National TB Control Program and Revised National TB Control Program MCQs With Answer

Introduction: The National TB Control Program and the Revised National TB Control Program (RNTCP) are core public health strategies for tuberculosis (TB) control, emphasizing DOTS implementation, standardized anti-TB treatment regimens, case detection by sputum smear microscopy, and robust surveillance. RNTCP focuses on treatment adherence, fixed-dose combinations, drug-susceptibility testing, management of drug-resistant TB (MDR-TB), and pharmacovigilance. For B. Pharm students, understanding first-line anti-TB drugs, adverse effects, drug interactions, role of pharmacists in counseling and DOT provision, and program indicators like case detection rate and treatment success is essential to support national TB control efforts. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which of the following is the central treatment strategy promoted by RNTCP for ensuring adherence and cure?

• Directly Observed Treatment, Short-course (DOTS)
• Mass community vaccination campaigns
• Self-administered long-course therapy without monitoring
• Herbal adjunct therapy

Correct Answer: Directly Observed Treatment, Short-course (DOTS)

Q2. In which year was the Revised National TB Control Program (RNTCP) launched nationally in India?

• 1962
• 1997
• 2005
• 2019

Correct Answer: 1997

Q3. Which first-line anti-TB drug is primarily considered bacteriostatic rather than strongly bactericidal?

• Isoniazid
• Rifampicin
• Ethambutol
• Pyrazinamide

Correct Answer: Ethambutol

Q4. What is the standard Category I treatment regimen under RNTCP for new sputum smear-positive pulmonary TB?

• 2 months HRZE followed by 4 months HR
• 6 months HRZE throughout without change
• 8 months HRE without intensive phase
• 12 months daily rifampicin monotherapy

Correct Answer: 2 months HRZE followed by 4 months HR

Q5. Which of the following lists the five core components of the DOTS strategy?

• Political commitment, case detection by microscopy, standardized treatment with supervision, effective drug supply, monitoring and evaluation
• Mass screening, decentralization, herbal therapy, private sector exclusion, single drug therapy
• Vaccination, quarantine, hospital-only treatment, homeopathy, no monitoring
• Rapid molecular testing only, no microscopy, no supervision, no drug supply chain

Correct Answer: Political commitment, case detection by microscopy, standardized treatment with supervision, effective drug supply, monitoring and evaluation

Q6. Under RNTCP, what is the primary initial diagnostic test used for detecting pulmonary TB in most peripheral settings?

• Sputum smear microscopy (Ziehl–Neelsen)
• Chest CT scan
• Bone marrow biopsy
• Urine culture

Correct Answer: Sputum smear microscopy (Ziehl–Neelsen)

Q7. How is a “new smear-positive” pulmonary TB case defined under RNTCP?

• Patient previously treated for TB for more than 6 months
• Patient never treated for TB or treated for less than one month
• Patient with extrapulmonary TB only
• Patient on second-line drugs from start

Correct Answer: Patient never treated for TB or treated for less than one month

Q8. What is the standard Category II (re-treatment) regimen used under RNTCP?

• 2 months HRZES, 1 month HRZE, 5 months HRE (total 8 months)
• 6 months HR only
• 12 months daily streptomycin monotherapy
• Short 3-month regimen of only rifampicin and isoniazid

Correct Answer: 2 months HRZES, 1 month HRZE, 5 months HRE (total 8 months)

Q9. Which adverse effect is classically associated with ethambutol therapy?

• Hepatotoxicity with jaundice
• Optic neuritis leading to decreased visual acuity and color vision defects
• Peripheral neuropathy prevented by pyridoxine
• Gout due to uric acid increase

Correct Answer: Optic neuritis leading to decreased visual acuity and color vision defects

Q10. Among the first-line anti-TB drugs, which one is most strongly associated with hepatotoxicity?

• Ethambutol
• Streptomycin
• Pyrazinamide
• Cycloserine

Correct Answer: Pyrazinamide

Q11. What is a key advantage of fixed-dose combinations (FDCs) in RNTCP?

• Increase chance of monotherapy
• Reduce pill burden, improve adherence, and prevent selective drug intake
• Require complex individual dose calculations for each patient
• Are intended for use only in MDR-TB patients

Correct Answer: Reduce pill burden, improve adherence, and prevent selective drug intake

Q12. At what point during treatment is sputum smear microscopy commonly performed to assess early sputum conversion?

• At 2 months (end of intensive phase)
• At 12 months only
• Only before starting treatment
• At 24 hours after the first dose

Correct Answer: At 2 months (end of intensive phase)

Q13. Which of the following best describes a key role of a B. Pharm graduate within RNTCP activities?

• Designing surgical TB interventions
• Counseling patients on adherence, managing adverse drug reactions, and ensuring rational dispensing
• Performing radiological diagnosis independently
• Prescribing second-line TB regimens without supervision

Correct Answer: Counseling patients on adherence, managing adverse drug reactions, and ensuring rational dispensing

Q14. How is MDR-TB defined in programmatic terms?

• Resistance to pyridoxine and ethambutol
• Resistance to at least isoniazid and rifampicin
• Resistance to all first-line drugs including streptomycin only
• Susceptibility to isoniazid and rifampicin but resistance to pyrazinamide

Correct Answer: Resistance to at least isoniazid and rifampicin

Q15. What does PMDT stand for in the context of TB control?

• Programmatic Management of Drug-resistant TB
• Public Monitoring of DOTS Treatment
• Primary Management of Drug Therapy
• Prevention of Multidrug Transmission

Correct Answer: Programmatic Management of Drug-resistant TB

Q16. Which rapid molecular test recommended under RNTCP detects Mycobacterium tuberculosis and rifampicin resistance simultaneously?

• Mantoux test
• GeneXpert MTB/RIF (CB-NAAT)
• Ziehl–Neelsen smear alone
• Blood culture

Correct Answer: GeneXpert MTB/RIF (CB-NAAT)

Q17. What is the commonly used target threshold for treatment success rate under RNTCP goals?

• Less than 50%
• About 60%
• At least 85%
• 100% mandatory for all programs

Correct Answer: At least 85%

Q18. Which of the following is NOT a component of DOTS strategy under RNTCP?

• Supervised standardized treatment (DOT)
• Case detection by sputum smear microscopy
• Provision of an uninterrupted drug supply
• Unsupervised self-administered antibiotic therapy as standard practice

Correct Answer: Unsupervised self-administered antibiotic therapy as standard practice

Q19. Which adverse effect is most typically associated with isoniazid and can be prevented by pyridoxine supplementation?

• Ototoxicity
• Peripheral neuropathy
• Optic neuritis
• Hyperuricemia

Correct Answer: Peripheral neuropathy

Q20. Who may serve as a DOT provider under RNTCP guidelines?

• Only an accredited medical specialist in tertiary centers
• A trained health worker, community volunteer or designated family member
• Only laboratory technicians performing sputum microscopy
• Any pharmacist as the sole authorized prescriber

Correct Answer: A trained health worker, community volunteer or designated family member

Q21. Which recording and reporting tools are integral to RNTCP patient management at peripheral health facilities?

• TB treatment card and TB register
• Only verbal notes with no register
• National inpatient electronic record for all admissions only
• Pharmacy invoice register exclusively

Correct Answer: TB treatment card and TB register

Q22. Under RNTCP, persistent sputum smear positivity at which time point raises strong suspicion for treatment failure and possible drug resistance?

• At 5 months or at completion of treatment
• At 24 hours after starting therapy
• Only after 2 years of treatment
• If smear negative at 2 months

Correct Answer: At 5 months or at completion of treatment

Q23. Which first-line anti-TB drug primarily acts by inhibiting mycolic acid synthesis in the mycobacterial cell wall?

• Rifampicin
• Isoniazid
• Streptomycin
• Ethambutol

Correct Answer: Isoniazid

Q24. Which anti-TB drug is particularly active in acidic intracellular environments such as within macrophages?

• Ethambutol
• Isoniazid
• Pyrazinamide
• Streptomycin

Correct Answer: Pyrazinamide

Q25. True or False: RNTCP was formally renamed the National TB Elimination Programme (NTEP) in 2019.

• True
• False
• Renamed to TB Eradication Program in 2005
• Never renamed

Correct Answer: True

Q26. Which test is commonly used for screening latent TB infection in individuals under national guidelines?

• Mantoux tuberculin skin test (TST)
• Sputum culture only
• Chest X-ray as the sole test for latent TB
• Urine antigen test

Correct Answer: Mantoux tuberculin skin test (TST)

Q27. What is a major limitation of sputum smear microscopy in TB programs?

• It is highly specific for drug resistance
• It cannot detect drug resistance and has limited sensitivity in paucibacillary cases
• It provides rapid drug-susceptibility patterns
• It requires expensive reagents and sophisticated equipment

Correct Answer: It cannot detect drug resistance and has limited sensitivity in paucibacillary cases

Q28. Which injectable antibiotic is included in Category II intensive phase under older RNTCP retreatment regimens?

• Amikacin
• Streptomycin
• Vancomycin
• Ciprofloxacin

Correct Answer: Streptomycin

Q29. Which of the following describes a major drug interaction caused by rifampicin relevant to pharmacists?

• Rifampicin inhibits CYP450, increasing levels of most drugs
• Rifampicin induces CYP450 enzymes, reducing plasma concentrations of oral contraceptives and many drugs
• Rifampicin has no interactions and is safe with all oral contraceptives
• Rifampicin only interacts with antacids and no systemic drugs

Correct Answer: Rifampicin induces CYP450 enzymes, reducing plasma concentrations of oral contraceptives and many drugs

Q30. What is the primary objective of pharmacovigilance activities within the TB control program?

• To promote over-the-counter sale of anti-TB drugs
• To monitor, detect and manage adverse drug reactions and ensure patient safety during anti-TB therapy
• To replace treatment registers with pharmacy sales data only
• To delay reporting of serious adverse events

Correct Answer: To monitor, detect and manage adverse drug reactions and ensure patient safety during anti-TB therapy

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