Exercise A: Written exercise

Now do Exercise A – Written Exercise

When you have reached this point in the module, you are now ready to do Exercise A. Follow the instructions for Exercise A. Do this excercise by yourself. Then discuss your answers with a facilitator.

Identify MDR-TB Suspects

In this exercise you will identify those patients that should be considered high-risk for having MDR-TB. Read each of the cases below. For each case, put a check on “Yes” for those who should be considered MDR-TB suspects and determine to which high-risk group they belong. Put a check on “No” for those who are not considered MDR-TB suspects.

Case 1

A 34 year old female patient, who took only 4 months of Category I treatment last year, has returned to the DOTS facility. The patient was sputum smear (-) on the 2nd and 4th months of follow-up but thereafter stopped treatment since she was already feeling better. Now the patient complains of a persistent cough for the last 4 weeks with back pain, hemoptysis and weight loss. Sputum examination result was smear-positive.

MDR-TB suspect? Yes No High-risk group

Case 2

A female patient who has received 3 different courses of TB medications over a period of many years with a private doctor has come to your facility for consultation. The patient said she took all of the medicines and completed treatment each time but now has a cough and fears it may again be TB. She also has weight loss, hemoptysis, occasional fever, chest pain and night sweats. She has come to the DOTS facility because she no longer has money to pay for treatment.

MDR-TB suspect? Yes No High-risk group

Case 3

A 55 year old male has been complaining of cough for three weeks, night sweats and fatigue. When interviewed, he says that he has not been sick for a long time but his wife told him he must come in to be checked because their 25 year old son who lived in the same house with them died of MDR-TB last year. The patient has no history of TB and has a normal chest x-ray.

MDR-TB suspect? Yes No High-risk group

Case 4

A 17 year-old female student has come to your DOTS facility for cough of more than two weeks and fever of five days. She has never been diagnosed or treated for TB in the past. She denies exposure to anybody with TB in the home or in school. You examine her and she has rales on both lower lung fields.

MDR-TB suspect? Yes No High-risk group

Case 5

A female patient, 18 years old, who is being treated for HIV in one of the treatment hubs in Metro Manila develops fever, and weight loss. The DOTS facility recognized her to be the sister of a non-converting Category II patient who has been going to this health center for TB treatment.

MDR-TB suspect? Yes No High-risk group

Case 6

A Category II (relapse) male patient just finished the third month of treatment and is still smear-positive. He still has cough and back pain and has been losing weight. The patient has had no adverse events and complies with the treatment schedule.

MDR-TB suspect? Yes No High-risk group

When you have finished this exercise, please discuss your answers with a facilitator.

Then read until the nex t exercise.