anti-TB treatment about a year ago. His Xpert/MTB RIF test result was “MTB detected,
Rif resistance not detected”, hence he was registered as a Relapse case and was given
Regimen 1 treatment. After 2 months of intensive phase (2HRZE), his follow-up SM
was still positive (1+).

IF YES: DSTB DR-TB
Registration Group:
Case 6
Patient MEB, 44 years old, is a public school teacher who consulted at your clinic
because of 15 days of cough and low grade fever for 7 days. She has taken anti-TB
drugs: HRZES, Lfx for 2 months from a private physician last year.

IF YES: DSTB DR-TB
Registration Group:
Case 7
Patient KBL, a call center agent has been coughing for 8 days upon consultation. She
verbalized having fever at night for 16 days and chest pain. She has no previous TB
treatment nor TB exposure to anyone.
Upon interview, you found out that she has DM type II and is on metformin for 2
years now.

Registration Group:
6
Case 8
Patient FOJ. is 72 years old and has cough for more than 2 weeks. He came to your
clinic with complains of chest pain, difficulty of breathing and fever for 3 days. He has
no previous TB treatment nor TB exposure to anyone.

Registration Group:
Case 9
Patient RMD, 23 years old, who is being treated for HIV in one of the treatment hubs
in Metro Manila, has been experiencing cough for 7 days. He has no previous anti-TB
treatment and has no SM done prior to referral.

IF YES: DSTB DR-TB
Registration Group:
Refer to case # 3:
You have found out that patient OCM is the son of a confirmed DR-TB patient of your
facility.

IF YES: DSTB DR-TB
Registration Group:
Case 10
Patient HLI, 25 years old came to your facility with complains of fever for 4 days and
cough for 15 days. She has no history of previous anti-TB treatment nor TB exposure
to anyone.

Registration Group:
7
Case 11
Patient SDS, a staff nurse in a rural health unit, has been experiencing cough for 14
days accompanied by body malaise and on and off fever. She has no history of anti-
TB treatment.

Registration Group:
Case 12
Patient ABC, 32 years old, consulted at your clinic because of 18 days of cough, chest
pain and weight loss of approximately 5kg in a month. She has no previous anti-TB
treatment nor TB exposure to anyone.

IF YES: DSTB DR-TB
Registration Group:
8
INSTRUCTIONS: Fill out the DR – TB screening form for the case provided below. Assume
that you are the staff of LCP – NCPR and that the date of screening is the same as the
date of referral. Assume that the last presumptive DR-TB patient screened was assigned
the screening code: 03-19-11-039. Additional information is also provided below.
The facilitators will conduct a screening simulation while the participants will fill-out
the blank screening form provided.
Screening Center: LCP – National Center for Pulmonary Research (LCP – NCPR)
KOICA Building, Lung Center of the Philippines, Quezon Ave., Quezon City
(02) 921-5877
If you are not a physician, write Dr. Marietta Solante as the attending physician
CASE 1: HAYDE DAYAN LIMA
I. Demographics
Date of birth: January 25, 1985
Sex : Female
Civil status: Single
Religion: Roman Catholic
Nationality: Filipino
Close contacts: Ronnie Lima (Father) – 60 years old
Antonia Lima (mother) – 55 years old
Edgar Lima (brother) – 20 years old
Permanent address: #19 Everlasting St. Brgy Kalusugan Quezon City, NCR, 1111
City address: #19 Everlasting St. Brgy Kalusugan Quezon City, NCR, 1111
Contact nos.: (02) 8921 – 2961 / 0933-9214086
Occupation: none
E-mail address: none
Person to notify in case of emergency: Antonia Lima (mother)

Address: #19 Everlasting St. Brgy Kalusugan Quezon City, NCR, 1111
Contact. no.: (02) 8921 – 2961
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II. Review of Symptoms & Past Medical History
Ms. Lima complains of persistent productive cough for about a month already, with
sputum usually greenish in color. Ms. Lima also verbalizes upper back pain for about
a month with pain greater in right upper back area. Ms. Lima reports of experiencing
4 episodes of coughing out blood, bright red in color, for the last 2 weeks. Ms. Lima
also reports weight loss of approximately 5 kg in a span of 1 month.
Ms. Lima looks dyspneic and verbalized difficulty of breathing on exertion.
Ms. Lima verbalizes no known exposure to active TB, any co – morbidities, any history
of allergic reaction to food or drugs, or any type of previous surgery. She is currently
taking trust pill as a contraceptive.
III. Social History

Ms. Lima reports no previous history of use of tobacco, alcohol, and prohibited drugs.
She verbalizes that she is currently sexually active with only one partner. Ms. Lima
verbalizes that she had just had her menstruation today.
IV. Physical examination and laboratory procedures:

Height: 155 cm. Weight: 43 kg. Temp.: 37.5 degrees Celsius
Pulse rate: 90/min Respiratory rate: 25/min Blood pressure: 130/90 mmHg
Ms. Lima looks distressed, cachetic, and generally weak. Upon examination, her skin,
conjunctiva, palms, and nail beds looks pale. No BCG scar could be seen on either
deltoid. Using the stethoscope, crackles could be heard on both upper lung fields,
which could be appreciated more on the right lung field, heaving could also be
observed. No other pertinent findings.
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INSTRUCTIONS: Fill out the TB Laboratory Specimen Receiving Form for Hayde Lima’s
Sputum Specimen. Refer to her accomplished screening form for further information,
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INSTRUCTIONS: Fill out the Presumptive TB Masterlist using the patient data collected
from the DR-TB Screening Form done on Exercise 2. Assume that the last presumptive
DR-TB patient screened was assigned the screening code: 03-19-11-039
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INSTRUCTIONS: Classify each of the cases below based on
(1) Anatomical Site

(2) Bacteriologic Status,
(3) Treatment History
(4) Drug Susceptibility Test.
If specifying the classification is not yet possible, write N/A (not applicable) then
determine the best next step that should be done to address the patient’s needs.
Case 1
You received HDL’s Xpert MTB/RIF test result as shown on below:
Anatomic Site:
Bacteriologic Status:
Treatment History:
Xpert MTB/RIF Test Result:
Next Step
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Case 2
You received JSP’s Xpert MTB Rif Test result, which indicated, MTB Detected
Rifampicin Resistance Detected.
Anatomic Site:
Treatment History:
Next Step
Case 3
OCM, the 4 years old boy could not expectorate. Upon further investigation, you
found out that OCM is a son of a confirmed MDR-TB case who was successfully
treated.
Anatomic Site:
Treatment History:
Next Step
Case 4
You received GYM’s Sputum Xpert MTB RIF Test result, which indicated MTB
Detected, RIF Resistance Detected
Anatomic Site:
Treatment History:
Next Step
Case 5
You received RJH’s Xpert MTB RIF Test result, which indicated MTB Detected RIF
Resistance Not Detected
Anatomic Site:
Treatment History:
Next Step
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Case 6
You received MEB’s Xpert MTB RIF Test result, which indicated MTB Detected RIF
Resistance Detected
Anatomic Site:
Treatment History:
Next Step
Case 7
You received KBL’s Xpert MTB Rif Test result, which indicated MTB Detected RIF
Resistance Detected
Anatomic Site:
Treatment History:
Next Step
Case 8
You received FOJ’s Xpert MTB Rif Test result, which indicated MTB Detected
Rifampicin Resistance Not Detected
Anatomic Site:
Treatment History:
Next Step
Case 9
You received RMD’s Xpert MTB Rif Test result, which indicated MTB Not Detected
Anatomic Site:
Treatment History:
Next Step
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Case 10
You received HLI’s Xpert MTB Rif Test result, which indicated MTB Detected RIF
Resistance Not Detected
Anatomic Site:
Treatment History:
Next Step
Case 11
You received SDS’s Xpert MTB Rif Test result, which indicated MTB Detected
Rifampicin Resistance Not Detected
Anatomic Site:
Treatment History:
Next Step
Case 12
You received ABC’s Xpert MTB Rif Test result, which indicated MTB Detected
Rifampicin Resistance Detected
Anatomic Site:
Treatment History:
Next Step
Case 13
You collected a second sputum sample for HDL on December 2, 2019, On December
4, 2019; the result released was MTB Detected Rifampicin Resistance Detected
Anatomic Site:
Treatment History:
Next Step
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INSTRUCTIONS: Update the Presumptive TB Masterlist using the latest available
information from the previous exercises, fill-out the return slip of Hayde Lima, and give
feedback to the referring unit.
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INSTRUCTIONS: Determine the regimen and doses.
LJB, 28-year-old male has been having problems of recurrent findings of pneumonia
in a series of chest x-rays taken 3x every 2 months. He was given 2 courses of
antibiotics but the chest x-ray findings were still there. He is applying for a permanent
position in a company. On further interview, he said that he has on and off cough for
almost 3 months but with minimal phlegm. He cannot recall any previous treatment
with TB.
His SM result was 2+/3+ and Xpert MTB/Rif result is MTB detected; Rif Resistance not
detected.
Weight= 38 kg
Give the appropriate regimen and dosage:
___________________________________________________________________________
On the 1st month of treatment the patient is insistent of obtaining a clearance for
work. What will you do?
___________________________________________________________________________
SM monitoring on the 2nd month of treatment turned out to be positive. What will
you do?
___________________________________________________________________________
Xpert MTB/Rif test result was MTB detected; Rifampicin resistance not detected. Next
step?
___________________________________________________________________________
On the 4th month of treatment patient decided to transfer to the province for the
continuation of treatment. However, he did not inform you. He was not able to take his
medications for 1 month while in the province. He decided to come back to Manila and
continue his treatment again in your facility. By this time he interrupted treatment for
1.5 months. What will you do?
___________________________________________________________________________
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After 2 days, SM result was released with negative result. What will you do?
___________________________________________________________________________
Patient became compliant, was able to finish the treatment however, found it difficult
to expectorate sputum for monitoring. What is the outcome of treatment?
___________________________________________________________________________
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INSTRUCTIONS: In groups of 3-4 participants, discuss the patient information provided
below then decide the appropriate regimen for the patient. Encircle the most appropriate
regimen.
1. Patient HDL
Age/Sex/Wt. 34/female/43 kg
Anti-TB Drugs Taken: 2HRZE/1HR
Xpert MTB/Rif Test Result: MTB Detected Rifampicin Resistance Detected
TB Disease Classification: BC, Pulmonary, Retreatment, RRTB
Contact of TB Case: No
Co-morbidity: None
Pregnancy Test Negative (-)
Creatinine: .9 mg/dl
What is the appropriate regimen for this patient?
a) DSTB
b) SSOR
c) SLOR FQ (S)
d) SLOR FQ (R)
e) ITR
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2. Patient JSP
Age/Sex/wt 56/male/34 kg
Anti-TB Drugs Taken: 2HRZES/HRZE/5HRE
Xpert MTB/Rif Test Result: MTB Detected Rifampicin Resistance Detected
Contact of TB Case: No
Co-morbidity: None
Creatinine: .7 mg/dl
Baseline tests:
ECG: Normal
a) DSTB
b) SSOR
c) SLOR FQ (S)
d) SLOR FQ (R)
e) ITR
3. Patient OCM
Age/Sex/wt. 4/male/20kg
Anti-TB Drugs Taken: None
Xpert MTB/Rif Test Result: None (Could not expectorate)
TB Disease Classification: CD, Pulmonary, New
Contact of TB Case: Yes, MDR-TB (HR – Resistant)
CXR: Infiltrates on the right upper lobe
TST: 12mm
a) DSTB
b) SSOR
c) SLOR FQ (S)
d) SLOR FQ (R)
e) ITR
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4. Patient GYM
Anti-TB Drugs Taken: None
Xpert MTB/Rif Test Result: MTB Detected, Rifampicin Resistance Detected
TB Disease Classification: BC, Pulmonary, New,
MDR-TB – ongoing on the 10th month of SSTR
Contact of TB Case:
DST of index: HR resistant
Co-morbidity: None
Pregnancy Test: Negative (-)
a) DSTB
b) SSOR
c) SLOR FQ (S)
d) SLOR FQ (R)
e) ITR
5. Patient MEB
Age/Sex/Wt 44/female/48kg
Anti-TB Drugs Taken: HRZES Lfx (for 2 months)
Xpert MTB/Rif Test Result: RRTB
Contact of TB Case: None
Co-morbidity: None
Pregnancy Test: Negative (-)
a) DSTB
b) SSOR
c) SLOR FQ (S)
d) SLOR FQ (R)
e) ITR
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6. Patient KBL
Age/Sex/wt. 25/female/40 kg
Anti-TB Drugs Taken: 2011: 4 HRE declared cured by Private MD
MTB Detected Rifampicin Resistance Not
Xpert MTB/Rif Test Result:
Detected
LPA Drug Resistance
Fq and SLI susceptible
Result:
DST Result: pending
TB Disease Classification: BC, Pulmonary, Retreatment, MDR-TB
Contact of TB Case: DS-TB
Co-morbidity: None
ECG: QTc = 314 msec.
Baseline tests:
FBS: 120 mg/dl
Creatinine: 87 umol/L (Eccl: 54.98 ml/min)
Pregnancy Test: Negative ( - )
a) DSTB
b) SSOR
c) SLOR FQ (S)
d) SLOR FQ (R)
e) ITR
7. Patient FOJ
Age/Sex/Wt. 72/male/48 kg
Anti-TB Drugs Taken: No previous history of anti-tb treatment
Xpert MTB/Rif Test Result: MTB detected; Rif resistance not detected
TB Disease Classification: BC, Pulmonary, New
Co-morbidity: Type 2 Diabetes Mellitus controlled with Insulin
a) DSTB
b) SSOR
c) SLOR FQ (S)
d) SLOR FQ (R)
e) ITR
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8. Patient HLI
Anti-TB Drugs Taken: No history of TB treatment
Xpert/MTBRIF:
MTB detected; Rif Resistance not detected
Co-morbidity: None
a) DSTB
b) SSOR
c) SLOR FQ (S)
d) SLOR FQ (R)
e) ITR
9. Patient SDS
Anti-TB Drugs Taken: No history of TB treatment
Xpert MTB/Rif Test Result: MTB detected; Rifampicin Resistance not detected
Contact of TB Case: Yes, DSTB
Co-morbidity: None
a) DSTB
b) SSOR
c) SLOR FQ (S)
d) SLOR FQ (R)
e) ITR
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10. Patient ABC
Anti-TB Drugs Taken: No previous TB treatment
SM: 1+/2+
Xpert MTB/RIF test: (2nd MTB detected; Rifampicin Resistance detected
test)
Co-morbidity: None
a) DSTB
b) SSOR
c) SLOR FQ (S)
d) SLOR FQ (R)
e) ITR
11. Patient MMM

Age/Sex/wt. 29/male/ 40 kg
2009: 2HRZE/3HR- NE
2010: 2HRZE/4HR- Cured
2011: LfxAmxClv by private MD, 3/11-2013- NE
2013: Z-KmLfxPtoCs- shifted Lfx-Mfx- Treatment
Anti-TB Drugs Taken:
Failed
2014: -ZKmMfxPtoCsPASAmxClvCfz (Empiric XDR-
TB)
2016: Type of Case: BC-XDR-TB
Xpert MTB/Rif Test Result: RRTB
DST: 2016: HRESCmLfx Resistant (XDR-TB)
LPA Drug Resistance 2015: Fluoroquinolone and E Resistance Detected
Result: 2016: Hh and R Resistance Detected
BC, Pulmonary, Retreatment (Cat IV Treatment
TB Disease Classification:
Failed), XDR-TB
Co-morbidity: Type 2 Diabetes Mellitus controlled with Insulin
a) DSTB
b) SSOR
c) SLOR FQ (S)
d) SLOR FQ (R)
e) ITR
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1. Mrs. Cruz, 25 year old woman, sought consultation in your clinic with chief complaints of
hemoptysis, 2 weeks cough and afternoon fever. As a competent healthcare worker, you
are most likely do the following initial evaluation for all cases of Tuberculosis among child
bearing age in assessing for pregnancy. (Select all that apply)
a. Do a pregnancy test
b. Obtain blood sample for FBS
c. Get information on the first day of LMP
d. Get information on the last day of LMP
2. The regimen for Mrs. Cruz once she is confirmed pregnant should include three to four
oral drugs deemed to be effective but should not include the following: (select all that
apply)
a. Isoniazid
b. Prothionamide
c. Streptomycin
d. Ethambutol
3. Patient Conching was diagnosed with Tuberculosis. However, she is nursing her 3 month
old baby. As her carer, you will suggest to feed her baby:
a. After taking her anti-TB meds
b. Before taking her anti-TB meds
c. Anytime of the day
d. Both a and c
4. Patient Corazon is under your care and she is receiving anti-TB medication which includes
Bedaquiline and Delamanid in her regimen. She is lactating to her 5 month old baby.
Based on her sputum microscopy, she remained positive for tubercle bacilli. As her carer,
what is the best action to suggest to patient Corazon?
a. Continue breastfeeding her baby
b. Discontinue breastfeeding her baby
c. Defer breastfeeding until 2 years old
d. Provide cup feeding instead of breastfeeding
5. When breastfeeding an infant from a mother who is not undergoing appropriate treatment
or still has positive culture, it is important to emphasize to the mother that during
breastfeeding, she should:
a. Use a surgical mask or respirator
b. There are no special preparations needed
c. None of the above
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6. Female patients who vomits at any time after, or within the first two hours after taking
contraceptive tablet should use:
a. Vasectomy
b. Lactation amenorrhea method
c. Barrier method
d. Symptom-thermal method
7. Patient Lina is currently receiving Rifampicin as one component of her anti-TB regimen. At
the same time she is also taking oral contraceptive as her family planning method. As her
carer, you provided information to her that she has the option to do the following:
a. Use progesterone only injectables
b. Use of combined contraceptive patch
c. Use of an oral contraceptive with higher dose of estrogen
d. All of the above
8. Ana Cleta, 28 years old was diagnosed with MDR TB and was initiated immediately with
anti TB medications. You have known based on the information gathered that she is taking
an oral contraceptive pill. During health teaching, you will emphasize to take her oral
contraceptive pill:
a. Alongside with anti-TB meds
b. 30 minutes after taking her anti-TB meds
c. 1 hour prior to her anti-TB meds
d. At hours of sleep/bedtime
9. Patient Katri Ng, a 48 year old diabetic patient is under your care for both management of
TB and DM. As her competent carer, you know that co-administraton of Bedaquiline and
oral hypoglycemic agent will result to:
a. QTc prolongation
b. Damage to kidneys
c. Blindness
d. Sensory neural hearing loss
10. The presence of Diabetes Mellitus may increase the chances of adverse effects of anti-TB
medications especially:
a. Renal insufficiency and liver damage
b. Renal dysfunction and peripheral neuropathy
c. Blindness and renal calculi
d. Depression
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INSTRUCTIONS: Determining and computation of appropriate treatment regimen /
doses for the cases provided below.
HDL
Anti-TB drugs previously taken:
HRZE
Drug resistance: Rifampicin Resistant
Bacteriologically confirmed, Pulmonary, Retreatment, RR-TB
Regimen: SSOR
Age: 34
Weight (kg): 43kg
GROUP DRUG DOSAGE
Group A
Group B
Group C
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OCM
None
Drug resistance: N/A
Clinically Diagnosed MDR-TB, Pulmonary, New
Regimen: Pediatric Regimen
Age: 4
Weight (kg): 20kg
GROUP DRUG DOSAGE
Group A
Group B
33
MEB
HRZES Lfx (for 2 months)
Drug resistance: RRTB
Bacteriologically confirmed, pulmonary, retreatment, RR-TB
Regimen: SLOR FQ(R)
Age: 44
Weight: 48 kg
GROUP DRUG DOSAGE
Group A
Group B
34
RJH
HRZES
Drug resistance: RRTB
Bacteriologically confirmed, pulmonary, retreatment, RR-TB
Note: with renal insufficiency (Creatinine: 234.7 µmol/L)
Creatinine clearance: _______________
ECG (qTC): 410ms
Regimen: SSOR
Age: 36
Weight: 45 kg
GROUP DRUG DOSAGE
Group A
Group B
Group C
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INSTRUCTIONS: Fill – out the DR-TB Treatment Card for Ms. Hayde Lima and register
the case in the DR-TB register. Use the information provided in Ms. Lima’s DR-TB
Screening Form. Assume the following:
• Today is December 21, 2019

• The last DR-TB case registered had a registration number of R19 – 0110.
• All the household contacts of Ms. Lima were assessed at your facility on December
22, 2019. Xpert MTB RIF Test Results turned out MTB Not Detected
• Record in the treatment card that Ms. Hayde Lima has taken her first 3 doses
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INSTRUCTONS (Part I): Update the DR-TB treatment card and the DR-TB register based
on the results of the monitoring of treatment response indicated below.
• Ms. Hayde Lima submitted baseline specimens on December 21, 2019. Baseline
CXR was also done on the same day and showed bilateral infiltrates with cavitary
lesion on the right upper lung. After one day, the SM results were 2+ and 1+.
• On January 04, 2020 the LPA result was released and showed Fluoroquinolones and
Second Line Injectables susceptible. (Please refer to the LPA result on the next page)
• On January 21, 2020, Ms. Lima submitted her first sputum follow – up. Her weight
was 45kg. After two days the SM result was received by the facility and was already
negative.
• On February 23, 2020, Ms. Lima submitted sputum for follow – up. Her weight was
48kg. After two days the SM result was received by the facility and was negative.
• On March 22, 2020, Ms. Lima submitted sputum for follow – up. Her weight was
The baseline TB culture results were released and turned out both positive for MTB.
• On April 24, 2020, Ms. Lima submitted sputum for follow – up. Her weight was
The TB culture result for the month one follow – up examination was released and
turned out still positive for M.TB. On the other hand, the TB culture result for the
month two follow – up examination was released at the same time and turned out
negative. The baseline DST result was also released and showed resistance to both
isoniazid and rifampicin. (Refer to the DST result on the next page)
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INSTRUCTIONS (Part II): Decide on the appropriate action to take for each patient
based on the monitoring of sputum.
Case 1: Patient A. Below are the results of HDL monitoring of treatment response.
Results of Sputum Monitoring Weight

Month Date SM Culture (kg)
0 12/21/19 2+/1+ MTB/MTB 43
1 01/21/20 0 MTB 45
2 02/23/20 0 0 48
3 03/22/20 0 50
4 04/24/20 0 51
What is the appropriate action for HDL?
Case 2: Patient B. Below are the results of patient B’s monitoring of treatment
response to SSOR.

0 11/2/18 3+ MTB 52
1 12/2/18 2+ MTB 51.2
2 1/2/19 0 0 51.5
3 2/3/19 0 52.5
4 3/3/19 1+ 54
What is the appropriate action for this patient now?
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Case 3: Patient C. A diabetic patient, who is receiving SSOR with poor sugar control,
is experiencing worsening cough and weight loss. Below are the SM and TB culture
examination results from this patient’s DR-TB Treatment Card.

0 5/10/18 3+ MTB/MTB 52
1 6/11/18 0 0 52
2 7/11/18 2+ 49
3 8/11/18 2+ 45
What is the appropriate action for this patient now?
Case 4: Patient D. Below are the results of monitoring treatment response of a DR-
TB patient who is enrolled to SSOR.

0 5/5/19 3+ MTB/MTB 59
1 6/5/19 2+ MTB 59
2 7/6/19 0 0 60.5
3 8/7/19 0 0 61
4 9/8/19 1+ 61
5 10/9/19 0 60
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Case 5: Patient E. Below are the results of monitoring treatment response from this
patient who is receiving SSOR. The patient is almost asymptomatic and the chest x-
ray is improving significantly. His weight is increasing.

0 5/5/19 3+ MTB 59
1 6/5/19 0 0 59
2 7/6/19 0 0 60.5
3 8/7/19 0 0 61
4 9/8/19 0 0 61
5 10/8/19 0 0 60
6 11/8/19 0 0 61
7 12/9/19 0 61
8 1/10/20 1+ 62
What is the appropriate action for this patient now? Explain what the health worker
should do and why.
Case 6: Patient F is enrolled in ITR with SLI, below is the monitoring treatment
response. Patient is adherent to the treatment, ADR is being managed well and no co-
morbidity.
What is the appropriate action?

0 5/5/18 3+ MTB 59
1 6/5/18 0 0 59
2 7/6/18 0 0 60.5
3 8/7/18 0 0 61
4 9/8/18 0 0 61
5 10/8/18 0 0 60
6 11/8/18 0 0 61
7 12/9/18 0 ND 61
8 1/9/19 1+ MTB 62
9 2/10/19 0 62
10 3/10/19 0 62
48
Case 7: Patient G. Below are the results of monitoring treatment response of a DR-
TB patient who is enrolled to ITR.

0 5/5/18 3+ MTB/MTB 59
1 6/5/18 2+ MTB 59
2 7/6/18 0 0 60.5
3 8/7/18 2+ MTB 61
4 9/8/18 1+ MTB 61
5 10/8/18 0 0 60
6 11/8/18 0 61
7 12/9/18 0 61
Case 8: Patient H. Below are the results of monitoring treatment response of a DR-
TB patient who is enrolled to SSOR. The patient is adherent in submitting sputum.

0 5/5/18 2+ MTB/MTB 59
1 6/5/18 0 0 59
2 7/6/18 0 0 60.5
3 8/7/18 0 0 61
4 9/8/18 0 0 61
5 10/08/18 0 63
6 11/09/18 0 65
49
INSTRUCTIONS: Record in the DR-TB Treatment Card the doses taken as enumerated
then write your next action in the Patient’s Progress Report Form (PPRF) provided.
50
51
52
INSTRUCTIONS (Part I): Answer the following questions below.
1. What DR-TB drug is most likely to cause hepatoxicity? Encircle the letter of your
choice.
a. Amikacin
b. Prothionamide
c. Pyrazinamide
d. Moxifloxacin
2. What DR-TB drug is most likely to cause psychosis, seizures, and depression?
Encircle the letter of your choice.
a. Prothionamide
b. Pyrazinamide
c. PAS
d. Cycloserine
3. Baseline and quarterly TSH levels should be taken if the regimen contains:
a. Pto and Cs
b. Pto and Cfz
c. Pto and PAS
d. All of the above
4. How will you manage mild vomiting?
5. An MDR-TB patient complains of abdominal pain and jaundice. The AST and ALT
results are elevated >5x ULN. What is the severity/grade of the adverse event?
What are the appropriate action to take?
6. A female MDR-TB patient complains of chest pain, dizziness and nausea. ECG result
measure a QTc interval of 550 ms. Baseline QTc was 400 ms. What is the
severity/grade of the adverse event? What are the appropriate actions to take?
53
7. An MDR-TB patient on SLOR Fq Susceptible regimen complains of lower body
weakness. The patient could no longer walk nor stand by himself/herself and had
to be assisted going to the facility. What ADR could the patient be experiencing?
What should you do?
9. A patient on ITR Regimen with SLI complains of tinnitus and dizziness. Below is her
audiometry test result.
Audiometry Test Frequency Result
Month 1 kHz 2 kHz 3 kHz 4 kHz 6 kHz 8 kHz
B 10 dB 25 dB 10 dB 30 dB 15 dB 10 dB
1 40 dB 25 dB 15 dB 60 dB 20dB 15dB
What is the severity/grade of the adverse event?
54
Part I
1. RMN complained of lower body weakness and difficulty in walking on January 3,

2019. Serum K levels tested on same date and was 3.0 mmol/L
a) Serious Adverse Event?
b) Adverse Event of Special Interest?
c) Not reportable
2. LCD after taking his meds went home to rest on February 14, 2019. While traveling
back to his residence, He experienced dizziness and fell down the jeep while in
transit. LCD suffered a hairline fracture in his left humerus and was hospitalized for
5 days.
c) Not reportable
3. On March 3, 2019, JBL reported to your facility that she was experiencing
abdominal cramping and bouts of diarrhea upon going home. She verbalized that
she goes to the bathroom at least 5 times in a day with liquid stools.
c) Not reportable
4. To whom does ADSM apply?

a. To all patients receiving Lfx and Pto
b. To all patients receiving a regimen containing Bdq and Dlm
c. To all patient receiving standard short all oral treatment regimen (SSOR)
d. A&C
e. B&C
5. One of the essential activities of ADSM:

a. Management of AEs in a timely manner
b. Collection of all AES
c. Passive clinical assessment to determine drug toxicity
6. The following are AESI, EXCEPT:

a. Acute asthmatic attack which prompted ER management
b. Mild hypokalemia
c. Hypothyroidism
55
7. Where to report SAEs and AESIs?
a. Fax report to FDA
b. Submit to ntp.pharmacovigilance@gmail.com
c. Submit to pharmacovigilance@fda.gov.ph
d. Submit to dohpdpimu@gmail.com
e. B, C & D
8. One of the following is a reportable adverse event according to national policy:

a. Dizziness and vomiting
b. Mild nausea relieved by taking medication with light meal
c. AST/ALT >3x ULN with clinical manifestations
d. Mild joint pain relived by taking of paracetamol
9. In filling out the FDA SAR form:

a. The contact number and address of the patient should be written
b. The contact number and address of the reporter should be written
c. The contact names and addresses of both the reporter and should not be
written
10. Which statement is TRUE regarding the time/schedule of reporting SAEs?

a. Should be reported within 3 days except for death which should be reported
within 48 hours
b. Deaths should be reported within 24 hours while the other SAEs should be
reported within 3 days
c. All SAEs should be reported within 24 hours
11. Adverse Event is:

a. A harmful health experience that occurs before treatment which may or may
not be associated with the medicine
b. A harmful effect suspected to be caused by a medicine when used at normal
therapeutic dose
c. A harmful experience that occurs during treatment which may or may not be
associated with the medicine
Part II
56
Instructions: Accomplish the FDA Form for patient MBC using the information below.
Assume that today is September 7, 2020.
1. Treatment facility: Lung Center of the Philippines National Center for Pulmonary
Research (LCP-NCPR)
2. Patient information:
Patient’s name: MBC
Age: 57 years old

Birthday: 07/12/1962
Sex: Male
Weight: 50.5 kg
Height: 158 cm
Ethnic Group: Filipino
3. You started MBC on the SLOR FQ S regimen last April 8, 2020. Below are the
drugs in his regimen and the daily dose:
Brand name Daily dose Manufacturer and Batch & Lot No.
Levofloxacin (Leviquin 500 mg) 1000mg Macleods BLB48957
Clofazimine (Lamprene 100 mg) 100 mg Novartis HX 0385
Linezolid (Zyvox 600 mg) 600 mg Pfizer 123GHJ
4 tabs OD then 2 tabs OD
Bedaquiline (Sirturo 100 mg) Janssen Pharmaceutica CM44785
M/W/F for 22 weeks
Vitamin B6 (Nestrex 50 mg) 200 mg Teva Operations 4578KJFD
4. He has no known allergy, no comorbidities, and concomitant drugs.
5. Monthly Brief Peripheral Neuropathy Screening result:
• Baseline: 4/6/2020: 0
• Month 1: 5/6/2020: 0
• Month 2: 6/8/2020: 0
• Month 3: 7/6/2020: 0
• Month 4: 8/6/2020: 0
6. Last September 6, 2020, at 10:00 am, the patient came to your facility for his
monthly laboratory follow up. During your assessment, the patient complained of
pain and numbness of both feet and legs. On the same day, you performed a Brief
peripheral neuropathy screening, and the patient got a score of 6 (Grade 2). You
then referred your patient to your STC physician. Upon consultation, your STC
physician instructed you to Stop linezolid, increase vitamin B6 to 200 mg daily and
give Gabapentin 300 mg daily.
57
58
INSTRUCTIONS: Decide and record the treatment outcomes of the following patients.
Case 1: Hayde Lima completed 9 months of DR-TB treatment under SSOR, on

September 25, 2020. Below are the results of her monitoring of treatment response.
Weight
Results of Sputum Monitoring
(kg)
Month Date SM Culture
0 12/21/19 2+/1+ MTB/MTB 43
1 01/21/20 0 MTB 45
2 02/23/20 0 0 48
3 03/22/20 0 0 50
4 04/24/20 0 0 51
5 05/21/20 0 0 53
6 06/21/20 0 0 56.5
7 07/21/20 0 0 56.8
8 08/21/20 0 57.1
9 09/21/20 0 57.5
TREATMENT OUTCOME:
DATE:
59
Case 2: Patient B is receiving SSOR, completed 10 months of treatment on September
16, 2019. He is adherent to his treatment and is now asymptomatic but he had poor
compliance to sputum monitoring. Below are his SM and culture results.

0 11/2/18 3+ MTB/MTB 52
1 12/2/18 0 MTB 51.2
2 1/2/19 0 0 51.5
3 2/3/19 0 0 52.5
4 3/3/19 1+ 0 54
5 4/3/19 0 0 56
6 5/4/19 ND ND 56.5
7 6/5/19 0 0 56.8
8 7/6/19 ND ND 57.1
9 8/7/19 ND ND 57.5
10 9/7/19 0 58
TREATMENT OUTCOME:
DATE:
Case 3: Patient C under SSOR, a diabetic with poor sugar control and weight loss had
positive sputum smears on the 6th month with 2 consecutive MTB culture. His last
dose was given on November 11, 2018.

0 5/10/18 3+ MTB/MTB 52
1 6/11/18 0 0 52
2 7/11/18 2+ MTB 50
3 8/11/18 2+ 0 49
4 9/11/18 2+ MTB 47
5 10/11/18 2+ 45
6 11/11/18 1+ 45
TREATMENT OUTCOME:
REASON:
DATE:
60
Case 4: Below are patient D’s monitoring of response to treatment. It’s been two
months since she last came for treatment on November 26, 2019. When the health
worker went to her home 2 weeks earlier, the apartment was vacant. The contact
person, the vendor, told the health worker that the family had moved away. The vendor
said that Patient D told her that he had finished the DR-TB treatment. She did not
know where they moved.

0 5/5/19 3+ MTB/MTB 59
1 6/5/19 0 MTB 59
2 7/6/19 0 0 60.5
3 8/7/19 0 0 61
4 9/8/19 1+ 0 61
5 10/9/19 0 0 60
6 11/8/19 0 0 61
7 ND ND
8 ND ND
TREATMENT OUTCOME:
REASON:
DATE:
Case 5: Patient E who is receiving SSOR completed 10 months of treatment on March

17, 2020. He is adherent to his treatment and submission of sputum.

0 5/5/19 3+ MTB/MTB 59
1 6/5/19 0 0 59
2 7/6/19 0 0 60.5
3 8/7/19 0 0 61
4 9/8/19 1+ 0 61
5 10/8/19 0 0 60
6 11/8/19 0 0 61
7 12/9/19 0 0 63
1/10/20
8 1+ / 0 0 63
1/13/20
9 2/9/20 0 64
10 3/9/20 0 65.5
TREATMENT OUTCOME:
DATE:
61
Case 6: Patient F is enrolled in ITR with SLI. Below is the treatment response of the
patient.
Last dose intake: May 12, 2019.
Weight
Results of Sputum Monitoring
(kg)
Month Date SM Culture
0 5/5/18 3+ MTB/MTB 59
1 6/5/18 0 0 59
2 7/6/18 0 0 60.5
3 8/7/18 0 0 61
4 9/8/18 0 0 61
5 10/08/18 0 0 60
6 11/09/18 0 0 61
7 12/8/18 0 ND 63
8 1/9/19 1+ MTB 60
9 2/9/19 1+ ND 58
10 3/9/19 2+ MTB 57.6
11 4/10/19 2+ 56
12 5/10/19 0 55
TREATMENT OUTCOME:
REASON:
DATE:
62
Case 7: Patient G is receiving ITR, below is completed 21 months of treatment on
February 15, 2020. He is adherent to his treatment and submission of sputum.

0 5/5/18 3+ MTB/MTB 59
1 6/5/18 2+ MTB 59
2 7/6/18 0 0 60.5
3 8/7/18 2+ 0 61
4 9/8/18 1+ 0 61
5 10/8/18 0 0 60
6 11/8/18 0 0 61
7 12/9/18 0 0 63
8 1/9/19 0 ND 63
9 2/9/19 0 0 64
10 3/9/19 0 ND 65.5
11 4/10/19 0 0 66
12 5/10/19 0 ND 66.5
13 6/10/19 0 0 67
14 7/10/19 0 ND 67
15 8/10/19 0 0 67.3
16 9/10/19 0 ND 67
17 10/11/19 0 0 67
18 11/11/19 0 ND 68
19 12/11/19 0 Pending 68
20 1/11/20 0 68
TREATMENT OUTCOME:
DATE:
63
Case 8: Patient H is clinically diagnosed receiving SSOR, below is the completed 9
months treatment response of the patient. Last dose intake was on December 15, 2019.

0 3/5/19 0 0 59
1 4/5/19 0 0 59
2 5/6/19 0 0 60.5
3 6/7/19 0 0 61
4 7/8/19 0 0 61
5 8/6/19 0 0 60
6 9/5/19 0 0 61
7 10/5/19 0 0 63
8 11/5/19 0 63
9 12/6/19 0 64
TREATMENT OUTCOME:
DATE:
64
INSTRUCTIONS: Demonstrate interpersonal communication and counseling by
participating in this role play activity
The facilitator will conduct a discussion of the role-play experience after the activity.
65
Select the best answer the following questions. Encircle the best answer.
1. The institution of patient-centeredness in TB care recognizes the patient as an important

partner in the decision-making process on the diagnosis, treatment and management of
the TB disease.
A. True
B. False
2. Addressing the patient’s social and economic conditions underlying the occurrence of the
TB disease does not in any way significantly impact tuberculosis care of the patient.
A. True
B. False
3. Development of a comprehensive treatment and care plan should take the following into
consideration, EXCEPT:
A. Use of a standardized patient assessment and care plan
B. Review and update plan monthly based on both clinical and non-medical needs of
patient (social, psychological, economic)
C. Prioritize patients with high probability for treatment cure and completion for
supportive care
D. Ensure confidentiality of patient information
4. Location of treatment as preferred by the patient, can be:

A. At home
B. Workplace
C. Both
D. Neither
5. Treatment supporters for patients treated at the community level can be anyone of the
following, EXCEPT:
A. Community health volunteer
B. Family member oriented into the TB treatment of the patient
C. Both
D. No exception
6. Provision of nutritional support to TB patients on treatment could be accorded with:

A. Conducting baseline and periodic nutritional assessments through computation of the
patient’s BMI
B. Nutritional advice from a nutritionist in promoting build-up or nutritional rehabilitation
C. Both
D. Neither
66
7. TRUE of palliative care:
A. Palliative care is offered only at the time that the patient has failed treatment and is
medically improbable to proceed to another course of treatment.
B. Palliative care and hospice care are essentially the same.
C. Palliative care can be offered to the patient, as decided by the TB Medical Advisory
Committee or when the patient fails the alternatives to treatment and there is no
possible cure.
D. It is not considered as an option in the treatment and management for DR-TB patients.
8. Regular monitoring and treatment of the patient’s mental health, includes:

A. Ancillary medications to treat depression and other mental health conditions
B. Baseline and periodic assessment of the patient’s mental health condition through a
standardized assessment tool
C. Both
D. Neither
9. TB patients with the following comorbid conditions are appropriately managed and treated
during the course of the TB treatment:
A. Patients on illicit drug use
B. Patients with excessive alcohol use or alcohol-dependent
C. Both
D. Neither
10. The following are important policies governing patient-centered approach to TB care,
EXCEPT;
A. The impact of poverty and food insecurity on TB diagnosis and treatment shall be
recognized and addressed by linking TB patients to social protection measures.
B. Psycho-emotional support and protection from social isolation or discrimination shall
be provided to all TB patients.
C. The patient’s physical comfort, safety and wellness shall be maximized by providing
evidence-based integrated care for TB and other comorbidities.
D. Throughout the continuum of TB care, patient can only participate in deciding on their
treatment and management when permitted by their provider.
67
INSTRUCTIONS: Based from the INVENTORY COUNT OF SLDS, make a stock card for
each drug.
Use February 4, 2019 as entry date in the Stock Card
Drug Name UOM Batch number Expiry Date Quantity

Prothionamide 250mg Tablet PTAHH0058 02/23/2022 500
Clofazimine 100mg Capsule JC2600 06/01/2023 26
Clofazimine 100mg Capsule JC3600 03/01/2024 200
Bedaquiline 100mg Tablet TMC18017 05/31/2023 374
Levofloxacin 500mg Tablet EQA105 01/31/2024 500
Pyrazinamide 500mg Tablet EPB8416A 07/01/2023 700
68
69
70
71
72
73
74
75
INSTRUCTIONS: Do the following instructions provided below.
1. Based from the information/scenario provided, dispense the following NTP

Products.
PROJECTED
PROJECTED DAILY PROJECTED WEEKLY
DRUG MONTHLY
COMSUMPTION COMSUMPTION
COMSUMPTION
Prothionamide
14 98 420
250mg
Clofazimine
4 28 120
100mg
Bedaquiline
2 14 60
100mg
Levofloxacin
10 70 300
500mg
Pyrazinamide
20 140 600
500mg
1. Assume that today is February 4, 2019. Using the projected weekly consumption,
update the stock cards reflecting the quantities you were supposed to dispense
this week
2. Dispense for the following week use February 11, 2019 as the date. Suppose
that there are still 2 tablets of Prothionamide, 3 capsules of Clofazimine
100 mg, 4 tablets of Bedaquiline, 2 tablets of Levofloxacin 500 mg, and 4
tablets of Pyrazinamide left in the facility’s’ medicine box
3. Assume that today is March 11, 2019 and a delivery of second line drugs came
from the warehouse. Based on the delivery receipt provided, update the stock
cards accordingly.
76
GENERAL FORM NO. 30(A) IR-DOH-PMDT (SL-AM)-564-14
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF HEALTH
INVOICE – RECEIPT FOR PROPERTY
March 11, 2019
TRANSFER of the property from the Department of Health to Lung Center of the Philippines (PMDT – TC) National Center
for Pulmonary Research Building, Quezon Avenue, Quezon City authorized by Office of the Secretary.
CONTRACT/ UNIT
QTY UNIT NAME AND DESCRIPTION LOT NUMBER EXPIRY DATE TOTAL VALUE
PO NUMBER VALUE
Pyrazinamide 500 mg /
1 CAN EPB8523A 07/31/2024 2,000.00 2,000.00
1000 tabs/can
Prothionamide 250 mg /
2 BOX PTAHH0058 02/23/2022 2,345.69 4691.38
100 tabs/box
Levofloxacin 500 mg/ 658.46
2 BOX EQA105 01/31/2024 329.23
100 tabs/box
x-x x-x-x-x-x-x-x
Total: Php 7,349. 84
VIA LAND FREIGHT

Contact Person:
Cristina Joy Brigaha
0905-4628274
02-9215877/ 02-9246101 local 250
Address:
National Center for Pulmonary Research (NCPR) Bldg., Quezon Avenue, Quezon City
INVOICE RECEIPT
I certify that have this _____ day of __________ invoiced to I certify that have this _____ day of __________ received from
____________________________________ _____________ ________________________________ _____________
(Name) (Designation) (Name) (Designation)
the above listed articles, property of DOH. The above listed articles, property of DOH.
(Name of bureau or office)
DAVID P. MASYADO JR., ME, MM
OIC, Material Management Division (Printed Name/Signature of Receiving Accountable Officer
77
Encircle the best answer.
1. Recording and reporting for NTP shall be implemented in screening and diagnosing
facilities only, whether public or private.
A. True
B. False
2. The following statements are true regarding general procedures on ITIS, except:
A. Screening forms, treatment cards, laboratory results, and update on patient charts
should be encoded at least once a week and real time for DOT and laboratory
requests.
B. Assign at least one staff as the ITIS Encoder and the head of the facility or the
physician as ITIS Validator to ensure the accuracy and consistency of records and
encoded data.
C. ITIS account of personnel who are already resigned or have been transferred to
other program can be used by the new staff in the facility.
D. For facilities implementing the ITIS Laboratory Module, encode Laboratory
Request Forms by requesting facility prior to sending of specimen to the
laboratory.
3. Which of the following is the correct format in writing the DATE?

A. M/DD/YYYY
B. MM/DD/YY
C. MM/DD/YYYY
D. DD/M/YYYY
4. The following statements are correct regarding the Integrated TB Information System
(ITIS), EXCEPT:
A. ITIS is an integrated patient – based information system used for recording and
reporting TB/DR-TB cases.
B. ITIS is the official electronic TB information system of the National TB Control
Program.
C. ITIS available in online and offline versions for both Drug Susceptible and Drug
Resistant TB.
D. ITIS can generate reports for both Drug Susceptible and Drug Resistant TB.
5. For new health workers requesting access to ITIS, he/she must do this FIRST:
A. Request for an NTP Facility Code
B. Send an e-mail to integtbis@gmail.com
C. Request inclusion to the TB Care Providers Database through respective
Regional ITIS Admin
D. Fill out the KMITS Service Request Form
78
6. All NTP paper-based records shall be kept for _______ after treatment outcome before
properly being discarded.
A. 5 years
B. 10 years
C. 7 years
D. 3 years
7. It is the process of transferring data or records in a less frequently used storage in order
to still keep the record in case of future need.
A. Storage
B. Archiving
C. Data privacy
8. The following statements are correct, Except:

A. Notification of DOTS facilities, whether referring or treating, is through the TB
Register and/or DR-TB Register.
B. A diagnosing facility shall ensure that all diagnosed cases are started on treatment.
Diagnosing facilities will monitor their enrolment rate.
C. A treating facility shall ensure that all treated patients are successfully treated.
Treating facilities will monitor their treatment success rate.
D. All diagnosed TB cases shall be notified by the treating facility.
9. In recording patient’s data, which of the following statements is correct?

A. Do not leave any blanks. Indicate “NA” if not applicable to patient or patient is
ineligible, “ND” if patient is eligible but activity was not done, “none” or “0” if
nothing, and “Unk” if unknown by staff or patient, accordingly.
B. Transferred-in patients may not be written in the TB register.
C. Use liquid eraser or correction tape in case of error corrections in paper records.
D. Update records only before the scheduled data quality check.
10. It is the aspect of data management that deals with determining what data in an
information system can be shared with third parties
A. Screening
B. Storage
C. Archiving
D. Data Privacy
79
Encircle the best answer to the following questions.
1. It is a systematic process intended to identify previously undiagnosed cases of TB/DR-

TB among contacts of an index case.
A. Contact Investigation
B. Administrative Control
C. Environmental Control
D. Managerial Activities
2. Which of the following statement is FALSE?

A. Place or re-arrange furniture and seating such that staff-patient interaction occur
with airflow passing from patient to health worker (i.e., airflow from “dirty” to
“clean”).
B. Evaluate and document direction of airflow daily in high-risk areas within the health
facility. Use smoke test (incense sticks or mosquito coil) to visualize air movement.
C. Use natural ventilation by opening windows and doors or using tents.
D. Ensure that fans are clean and working properly.
3. TB prevention and infection control measures shall be implemented in all health care
settings.
A. True
B. False
4. Which of the following criteria does not determine the infectiousness of a patient?
A. Pulmonary cavitation
B. Sputum smear
C. Nutritional status
D. Force and frequency of the cough
5. It is the first line of defense, and the most important level in the hierarchy of TB
Infection Control.
A. Environmental Control
B. Respiratory Control
C. Administrative Control
D. None of the above
6. It ensures the smooth and effective implementation of the administrative,

environmental, and respiratory protection control measures.
A. Contact Investigation
B. Administrative Control
C. Environmental Control
D. Managerial Activities
80
7. Which of the following does not influence the number of infectious bacilli released?
A. Cough etiquette
B. Immune status
C. Frequency of contact
D. Frequency of cough
8. All of the following are institutional factors, except:

A. Lack of adequate ventilation
B. High risk procedures
C. Policies and practices in place
D. None of the above
9. Which of the following under the recipient factors influence the dose of inhaled bacilli?
1. Risk of TB infection
2. Closeness, duration and frequency of contact
3. Adherence to Infection Control practices
4. Immune status and general health
A. 2 and 3
B. 1 and 3
C. 2 and 4
D. 1 and 4
10. Preventive therapy shall be given to close contacts of DR-TB patients.

A. True
B. False
11. Which of the following is not Respiratory Protection Control?

A. Use of natural ventilation.
B. Perform fit test every 6 months or as needed.
C. Identification who among the health facility staff will wear respirators.
D. Train staff on how to maintain and proper disposal of the respirator.
12. Intrinsic virulence factor of MDR-TB bacilli is greater than drug susceptible bacilli.
A. True
B. False
13. It is the minimum infection prevention practices that apply to all patient care,
regardless of suspected or confirmed infection status of the patient, in any setting
where health care is delivered.
A. Contact Precaution
B. Droplet Precaution
C. Standard Precaution
D. Airborne Precaution
81
14. Given the following statements, which of the following is not an infectious TB Case?
A. Completed appropriate therapy for 1 week with high improvement of signs and
symptoms.
B. A smear positive patient but with improved signs and symptoms.
C. Finished 2 weeks of TB medication under direct observation.
D. A & B
15. Administer BCG vaccination at birth.

A. True
B. False
82
Encircle the best answer.
1. Which statement is true for Latent TB Infection (LTBI)?
a. Person who are not infected by mycobacteria TB can have LTBI

b. A state of persistent immune response to stimulation by Mycobacterium
tuberculosis antigens when a person is infected by mycobacteria tuberculosis with
no evidence of clinical manifestations of active TB disease
c. The vast majority of people with LTBI manifest signs and symptoms
d. There is a gold standard test to identify a person has LTBI or not
2. Which statement is true for the identification of persons with LTBI?
a. Can identify by signs and symptoms

b. Can identify by TST
c. There is no gold standard that can identify a person has definitely LTBI
3. Which statement is true for persons who are potentially eligible for preventive TB
treatment?
a. People living with HIV including infant < 1 year old are potentially eligible
b. Household close contacts only <5 years old are eligible
c. All household contacts of bacteriologically confirmed pulmonary TB (all ages) are
eligible
d. Children ˂5 years old who are household contacts of clinically diagnosed TB cases
are not eligible
4. What is the initial step before deciding if a person is eligible to take TB preventive
treatment or not?
a. Exclusion of active TB disease

b. Exclusion of HIV
c. Exclusion of Diabetes Mellitus
83
5. Which procedure is required as an initial step for the exclusion of active TB disease in
children <5 years old household contacts of bacteriologically confirmed TB cases?
a. Only checking by signs and symptoms such as current cough, fever, weight loss
and night sweat
b. Tuberculin Skin Test (TST) is mandatory
c. CXR is mandatory
6. Which statement is true for the required initial step for the exclusion of active TB
disease in adults and children > 5 years old household contacts?
a. TB signs and symptoms and CXR are both required procedures

b. TB signs and symptoms, CXR and TST are mandatory for all adult household
contacts
c. TB signs and symptoms and either CXR or TST are required procedures
7. Who requires TST prior to starting TB preventive treatment?
a. PLHIV
b. <5 years old, household contact of BCTB
c. >=5years old, household contact of BCTB WITH other TB risk factors (such as
diabetes, smoking, malnourished, etc.)
d. 5 years and older, household contacts, BCTB but with no risk factor for TB
8. For whom TST is not mandatory prior to starting TB preventive treatment?
a. Children <5 years old who is household contact of bacteriologically confirmed TB

case
b. People living with HIV who are >1 year old
c. Adult household contact with bacteriologically confirmed TB case with at least one
other risk factor (such as diabetes, smoking, malnourished, etc.)
d. Adult household contact with bacteriologically confirmed TB case without any risk
factor
e. All close contacts of clinically diagnosed TB cases
f. None of the above
g. Children <5 years old who is household contact of bacteriologically confirmed TB
case, People living with HIV who are >1 year old, Adult household contact with
bacteriologically confirmed TB case with at least one other risk factor (such as
diabetes, smoking, malnourished, etc.)
84
9. What are the regimens for TB preventive treatment?
a. 3 HP, 6HRZE, 6H
b. 3 HP, 6H, 3 HR, 4R
c. 12H, 4HR, 3 HP
10. Which statement is not true for the required initial step for the exclusion of active TB
disease in adults and children > 5 years old household contacts?
a. TB signs and symptoms is negative, at least CXR or TST is required in adult close
contacts of bacteriological confirmed TB case.
b. TB signs and symptoms, CXR and TST are mandatory for all adult household
contacts
c. TB signs and symptom is positive in children < 5 years old household contact,
further investigation for active TB disease is required.
85

Exercise Workbook April 2021

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Exercise Workbook April 2021

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TRAINING FOR

NATIONAL TUBERCULOSIS CONTROL PROGRAM

ADVANCING CLIENT CENTERED CARE AND EXPANDING

Exercise 2: Identifying Presumptive TB 5

Exercise 8: Assigning Appropriate Treatment Regimen and Monitoring of

Exercise 20: Use of Stock Cards 68

Exercise 22: Recording and Reporting for PMDT 78

Resistance Pattern Answer

10. H Z Lfx -resistant

11. H R Z E Lfx Mfx Bdq Lzd -resistant

Presumptive TB: YES NO

Presumptive TB: YES NO

Presumptive TB: YES NO

Presumptive TB: YES NO

Presumptive TB: YES NO

Presumptive TB: YES NO

Presumptive TB: YES NO

Presumptive TB: YES NO

Presumptive TB: YES NO

Presumptive TB: YES NO

Presumptive TB: YES NO

Presumptive TB: YES NO

Presumptive TB: YES NO

CASE 1: HAYDE DAYAN LIMA

Person to notify in case of emergency: Antonia Lima (mother)

Ms. Lima looks dyspneic and verbalized difficulty of breathing on exertion.

III. Social History

IV. Physical examination and laboratory procedures:

(1) Anatomical Site

Give the appropriate regimen and dosage:

What is the appropriate regimen for this patient?

What is the appropriate regimen for this patient?

What is the appropriate regimen for this patient?

What is the appropriate regimen for this patient?

What is the appropriate regimen for this patient?

What is the appropriate regimen for this patient?

What is the appropriate regimen for this patient?

What is the appropriate regimen for this patient?

What is the appropriate regimen for this patient?

What is the appropriate regimen for this patient?

11. Patient MMM

What is the appropriate regimen for this patient?

• Today is December 21, 2019

Results of Sputum Monitoring Weight

What is the appropriate action for HDL?

Results of Sputum Monitoring Weight

What is the appropriate action for this patient now?

Results of Sputum Monitoring Weight

What is the appropriate action for this patient now?

Results of Sputum Monitoring Weight

Results of Sputum Monitoring Weight

What is the appropriate action?

Results of Sputum Monitoring Weight

Results of Sputum Monitoring Weight

Results of Sputum Monitoring Weight

4. How will you manage mild vomiting?

1. RMN complained of lower body weakness and difficulty in walking on January 3,

4. To whom does ADSM apply?

5. One of the essential activities of ADSM:

6. The following are AESI, EXCEPT:

8. One of the following is a reportable adverse event according to national policy:

9. In filling out the FDA SAR form: