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HM2 Aug2011
Last update Jan25'11
109
Other
Not Applicable
01/13/2011

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Cards

Term
BUMEDINST 6224.8A
Definition
Tuberculosis Control Program
Term
NAVMED 6224/7
Definition
Initial Tuberculosis Exposure Risk Assessment
Term
NAVMED 6224/8
Definition
Interim Tuberculosis Exposure Risk Assessment
Term
NAVMED 6224/9
Definition
Monthly Evaluations for Patients Receiving Treatments for Latent Tuberculosis Infection (LTBI)
Term
LTBI stands for?
Definition
Latent Tuberculosis Infection
Term
NAVMED 6230/4
Definition
Adult Immunization Record
Term
NAVMED 6230/5
Definition
Child Immunization Record
Term
What is the scientific term for TB?
Definition
Mycobacterium tuberculosis
Term
What is the purpose of TB testing?
Definition
To identify persons with LTBI so that they may be treated before the disease becomes active and before transmission to others.
Term
When should the TB test be administered?
Definition

1. During the Periodic Health Assessment (PHA)

2. Operational Suitability screening

3. Within 6 months of separation from Naval Service

Term

True or False?

QFT-G is used with the TST

Definition

FALSE

Either the TST or the QFT-G is used, but not together.

Term
What does PPD stand for?
Definition
Tuberculin, Purified Protein Derivative
Term
What is the approved tuberculin skin test material for the routine Montoux test is the?
Definition

Tween-80-stabilized intermediate strength PPD available as

NSN-6505-00-105-0102

Term
Where should tuberculosis testing be recorded? (Adult & Child)
Definition
NAVMED 6230/4 Adult Immunization Record or NAVMED 6230/5 Child Immunization Record
Term
Name 4 authorized Navy electronic medical information systems
Definition

1. Armed Forces Health Longitudinal Technology Application (AHLTA)

2. Medical Readiness Reporting System (MRRS)

3. Shipboard Non-Tactical ADP Program (SNAP)

4. Automated Medical System (SAMS)

Term
PPD test reaction must be read within how many hours?
Definition
Within 48 to 72 hours after administration
Term
What should you record if the patient comes back late for reading or does not return at all?
Definition
"Not read"
Term
What should you record if there is no induration (reaction)?
Definition
"0 mm" or "zero mm".
Term
What is the US FDA approved BAMT to provide diagnostic aid for M. tuberculosis?
Definition
QuantiFERON -TB Gold (QFT-G)
Term
What does BAMT stand for?
Definition
Blood Assay for Microbacterium Tuberculosis
Term
What does TST stand for?
Definition
Tuberculin Skin Test
Term
What is the best situation to use the two-step procedure (TST/PPD)?
Definition
Most useful in reducing the likelihood of interpreting a boosted response as evidence of a new infection such as in older health care workers entering and MTF screening program.
Term
What should all persons with a positive QFT-G be evaluated for before LTBI is diagnosed?
Definition
Active TB
Term
Can a service member deploy while undergoing evaluation for a positive TST?
Definition
No. Service member must not deploy until all evaluations are complete and results have been reported.
Term
An increase in reaction size of 10 mm or more (TST/PPD), within a 3 year period, is considered what?
Definition
Skin test conversion/positive test indicative  of recent infection with TB.
Term

High Risk:

Reaction ≥5 mm of induration is considered positive in what three types of patients (TB)?

Definition

1. Recent close contacts of active TB patients

2. Persons with fibrotic or other changes on chest radiograph consistent with prior TB

3. Patients suspected of having active TB.

Term

Medium Risk:

Reaction ≥10 mm of induration is considered positive in what three types of patients?

Definition

1. Recent immigrations (within last 5 yrs) from high TB prevalence countries

2. Mycobacterium laboratory personnel

3. Persons with clinical conditions that place them at increased risk

Term

Low Risk:

Reaction ≥15 mm of induration is considered positive in what three type of patient?

Definition
Persons with no risk factors for TB
Term
At least one of what four types of medical practitioners must evaluate a newly identified patient w/ a positive BAMT or TST?
Definition

1. Medical Officer

2. Nurse practitioner

3. Physicians Assistant

4. Independent Duty Corpsman

Term
What document should be completed in the evaluation of a newly identified patient with positive BAMT or TST?
Definition
NAVMED 6224/7 Initial Tuberculosis Exposure Risk Assessment (TST).
Term
Which ICD-9 code in AHLTA should be used for documenting the NAVMED 6224/7 Initial Tuberculosis Exposure Risk Assessment?
Definition

V74.1

"Screening Exam for Pulmonary Tuberculosis"

Term
What should the chest x-ray be examined for when evaluating due to a postive BAMT or TST?
Definition
Fibrotic changes consistent with old TB infection and for any signs of active TB.
Term
What immediate action should be taken concerning a patient suspected of having active TB disease?
Definition
Immediately mask & isolate the patient and refer to the appropriate provider and/or facility for evaluation, diagnosis, and treatment.
Term
Does LTBI refer to an an infection with active TB disease?
Definition

No

LTBI refers to a LATENT TB Infection

Term
What is the preferred treatment for an patient who meets the criteria for LTBI?
Definition

Isoniazid (INH) treatment

INH 5 mg/kg (300 mg max) daily for 9 months to accomplish 270 daily doses within 12 months is preferred.

Term
What is the alternate treatment for a patient meeting the criteria for positive LTBI?
Definition
INH 15 mg/kg (900 mg max) twice weekly for 9 months only in combination with direct observation therapy (DOT).
Term
What tests should be completed on patients with increased risk for liver disease or INH-induced hepatoxicity before starting INH treatment?
Definition
serum AST (SGOT), ALT (SGPT), and bilirubin
Term
When should the care provider consider witholding INH treatment?
Definition
If a patients transaminase levels exceed 3 - 5 times the upper limits of normal.
Term

True or False?

 

INH is the only treatment for LTBI?

Definition
False
Term

How oftent should patients have follow-up visits during therapy for LTBI?

 

What form should be used during these follo-up visits?

Definition

Monthly

 

NAVMED 6224/9 Monthly Evluation of Patients Receiving Therapy for Latent Tuberculosis Infection (LTBI)

Term
Which ICD-9 code should be used in AHLTA for the NAVMED 6224/9 Monthly Evlauation of Patients Receiving Therapy for Latent Tuberculosis Infection (LTBI)?
Definition

V68.1

"issue of repeat prescriptions".

Term
What does DOT stand for?
Definition
Directly Observed Therapy
Term
DOT is expecially indicated for patients undergoing treatment for LTBI who. . . ?
Definition

1. Very high risk for developing active TB and who are high risk for non-adherence with treatment.

2. Patients diagnosed with active disease.

Term
If a person gives an undocumented history of a positive BAMT or TST w/out documentation of adequate course of treatment for LTBI or active TB what should you do?
Definition
Perform a BAMT or TST.
Term
Should you perform a new BAMT or TST on a patient with a creditable history of a past positive BAMT or TST?
Definition
No. Document whether the patient received an adequate course of treatment for LTBI or active TB. If there has been no adquate course of treatment proceed with chest x-ray, evatuation, and appropriate treatment.
Term

You should document that you educated the patient on the implications of his/her BAMT or TST results, benefits and risks of LTBI treatment, and potential signs of adverse drug effects.

On what form should you document that this patient education took place?

Definition
SF 600 Medical Record Chronological Record of Medical Treatment.
Term
If the patient has a 2 month or more interruption or gap in LTBI treatment, what needs to be done?
Definition

A provider must evaluate for active TB and consider use of DOT.

 - a 9-month daily INH regimen should not be re-started if the remainder of the 270 total doses can still be administered within a 12 month period. -

Term

All naval service beneficieries who transfer from the treating health care facility or leave military service before completing a course of treatment for LTBI must be counseled on the need for continued treatment.

This couseling must be documented on what form?

Definition
NAVMED 6224/9 Monthly Evaluation for Patients Receiving Treatment for Latent Tuberculosis Infection (LTBI).
Term
What actions besides documentation of counseling on the importance of continued treatment should the treating medical department take when a patient leaves before completing LTBI treatment?
Definition

1. Contact the gaining medical departments about all transferring members currently receiving treatment for LTBI

2. Ensure the member has enough medication to continue LTBI treatment enrout to gaining medical department where treatment is to continue.

 

Term
Are members leaving active service eligible for continued treatment for LTBI post seperation?
Definition
Yes. Members are eligible for follo-up care at Veterans Administration (VA) facilities by calling the local VA prior to seperation or discharge.
Term
SECNAVINST 1752.4A
Definition
Sexual Assault Prevention and Response
Term
What does the term "sexual assault" refer to in SECNAVINST 1752.4A?
Definition
Rape, Indecent Assault, Forcible Sodomy, Assault with Intent to Rape, and Assault with Intent to Commit Sodomy.
Term

True or False?

 

The victim of a crime has the right to be provided information about the conviction, sentencing, imprisonment, and release of the offender

Definition

True.

as per SECNAVINST 1752.4A Encl (1)

Crime bill of Rights #7

Term
Where can you find the instructions on completing an official report of a sexual assault for the DON Integrated Database (ID) on crime?
Definition
NAVPERS 1752/1: pages 9-13.
Term
BUMEDINST 6280.1A
Definition
Management of Infectious Waste
Term
Where is exposure to infectious waste more likely to occur?
Definition
Occupational settings that generate, transport, store, treat, or dispose of potentially infectious materials.
Term
What is the definition of Infectious waste?
Definition
Liquid or solid waste containing pathogens in sufficient numbers and sufficient virulence to cause infectious disease in susceptible hosts exposed to the waste.
Term
Examples on non-infectious waste
Definition
Used hygiene products, diapers, facial tissues, sanitary napkins (unless from postpartum suites or gynecological surgery wards), unless waste is from isolation rooms.
Term
Examples of infectious waste.
Definition
Sharps: Hypodermic needles, syringes, scalpel blades, suture needles, Pasteur pipettes, specimen slides, sover slips, glass petri plates, and broken glass contaminated with potentially infectious material.
Term
Is microbiological waste considered "infectious waste"?
Definition
Yes. Wastes from cultures and stocks containing microbes that, due to their species, type, and virulence, or concentration are know to cause disease in humans.
Term
More examples of infectious waste?
Definition
Liquid or semi-liquid body fluids, vaginal secretions, cerebrospinal fluid, amniotic fluids, live vaccine, saliva in dental procedures, and any body fluid visibly contaminated with blood.
Term
Segregate infectious waste and non-infectious waste at. . . . ?
Definition
Its point of origin.
Term
What should an infectious waste container be labeled with and/or what color should the container be?
Definition
The universal BIOHAZARD symbol should be present and/or a RED container.
Term
True or False? It is perfectly acceptable to transport BIOHAZARD containers in Chutes and Dumbwaiters?
Definition
FALSE
Term
How should anatomical pathology waste be packaged and treated?
Definition
Double-wall corrugated boxes or equivalent rigid containers that are double lined with plastic bags for transport and incineration in an infectious waste incinerator.
Term
What ethical constraints would prevent the normal transport and disposal of anatomical waste (human remains)?
Definition
Cremation or burial by a licensed mortician. Logistical constraints may require freezing before disposal.
Term
Can blood, suctioned fluids, or other potentially infectious liquid waste be decanted into a clinical sink?
Definition
Yes, (but NOT a hand washing sink), unless it is prohibited by State or local regulations.
Term
Do more strict state and/or local regulations override less strict regulations in the BUMEDINST 6280.1A?
Definition
YES
Term
To assist in the liquid infectious waste disposal, what can be added to blood and/or other potentially hazardous fluids?
Definition
Commercially available absorbent materials which form a semi-rigid gel when added to liquids. Formed gels still must be treated as infectious waste.
Term
How should you package and transport bulk blood that cannot be decanted into a clinical sink or solidified to a gel?
Definition
Placed into rigid containers that are double-lined with plastic bags for transport and incineration. Containers must be labeled and color coded.
Term
How long shall non-refrigerated infectious waste be stored?
Definition
7 Days (preferably less) accept in States with stricter regulations.
Term
What should be taken into consideration when contracting companies for infectious waste disposal?
Definition
Storage times
Term
Where should infectious waste be stored?
Definition
In a designated area located at or near the treatment or transport site.
Term
Construction of storage areas must consider what?
Definition
Prevention of rodent intrusion and other pests.
Term
What should be visible on the outside of the infectious waste storage area?
Definition
BIOHAZARD shall be clearly visible as well as the symbol.
Term
What must occur before infectious waste can be compacted or grinded?
Definition
It must be sterilized and rendered noninfectious.
Term
What pieces of information shall be included in your practical system of monitoring the disposal of infectious waste?
Definition
Date - Time - type of waste - amount (weight, volume, or number of containers) - disposition.
Term
What should you retrieve from your off-site disposal company?
Definition
Written documentation of proper treatment and disposal.
Term
When should all personnel with occupational exposure to infectious waste receive training and how often?
Definition
Training shall be receive at initial assignment and annually thereafter. Said training is required to be documented.
Term
What should areas exposed to an infectious waste liquid spill be decontaminated with?
Definition
An Environmental Protection Agency approved disinfectant or a solution of household bleach diluted 1:10 with clear water.
Term
What are the 4 major types of infectious waste?
Definition
1. Microbiological 2. Pathological 3. Bulk Blood & other Potentially Infectious Liquid 4. Sharps in sharps containers
Term
Name the 3 methods of treatment for microbiological waste?
Definition
Steam sterilization; chemical disinfection; incineration.
Term
Name the 2 methods of treatment for pathological waste?
Definition
Incineration & cremation
Term
Name the 1 method of treatment for Bulk blood and other potentially infectious liquids.
Definition
Gelitinization
Term
Name the 2 methods of treatment for sharps in sharps containers
Definition
Steam sterilization & incineration
Term
Which types of waste are disposed of in a sanitary landfill?
Definition
Microbiological, Pathological, Bulk blood & other potentially infectious liquids, and sharps in sharps containers.
Term
What types of waste are disposed of via burial?
Definition
Pathological
Term
What type of waste is disposed of in a sanitary sewer?
Definition
Bulk blood and other potentially infectious liquids.
Term
What requirements are there for steam sterilization for effectiveness?
Definition
121 degrees Celsius (250 degrees F), for at least 90 minutes at 15 lbs per square inch of gauge pressure.
Term
What disinfection is most appropriate for liquid waste?
Definition
Chemical
Term
Ash remaining after incineration may go directly to a sanitary landfill unless what?
Definition
State or local regulations require testing for characteristics of hazardous waste.
Term
Disposal of placentas by grinding with subsequent discharge to a sanitary sewer is acceptable unless?
Definition
Prohibited by State or local laws or regulations.
Term
BUMED INST 6280.1A
Definition
Management of Infectious Waste
Term
BUMEDINST 6440.5C
Definition
Health Services Augmentation Program (HSAP)
Term

HSAP (BUMEDINST 6440.5C)

Ch. 1

Definition
HSAP Assignment Guidlines
Term

HSAP (BUMEDINST 6440.5C)

Ch. 2

Definition
Administration of Deployable Personnel
Term

HSAP (BUMEDINST 6440.5C)

Ch. 3

Definition
Training
Term

HSAP (BUMEDINST 6440.5C)

Ch. 4

Definition
Personnel Management
Term

HSAP (BUMEDINST 6440.5C)

Ch. 5

Definition
Deployment Support
Term

HSAP (BUMEDINST 6440.5C)

Ch. 6

Definition
Medical Fleet Response Plan (MFRP)
Term

HSAP (BUMEDINST 6440.5C)

Ch. 7

Definition
Expeditionary Medicine Platform Augmentation, Readiness, and Training System (EMPARTS)
Term

HSAP (BUMEDINST 6440.5C)

Ch. 8

Definition
Individual Augmentation
Term

What are the Dental Item Classifications?

 

Definition

Critical

 

Semicritical

 

noncritical

Term
What are critical, semicritical, and noncritical dental item classifications based on?
Definition
The pathways through which cross contamination may occur and the location and technique of instrument in use.
Term
What are critical items?
Definition

Instruments and materials that penetrate the skin, mucous membranes, or bone.

 

Must be sterile before use

Term
What are semicritical items?
Definition

Instruments, equipment, or sterile materials that frequently contact mucous membranes but cannot be sterilized due to their design or inability to withstand heat.

 

These items require at least high level disinfection.

Term
What are noncritical items?
Definition

Instruments, equipment, or materials that do not normally penetrate or contact the mucous membranes but which are exposed to splatter, spray, or splashing of blood, or are touched by contaminated hands.

 

Require intermediate disenfection.

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