The following points are true regarding AFB smear microscopy

1. The following points are true regarding AFB smear microscopy Speed, highly specific for TB in high prevalence area and provides a highly accurate diagnosis Slow and tedious with low specificity but still provides a relatively highly accurate diagnosis Specific for TB because only Mycobacterium tuberculosis stains with carbol fuchsin

2. False positive AFB smear results are usually due to: Usually poor quality microscope Poor stain quality (basic fuchsin-filtration) Technician does not recognize morphology of AFB All of the above None of the above

3. The sensitivity of AFB smear microscopy depends on: Quality and number of sputum specimens as well as the quality of smear and staining The availability of culture confirmation The number of non-acid fast organisms seen in the smear. All of the above None of the above

4. Who is responsible for instructing the patient to give a good specimen ? Laboratory Technicians only Only nurses and physicians ordering the procedure Staff in both #1 and #2 should share this responsibility

5. The number of errors allowed in d=0 is: Two Three Zero One

6. Safety concerns of technicians in the TB laboratory are related to: Poor understanding of how TB is transmitted and poor understanding safe laboratory ventilation controls The low virulence of TB organisms and high infectivity of patients Lack of training on TB safety issues Both #1 and #2 Both #1 and #3

7. In follow-up smear microscopy, AFB are : likely to be very difficult to stain and are usually low in numbers generally not affected by TB drug treatment regimens obtaining quality results is not very technically challenging All of the above None of the above

8. What is the maximum number of AFB smears a technician should read in one day? 10 15 20 25

9. Is a smear positive rate of 10% among suspects a reasonable rate to consider in estimating supplies and staff for the laboratory? Yes No

10. Should each peripheral lab prepare their own stain reagents? Yes no

11. Why prepare stain reagents at the intermediate lab level? For better quality control of reagents To reduce the work load for peripheral lab Both 1 and 2

12. How often do lab staff meet with nurses and/or physicians to discuss patient results and lab reports and TB register ? Once per month Once per week Once per quarter No formal/informal meetings are held

13. What are the advantages of culture for AFB ? More sensitive than AFB smears but has relative use in low income countries except for susceptibility or to confirm TB smear negative cases It is very useful for TB control in high prevalence areas It is not a required first step for susceptibility All of the above

14. Use of rapid and more sensitive techniques for TB diagnosis Will require more stringent laboratory techniques and quality control procedures Will be more expensive for patients May be a source for cross contamination between patient cultures All of the above None of the above

15. Supervision checklists Promote uniform supervisory visits Require training for consistent application Can be used by non-laboratory supervisors All of the above

16. Quarterly supervisory visits are critical for: To maintain social relations with the peripheral laboratory To collect quarterly reports on slides tested, smear positivity, etc. To collect slides for rechecking

17. Panel testing slide sets should be validated to: Assure slide to slide consistency Avoid falsely accusing laboratories Assure that the performance measured is accurate All of the above

18. Which are the most difficult slides to interpret in panel testing? Negative 1-9 AFB/ 100 f 1+ 2+ 3+

19. Which are the most difficult slides to produce in panel testing? Negative 1-9 AFB/ 100 f 1+ 2+ 3+

20. Why should panel testing slide sets be identical between laboratories To help labs cheat To assure a consistent measure of performance To reduce costs To improve test sensitivity

21. A quantitation error is: A minor error A major error

22. LQAS PARAMETERS INCLUDE ALL EXCEPT: 1. Slide positivity rate 2. Annual turn-over of negative smears 3. Total annual turn-over of smears 4. Acceptance number �d� 5. Statistical confidence level

23. THE WORKLOAD FOR RECHECKING INCREASES STRONGLY WITH 1. Decreasing slide positivity rate 2. Decreasing false negative critical value 3. Increasing �d� 4. Increasing decentralization of microscopy 5. All of the above 6. None of the above

24. RECHECKING EQA CAN NOT BE DONE IF 1. There is a good DOTS programme 2. TB prevalence is very low 3. Intermediate laboratories do not have a fluorescence microscope 4. Samples have to be collected by non-lab supervisors 5. All of the above 6. None of the above

25. TECHNICAL REQUIREMENTS OF RECHECKING EQA 1. Are less important than statistical requirements 2. Must include QA of the NRL by a SRL 3. Include evaluation of the controllers from their results on the peripheral samples 4. Include use of random number tables to collect samples 5. All of the above

26. RECHECKING EQA IS THE METHOD OF CHOICE BECAUSE 1. It allows an accurate evaluation of individuals 2. It permits to correct patient diagnoses 3. It means less work for the higher levels 4. It is more indicative of reality and can be motivating 5. All of the above 6. It is not the method of choice

27. INDICATORS OF LAB QUALITY 1. Can only be collected during supervision 2. Can be used for internal as well as external QA 3. Always need to be calculated carefully 4. Need excellent technical knowledge of AFB-microscopy to be used properly 5. Are not influenced by factors outside the lab

28. A HIGH SUSPECT POSITIVITY RATE IN THE LAB 1. Can only be due to excellent work in the lab 2. Can be used to assess accessibility of the service 3. Is most often caused by false positives 4. Is a sensitive indicator of lab quality 5. Does not depend on prevalence of other diseases than TB

29. POSITIVITY RATE AMONG FOLLOW-UP SMEARS 1. Should be calculated excluding scanty 2. Is highly stable within the same lab 3. Indicates problems of staining if too low 4. Should be compared to low positive results among non-negative suspect smears 5. Is not a sensitive indicator

30. QUALITY OF SPUTUM COLLECTION 1. Can only be assessed by watching patients 2. Is reflected by the consistency rate of case smears 3. Is the concern of the nurses but not of the lab 4. Can not be estimated from looking at smears 5. All of the above 6. None of the above

31. LABORATORY REPORTS 1. Are useful to calculate supplies 2. Can be used to assess respect of NTP strategies and guidelines 3. Should be compared to case-detection reports 4. Should supplement supervision 5. All of the above