Tuberculosis: treatment regimens and monitoring MCQs With Answer

Introduction

This quiz collection on Tuberculosis: treatment regimens and monitoring is designed specifically for M.Pharm students studying Pharmacotherapeutics II (MPP 202T). It covers core concepts including first‑line and second‑line regimens, definitions of drug resistance, drug mechanisms, major adverse effects, therapeutic drug monitoring, drug–drug interactions and practical monitoring strategies during treatment. Questions range from regimen selection for drug‑sensitive and drug‑resistant TB to laboratory and clinical monitoring (LFTs, vision, audiometry, ECG, sputum/culture conversion) and special situations such as pregnancy, HIV co‑infection and preventive therapy. Use these MCQs to test and deepen your understanding of TB pharmacotherapy and monitoring protocols.

Q1. Which standard regimen represents the WHO‑recommended 6‑month treatment for drug‑susceptible pulmonary tuberculosis?

• 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol followed by 4 months of isoniazid and rifampicin (2HRZE/4HR)
• 6 months of isoniazid and ethambutol only
• 9 months of isoniazid monotherapy
• 2 months of streptomycin and isoniazid followed by 7 months of rifampicin

Correct Answer: 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol followed by 4 months of isoniazid and rifampicin (2HRZE/4HR)

Q2. Multidrug‑resistant tuberculosis (MDR‑TB) is defined as resistance to which of the following drugs?

• Isoniazid and rifampicin
• Any fluoroquinolone and at least one injectable second‑line agent
• Pyrazinamide only
• Isoniazid alone

Correct Answer: Isoniazid and rifampicin

Q3. Which monitoring test is most important before and during ethambutol therapy to detect a dose‑related adverse effect?

• Baseline and periodic visual acuity and color vision testing
• Serial liver function tests (ALT/AST)
• Monthly serum uric acid
• Baseline and weekly audiometry

Correct Answer: Baseline and periodic visual acuity and color vision testing

Q4. Isoniazid commonly causes peripheral neuropathy; which measure is recommended to reduce this risk in high‑risk patients?

• Administration of pyridoxine (vitamin B6) concurrently with isoniazid
• Co‑administration of probenecid
• Giving isoniazid only at night
• Increasing dietary protein intake

Correct Answer: Administration of pyridoxine (vitamin B6) concurrently with isoniazid

Q5. Which adverse effect is most characteristically associated with pyrazinamide and should be monitored clinically and biochemically?

• Hepatotoxicity and hyperuricemia leading to gout
• Optic neuritis
• Ototoxicity and nephrotoxicity
• Thrombocytopenia

Correct Answer: Hepatotoxicity and hyperuricemia leading to gout

Q6. Rifampicin has a major pharmacokinetic interaction due to which mechanism?

• Potent induction of hepatic cytochrome P450 enzymes leading to reduced plasma levels of many drugs
• Competitive inhibition of P‑glycoprotein causing increased levels of co‑medications
• Direct displacement of drugs from plasma albumin
• Inhibition of renal tubular secretion increasing levels of aminoglycosides

Correct Answer: Potent induction of hepatic cytochrome P450 enzymes leading to reduced plasma levels of many drugs

Q7. Which monitoring is most appropriate in patients on bedaquiline therapy?

• Regular ECG monitoring for QT interval prolongation and correction of electrolytes
• Monthly audiometry to detect ototoxicity
• Frequent visual acuity testing for optic neuritis
• Daily blood glucose monitoring

Correct Answer: Regular ECG monitoring for QT interval prolongation and correction of electrolytes

Q8. The WHO shorter MDR‑TB regimen that lasts approximately 9–12 months is indicated for which patients?

• Patients with confirmed MDR‑TB who have not been exposed to second‑line drugs and meet eligibility criteria
• All patients with any rifampicin resistance irrespective of prior treatment
• Only pediatric drug‑sensitive TB cases
• Patients who are pregnant and have XDR‑TB

Correct Answer: Patients with confirmed MDR‑TB who have not been exposed to second‑line drugs and meet eligibility criteria

Q9. Which of the following defines extensively drug‑resistant tuberculosis (XDR‑TB) under traditional criteria?

• MDR‑TB plus resistance to any fluoroquinolone and at least one of the second‑line injectable agents (amikacin, kanamycin, capreomycin)
• Resistance to isoniazid only
• Resistance to pyrazinamide and ethambutol only
• MDR‑TB with acquired resistance to bedaquiline

Correct Answer: MDR‑TB plus resistance to any fluoroquinolone and at least one of the second‑line injectable agents (amikacin, kanamycin, capreomycin)

Q10. Which agent used in drug‑resistant TB therapy is most associated with myelosuppression and peripheral/optic neuropathy requiring CBC and neurologic monitoring?

• Linezolid
• Ethambutol
• Rifampicin
• Pyrazinamide

Correct Answer: Linezolid

Q11. Therapeutic drug monitoring (TDM) in TB is most indicated under which clinical circumstances?

• Treatment failure or relapse, malabsorption, significant drug–drug interactions (e.g., with antiretrovirals), or severe/extensive disease
• All patients on standard 6‑month therapy without complications
• Patients receiving only isoniazid preventive therapy
• Children under 2 years receiving routine therapy

Correct Answer: Treatment failure or relapse, malabsorption, significant drug–drug interactions (e.g., with antiretrovirals), or severe/extensive disease

Q12. Which baseline investigations are routinely recommended before starting first‑line intensive TB therapy (includes pyrazinamide)?

• Liver function tests, baseline renal function, and assessment for hearing and vision when indicated
• Only a chest X‑ray is required
• Routine brain MRI and echocardiogram
• Genetic testing for isoniazid acetylation status in all patients

Correct Answer: Liver function tests, baseline renal function, and assessment for hearing and vision when indicated

Q13. Which monitoring parameter is most useful to document bacteriological response to therapy in pulmonary TB?

• Sputum smear and culture conversion (particularly culture) over time
• Serial chest circumference measurements
• Fasting blood glucose
• Weekly complete lipid profile

Correct Answer: Sputum smear and culture conversion (particularly culture) over time

Q14. What is the typical expectation for sputum smear conversion in drug‑susceptible pulmonary TB after starting an appropriate intensive phase regimen?

• Most patients become smear‑negative by the end of the 2‑month intensive phase
• Smear positivity persists for at least 6 months in all cases
• Sputum smear becomes negative within 24 hours of starting therapy
• Smear conversion is not relevant and should not be checked

Correct Answer: Most patients become smear‑negative by the end of the 2‑month intensive phase

Q15. Which of the following statements about streptomycin, when used as a second‑line injectable, is correct regarding monitoring?

• Periodic audiometry and renal function tests are needed due to risk of ototoxicity and nephrotoxicity
• No monitoring is required beyond clinical observation
• Only liver function tests are required because it causes hepatotoxicity
• Visual acuity testing is mandatory because of optic neuritis

Correct Answer: Periodic audiometry and renal function tests are needed due to risk of ototoxicity and nephrotoxicity

Q16. In patients co‑infected with HIV, which antiretroviral class is most affected by rifampicin co‑administration and typically requires regimen adjustment?

• Protease inhibitors (PIs) due to marked reduction in PI plasma concentrations
• Integrase inhibitors are universally unaffected
• Nucleoside reverse transcriptase inhibitors (NRTIs) are completely contraindicated
• Non‑nucleoside reverse transcriptase inhibitors (NNRTIs) increase rifampicin levels

Correct Answer: Protease inhibitors (PIs) due to marked reduction in PI plasma concentrations

Q17. Which preventive therapy regimen is commonly recommended for latent TB infection in many national programs?

• 6–9 months of isoniazid monotherapy
• 2 months of pyrazinamide monotherapy
• 12 months of ethambutol alone
• Daily rifampicin for 3 days

Correct Answer: 6–9 months of isoniazid monotherapy

Q18. Which drug used in MDR/XDR TB regimens is associated with QT prolongation and often combined with ECG monitoring and avoidance of other QT‑prolonging drugs?

• Bedaquiline (and delamanid also shares this concern)
• Isoniazid
• Ethambutol
• Rifampicin

Correct Answer: Bedaquiline (and delamanid also shares this concern)

Q19. Which clinical situation is a contraindication to the use of streptomycin in TB therapy?

• Pregnancy, because streptomycin is ototoxic to the fetus
• Controlled hypertension
• Well‑controlled diabetes without complications
• Mild anemia responding to iron therapy

Correct Answer: Pregnancy, because streptomycin is ototoxic to the fetus

Q20. According to common programmatic definitions, what finding at month 5 or later during treatment is most consistent with treatment failure for pulmonary TB?

• Persistent or recurrent positive sputum smear or culture at month 5 or later despite adequate therapy
• Residual chest X‑ray scarring without bacteriological evidence
• Weight gain but persistent cough
• Transient fever within the first two weeks of therapy

Correct Answer: Persistent or recurrent positive sputum smear or culture at month 5 or later despite adequate therapy

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