NLE Respiratory Nursing — Upper & Lower Respiratory InfectionsExam Answer Templates

Marks

1

Topic

Tuberculosis — Infection Control

Difficulty

easy

Template Id

T1

Examiner Tip

This is one of the highest-frequency NLE distractors: TB uses AIRBORNE precautions (droplet nuclei, <5 microns). Write the word 'airborne' explicitly — partial answers about masks without naming the precaution category earn zero on a 1-mark question.

Model Answer

Airborne precautions — the patient requires placement in a negative-pressure isolation room, and health-care workers must wear an N95 respirator when entering the room.

Question Type

very_short_answer

Answer Structure

• State the correct precaution type (Airborne) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'droplet precautions' — TB is the classic airborne-vs-droplet distractor on the NLE
• Writing only 'isolation' without specifying the type
• Stating 'surgical mask' for health-care workers — a surgical mask is placed on the patient during transport, not on the nurse caring for the patient

Key Phrases To Include

• airborne precautions
• negative-pressure room
• N95 respirator

Marks

1

Topic

Tuberculosis — Philippine NTP / Screening

Difficulty

easy

Template Id

T2

Examiner Tip

Philippine-context NLE items expect you to connect clinical signs to the national program. Always mention 'Philippine NTP' or 'National TB Control Program' by name for full credit.

Model Answer

A cough lasting two weeks or more is the primary screening trigger for presumptive tuberculosis under the Philippine National TB Control Program (NTP). Any person presenting with this symptom should be referred for GeneXpert MTB/RIF testing.

Question Type

very_short_answer

Answer Structure

• Identify the two-week cough as the TB screening trigger [1 mark]

Scoring Breakdown

Common Mark Deductions

• Failing to mention the two-week duration specifically — saying 'chronic cough' alone is not precise enough
• Not linking the symptom to the Philippine NTP context

Key Phrases To Include

• two weeks or more
• screening trigger
• presumptive tuberculosis
• Philippine NTP

Marks

2

Topic

Tuberculosis — RIPE Regimen Pharmacology

Difficulty

easy

Template Id

T3

Examiner Tip

NLE drug toxicity questions almost always follow a paired format: drug + toxicity, or drug + nursing action. Practice all four RIPE drug-toxicity pairs together as a set.

Model Answer

Isoniazid (INH) is the drug in the RIPE regimen responsible for peripheral neuropathy. This adverse effect is prevented by co-administering pyridoxine (Vitamin B6) throughout the course of TB treatment.

Question Type

short_answer

Answer Structure

• Part 1: Correctly name Isoniazid (INH) as the causative drug [1 mark]
• Part 2: State that pyridoxine (Vitamin B6) is given to prevent peripheral neuropathy [1 mark]

Scoring Breakdown

Common Mark Deductions

• Naming the wrong drug (e.g., ethambutol — ethambutol causes optic neuritis, not peripheral neuropathy)
• Knowing the drug but failing to state the prevention/antidote — costs the second mark
• Writing 'B complex' instead of specifically 'pyridoxine' or 'Vitamin B6'

Key Phrases To Include

• isoniazid
• INH
• peripheral neuropathy
• pyridoxine
• Vitamin B6

Marks

2

Topic

Tuberculosis — Rifampicin Side Effects / Patient Education

Difficulty

easy

Template Id

T4

Examiner Tip

Patient-education NLE items test whether you can translate drug knowledge into therapeutic communication. Always pair the clinical fact (orange urine = rifampicin) with the nurse's therapeutic response (reassure + explain).

Model Answer

The nurse should reassure the patient that orange-red discolouration of urine is an expected and harmless side effect of rifampicin. The nurse should explain that rifampicin colours all body fluids — including urine, sweat, saliva, and tears — orange-red, and that this does not indicate bleeding or any harmful condition. No change in medication is needed.

Question Type

short_answer

Answer Structure

• Part 1: Correctly identify the cause — orange-red urine is a normal effect of rifampicin, not haematuria [1 mark]
• Part 2: Provide therapeutic reassurance and patient education explaining the harmless nature of this effect [1 mark]

Scoring Breakdown

Common Mark Deductions

• Treating the finding as haematuria and ordering further tests — demonstrates failure to recognise the drug effect
• Reassuring without explaining why — loses the educational/patient-teaching mark
• Advising the patient to stop rifampicin — never advise stopping TB drugs; this drives MDR-TB

Key Phrases To Include

• rifampicin
• orange-red discolouration
• expected side effect
• harmless
• body fluids
• reassure

Marks

2

Topic

Tuberculosis — Pathophysiology / LTBI vs Active TB

Difficulty

medium

Template Id

T5

Examiner Tip

Differentiation questions require a clear parallel structure — address the same criteria (infectiousness, symptoms) for both sides. Examiners scan for contrast, not just individual facts.

Model Answer

In latent TB infection (LTBI), the person is infected with Mycobacterium tuberculosis but the immune system has contained the bacilli in a granuloma. The person is asymptomatic and NOT infectious to others, but the tuberculin skin test (Mantoux/PPD) is positive. In active pulmonary tuberculosis, the bacilli have reactivated and are actively destroying lung tissue. The person is infectious (spreading airborne droplet nuclei) and presents with classic symptoms: a chronic productive cough ≥2 weeks, low-grade afternoon fever, night sweats, unexplained weight loss, and haemoptysis.

Question Type

short_answer

Answer Structure

• Part 1: Describe LTBI — infected, immune system contained, asymptomatic, non-infectious, PPD positive [1 mark]
• Part 2: Describe active TB — bacilli reactivated, infectious, classic symptoms present [1 mark]

Scoring Breakdown

Common Mark Deductions

• Confusing latent with active — stating that LTBI patients are also infectious
• Listing symptoms without linking them to active (infectious) disease
• Omitting the PPD/Mantoux result from the LTBI description

Key Phrases To Include

• latent TB
• non-infectious
• asymptomatic
• positive PPD/Mantoux
• active TB
• infectious
• airborne
• cough ≥2 weeks
• night sweats
• weight loss

Marks

2

Topic

Tuberculosis — Philippine NTP / Diagnostics

Difficulty

medium

Template Id

T6

Examiner Tip

NLE items on TB diagnostics frequently test whether students know the updated Philippine NTP protocol. GeneXpert replaced smear microscopy as the primary test — this is a high-yield update that many students miss.

Model Answer

GeneXpert MTB/RIF is the first-line (primary) diagnostic test for presumptive tuberculosis under the current Philippine National TB Control Program. It is a rapid molecular test that can detect the presence of Mycobacterium tuberculosis AND simultaneously identify rifampicin resistance in approximately two hours. Its use has largely replaced sputum smear microscopy (DSSM) as the initial diagnostic tool, allowing faster diagnosis and early identification of drug-resistant TB.

Question Type

short_answer

Answer Structure

• Part 1: Identify GeneXpert as the first-line diagnostic test under the Philippine NTP [1 mark]
• Part 2: State its dual function — detects M. tuberculosis AND rifampicin resistance in ~2 hours [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing GeneXpert as only a TB detector without mentioning rifampicin resistance detection — loses the second mark
• Stating that DSSM/sputum smear is still the first-line test — this is outdated under the current Philippine NTP
• Confusing GeneXpert with the Mantoux/PPD skin test

Key Phrases To Include

• GeneXpert MTB/RIF
• first-line diagnostic
• Philippine NTP
• rifampicin resistance
• rapid molecular test
• two hours

Marks

3

Topic

Tuberculosis — RIPE Regimen Pharmacology

Difficulty

medium

Template Id

T7

Examiner Tip

Examiners reward organisation. Present each drug as a numbered list entry: Name — Adverse Effect — Nursing Action. This structured format makes it easy for the examiner to tick each mark criterion quickly.

Model Answer

The RIPE regimen consists of four first-line anti-TB drugs used during the 2-month intensive phase: 1. Rifampicin — causes orange-red discolouration of all body fluids (urine, sweat, tears). Also hepatotoxic and reduces the efficacy of oral contraceptives. 2. Isoniazid (INH) — causes peripheral neuropathy; prevented by co-administering pyridoxine (Vitamin B6). Also hepatotoxic. 3. Pyrazinamide — hepatotoxic and raises serum uric acid levels, which can precipitate hyperuricaemia and gout (joint pain). 4. Ethambutol — causes optic neuritis, manifesting as decreased visual acuity and red-green colour blindness. Patients must report any visual changes immediately.

Question Type

short_answer

Answer Structure

• Drug 1: Rifampicin — name + orange-red body fluids + hepatotoxic + OCP interaction [part of the 3-mark spread]
• Drug 2: Isoniazid — name + peripheral neuropathy + pyridoxine prevention + hepatotoxic [part of the 3-mark spread]
• Drug 3: Pyrazinamide — name + hepatotoxic + hyperuricaemia/gout [part of the 3-mark spread]
• Drug 4: Ethambutol — name + optic neuritis + visual acuity loss + red-green colour blindness [part of the 3-mark spread]
• Scoring: 1 mark per 2 correctly paired drugs with their toxicities (total 3 marks for all 4 with toxicities)

Scoring Breakdown

Common Mark Deductions

• Mixing up Isoniazid and Ethambutol toxicities — a very common error (INH = neuropathy; Ethambutol = eye)
• Listing drug names without any adverse effects — scores minimal marks
• Omitting the shared hepatotoxicity of R, I, and P — a cross-cutting point examiners reward
• Writing 'RHZE' without explaining what each letter stands for

Key Phrases To Include

• Rifampicin
• Isoniazid
• Pyrazinamide
• Ethambutol
• RIPE
• orange-red body fluids
• peripheral neuropathy
• pyridoxine
• hepatotoxic
• hyperuricaemia
• optic neuritis
• visual acuity

Marks

3

Topic

Tuberculosis — DOTS / Philippine NTP

Difficulty

medium

Template Id

T8

Examiner Tip

Three-mark answers need three distinct points. Structure your response in clear paragraphs or numbered points — one for definition, one for Philippine context, one for MDR-TB prevention. Examiners look for all three.

Model Answer

DOTS stands for Directly Observed Treatment, Short-course. It is the cornerstone strategy of the Philippine National TB Control Program (NTP). In DOTS, a trained treatment partner or health worker directly watches the patient swallow every single dose of anti-TB medication. TB diagnosis and the complete drug regimen are provided free of charge through public health centres under the NTP. DOTS is essential in preventing MDR-TB because the primary cause of drug resistance is incomplete or irregular treatment. When patients stop taking their medications early — usually because they feel better after a few weeks — surviving TB bacilli develop resistance to the drugs. DOTS eliminates this risk by guaranteeing 100% adherence through direct supervision for the full 6-month course.

Question Type

short_answer

Answer Structure

• Part 1: Define DOTS — Directly Observed Treatment, Short-course; explain the mechanism (health worker watches the patient swallow each dose) [1 mark]
• Part 2: Contextualise within the Philippine NTP — free drugs and diagnosis in public health centres [1 mark]
• Part 3: Explain the link to MDR-TB prevention — incomplete treatment = drug resistance; DOTS ensures full adherence [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing only the expansion of the acronym without explaining the mechanism — misses the mechanism mark
• Failing to connect DOTS to MDR-TB prevention — this is often the third mark criterion
• Not mentioning that drugs are provided free — misses the Philippine public health context mark

Key Phrases To Include

• Directly Observed Treatment Short-course
• treatment partner
• swallow every dose
• Philippine NTP
• free of charge
• adherence
• incomplete treatment
• MDR-TB
• drug resistance

Marks

3

Topic

Pneumonia — Clinical Manifestations

Difficulty

medium

Template Id

T9

Examiner Tip

For pneumonia questions, always mention RUST-COLOURED SPUTUM explicitly — it is the one feature that identifies pneumococcal pneumonia. Examiners include it as a definite mark criterion.

Model Answer

Community-acquired pneumonia caused by Streptococcus pneumoniae presents with an acute onset of the following manifestations: 1. High fever with chills and rigors 2. Productive cough with rust-coloured (blood-tinged) sputum — the hallmark of pneumococcal pneumonia 3. Pleuritic chest pain — sharp chest pain that worsens on inspiration or coughing 4. Dyspnoea (difficulty breathing) and tachypnoea (increased respiratory rate) On physical examination, the nurse may find crackles (crepitations) and bronchial breath sounds over the affected lobe, dullness to percussion, and increased tactile fremitus — all consistent with pulmonary consolidation. Important NLE note: In the elderly, the presentation may be atypical — confusion, sudden fall, or altered mental status may be the only signs, with minimal or absent fever.

Question Type

short_answer

Answer Structure

• Part 1: Systemic symptoms — fever, chills [1 mark]
• Part 2: Respiratory symptoms — productive cough with RUST-COLOURED sputum (hallmark), pleuritic chest pain, dyspnoea [1 mark]
• Part 3: Physical examination findings — crackles, bronchial breath sounds, dullness, increased fremitus — and atypical presentation in the elderly [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing only symptoms without the classic rust-coloured sputum — loses the hallmark mark
• Not including physical examination findings — these are frequently tested
• Failing to mention the atypical elderly presentation — a high-yield NLE point

Key Phrases To Include

• rust-coloured sputum
• Streptococcus pneumoniae
• pleuritic chest pain
• crackles
• bronchial breath sounds
• dullness to percussion
• increased tactile fremitus
• consolidation
• elderly — confusion

Marks

2

Topic

Pharyngitis — GABHS Complications / Patient Education

Difficulty

easy

Template Id

T10

Examiner Tip

Patient education questions on pharyngitis almost always target this teaching point. Memorise both complications as a pair: RHEUMATIC FEVER + GLOMERULONEPHRITIS. You need both for full marks.

Model Answer

Completing the full course of antibiotics (penicillin or amoxicillin, typically 10 days) for GABHS pharyngitis is critical to fully eradicate the bacteria and prevent serious post-streptococcal complications. The two major complications of untreated or incompletely treated GABHS are: 1. Acute rheumatic fever — an autoimmune inflammatory condition that can cause permanent damage to the heart valves (rheumatic heart disease) 2. Acute post-streptococcal glomerulonephritis — inflammation of the kidney glomeruli leading to haematuria, oedema, and hypertension

Question Type

short_answer

Answer Structure

• Part 1: State the reason — full course needed to eradicate GABHS and prevent autoimmune complications [1 mark]
• Part 2: Name the two specific complications — acute rheumatic fever (with cardiac involvement) and acute glomerulonephritis [1 mark]

Scoring Breakdown

Common Mark Deductions

• Naming only rheumatic fever and missing glomerulonephritis — loses a mark
• Stating 'to prevent recurrence' without specifying the post-streptococcal complications — too vague
• Confusing the mechanism — it is an immune-mediated complication, not direct spread of bacteria

Key Phrases To Include

• Group A beta-haemolytic streptococcus
• penicillin
• amoxicillin
• complete the course
• rheumatic fever
• rheumatic heart disease
• glomerulonephritis

Marks

5

Topic

Pneumonia — Nursing Process / Priority Setting

Difficulty

hard

Template Id

T11

Examiner Tip

Five-mark case-study questions are scored on structure as much as content. Use clearly labelled sections (a, b, c). The examiner is checking for: (1) correct NANDA format, (2) Maslow rationale, (3) specific interventions with rationale, and (4) a measurable outcome. Each of these is a separate mark criterion.

Model Answer

a) PRIORITY NURSING DIAGNOSIS: Impaired Gas Exchange related to alveolar consolidation and accumulation of exudate in the right lower lobe as evidenced by confusion, tachypnoea, and abnormal chest X-ray findings. Rationale for priority: Using Maslow's Hierarchy of Needs, oxygenation is a first-level physiological need. Impaired gas exchange directly threatens life and must be addressed before any other problem. b) NURSING INTERVENTIONS WITH RATIONALE: Intervention 1: Position the patient in high-Fowler's position (head of bed elevated 45–90°). Rationale: High-Fowler's position uses gravity to lower the diaphragm and expand the lungs, maximising tidal volume and alveolar ventilation, thereby improving gas exchange. Intervention 2: Administer supplemental oxygen as ordered and monitor SpO2 continuously; encourage deep breathing exercises and incentive spirometry every 1–2 hours. Rationale: Supplemental oxygen corrects hypoxaemia. Deep breathing exercises and incentive spirometry promote alveolar expansion, help mobilise secretions, and prevent atelectasis. Bonus/supporting intervention: Administer prescribed antibiotics (e.g., amoxicillin or azithromycin) promptly and on schedule, and maintain adequate hydration (2–3 litres per day unless contraindicated) to thin secretions and support antibiotic effectiveness. c) EXPECTED OUTCOME: The patient will demonstrate improved gas exchange as evidenced by SpO2 ≥95% on room air or prescribed oxygen, respiratory rate within normal limits (12–20 breaths/min), resolution of confusion, and patient/family verbalisation of understanding of deep-breathing exercises within 24–48 hours of initiation of treatment.

Question Type

case_study

Answer Structure

• Part a — Priority nursing diagnosis: NANDA-format nursing diagnosis (problem + related to + as evidenced by) with Maslow rationale [1–2 marks]
• Part b — Intervention 1: Specific action (high-Fowler's) + clinical rationale (maximises lung expansion) [1 mark]
• Part b — Intervention 2: Specific action (O2 + incentive spirometry) + clinical rationale (correct hypoxaemia + prevent atelectasis) [1 mark]
• Part c — Expected outcome: Measurable, time-bound, patient-centred outcome with specific parameters (SpO2, RR, mental status) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing a medical diagnosis instead of a NANDA nursing diagnosis — loses the diagnosis mark entirely
• Stating interventions without rationale — a 5-mark question requires rationale for each intervention
• Writing a vague outcome like 'patient will improve' — must be measurable with specific parameters and a time frame
• Prioritising psychosocial diagnoses over airway/oxygenation — fails Maslow-based prioritisation
• Omitting the 'as evidenced by' component of the nursing diagnosis

Key Phrases To Include

• impaired gas exchange
• related to
• as evidenced by
• Maslow's Hierarchy
• physiological need
• high-Fowler's
• supplemental oxygen
• SpO2
• incentive spirometry
• deep breathing
• measurable outcome
• atelectasis

Marks

5

Topic

Tuberculosis — Comprehensive Nursing Management

Difficulty

hard

Template Id

T12

Examiner Tip

Five-mark essay questions should be answered using clear numbered or Roman-numeral sections. Each section = 1 mark. This makes it impossible for an examiner to miss any of your points. Plan your 5 sections in the first 30 seconds before writing.

Model Answer

NURSING MANAGEMENT OF ACTIVE PULMONARY TUBERCULOSIS UNDER DOTS I. INFECTION CONTROL (Priority — Maslow: Safety Need) Active pulmonary TB is transmitted via airborne droplet nuclei. The nurse must implement AIRBORNE PRECAUTIONS: • Place the patient in a negative-pressure isolation room with at least 6–12 air changes per hour • Health-care workers must wear a fitted N95 respirator (NOT a surgical mask) when entering the room • Place a surgical mask on the patient during transport outside the room • Teach cough etiquette: cover mouth with tissue, dispose properly; ensure adequate home ventilation • A patient is generally considered non-infectious after approximately 2–3 weeks of effective therapy with clinical improvement and reduced cough, but the full 6-month course must continue II. DOTS — DIRECTLY OBSERVED TREATMENT • Under the Philippine National TB Control Program (NTP), the nurse or a trained treatment partner directly watches the patient swallow every dose of anti-TB medication • TB diagnosis and the complete RIPE drug regimen are provided free of charge at public health centres • Reinforce that completing the full regimen is non-negotiable — stopping early is the primary driver of MDR-TB III. DRUG REGIMEN EDUCATION — RIPE (2 months intensive + 4 months continuation = 6 months total) • Rifampicin: expect orange-red body fluids (harmless); avoid alcohol (hepatotoxic); reduces effectiveness of oral contraceptives • Isoniazid: take pyridoxine (Vitamin B6) daily to prevent peripheral neuropathy; avoid alcohol (hepatotoxic) • Pyrazinamide: report joint pain/swelling (hyperuricaemia/gout); avoid alcohol (hepatotoxic) • Ethambutol: report any visual changes or difficulty distinguishing red from green immediately (optic neuritis) • Take all drugs as a single daily dose, preferably on an empty stomach (unless GI upset) IV. MONITORING FOR ADVERSE DRUG EFFECTS • Hepatotoxicity (Rifampicin, Isoniazid, Pyrazinamide): monitor liver function tests; teach the patient to report jaundice, dark urine, nausea/vomiting, or right-upper-quadrant pain; advise complete alcohol abstinence • Peripheral neuropathy (Isoniazid): assess for tingling or numbness in the feet and hands • Optic neuritis (Ethambutol): perform and document baseline visual acuity and colour discrimination; schedule periodic eye checks • Hyperuricaemia (Pyrazinamide): monitor serum uric acid; assess for joint pain V. ADDITIONAL NURSING PRIORITIES • Promote adequate nutrition to support immune function and weight restoration • Perform contact tracing — instruct household contacts to be screened • Ensure infants and children in the household are up to date with BCG vaccination per the national immunisation schedule • Report the case to the local health authority per the Philippine Integrated Disease Surveillance and Response (PIDSR) system

Question Type

long_answer

Answer Structure

• Section I: Airborne precautions — negative-pressure room, N95 respirator, patient masking, cough etiquette [1 mark]
• Section II: DOTS mechanism — direct observation, free drugs under Philippine NTP, MDR-TB prevention [1 mark]
• Section III: RIPE regimen patient education — all four drugs with their specific teaching points [1 mark]
• Section IV: Monitoring for adverse effects — hepatotoxicity (R/I/P), optic neuritis (E), neuropathy (I), hyperuricaemia (P) [1 mark]
• Section V: Holistic nursing — nutrition, contact tracing, BCG, disease reporting [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'droplet precautions' for TB — a critical error that loses the infection control mark
• Describing only drug names without patient education or monitoring — loses pharmacology marks
• Omitting the Philippine NTP context (free drugs, DOTS treatment partner) — loses the program-specific mark
• Not addressing hepatotoxicity as a shared risk across three RIPE drugs
• Failing to include contact tracing and BCG vaccination — misses the community/public health dimension

Key Phrases To Include

• airborne precautions
• negative-pressure room
• N95 respirator
• DOTS
• Philippine NTP
• free of charge
• RIPE regimen
• 6 months
• MDR-TB
• hepatotoxicity
• optic neuritis
• peripheral neuropathy
• pyridoxine
• contact tracing
• BCG
• PIDSR

Marks

3

Topic

Acute Bronchitis / Influenza — Comparison

Difficulty

medium

Template Id

T13

Examiner Tip

Comparison questions earn the third mark when you explicitly state a difference or similarity. End your answer with a clear comparative statement — 'Both are viral; neither requires antibiotics. Influenza is distinguished by its abrupt, systemic presentation and benefits from early oseltamivir.'

Model Answer

ACUTE BRONCHITIS: • Causative agent: Viral (most commonly following an upper respiratory infection) • Key features: Cough initially dry then productive, lasting up to 3 weeks; low-grade fever and chest discomfort; no systemic myalgia • Antibiotics: NOT indicated — acute bronchitis is viral and self-limiting. Prescribing antibiotics promotes antimicrobial resistance. Management is supportive: rest, fluids, humidification, and antipyretics. INFLUENZA: • Causative agent: Influenza A or B virus (RNA virus) • Key features: ABRUPT onset of high fever, severe myalgia (body aches), headache, dry cough, and profound fatigue — more systemic and severe than bronchitis • Antibiotics: NOT indicated (viral). However, the antiviral oseltamivir (Tamiflu) is effective if started within 48 hours of symptom onset. Annual influenza vaccination is the primary prevention strategy.

Question Type

short_answer

Answer Structure

• Acute bronchitis: agent + key features + antibiotic non-indication + supportive care [1 mark]
• Influenza: agent + abrupt systemic features (myalgia, high fever) + antiviral (oseltamivir within 48 h) [1 mark]
• Comparison point: both viral and not requiring antibiotics; distinguished by systemic severity and abruptness of onset; oseltamivir specific to influenza [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating that antibiotics should be given for either condition — a significant clinical error
• Omitting oseltamivir and the 48-hour window for influenza — loses the pharmacology mark
• Not distinguishing the abrupt systemic onset of influenza from the gradual onset of bronchitis

Key Phrases To Include

• viral
• antibiotics NOT indicated
• supportive care
• abrupt onset
• myalgia
• profound fatigue
• oseltamivir
• within 48 hours
• annual influenza vaccination

Marks

3

Topic

Tuberculosis — Mantoux/PPD Diagnostics

Difficulty

medium

Template Id

T14

Examiner Tip

The single most common error on Mantoux questions is confusing induration with erythema. Examiners specifically test this. Write the word INDURATION in capital letters to emphasise it — and explicitly state 'NOT redness.'

Model Answer

The Mantoux test (Tuberculin Skin Test / PPD test) is a diagnostic tool used to detect infection with Mycobacterium tuberculosis. It indicates exposure or infection but does NOT distinguish between latent TB and active TB, and a positive result can occur in previously BCG-vaccinated individuals. PERFORMANCE: • Purified Protein Derivative (PPD) is injected intradermally (not subcutaneously) into the forearm, producing a small wheal (bleb) • The injection site is marked and the patient is asked to return in 48–72 hours for reading INTERPRETATION: • The nurse measures the diameter of the INDURATION (raised, firm area) in millimetres — NOT the area of redness (erythema) • A result of ≥10 mm of induration is generally considered positive in most individuals; a lower threshold (≥5 mm) applies to immunocompromised patients, HIV-positive individuals, and close contacts of TB cases • A positive Mantoux indicates TB infection/exposure and warrants further evaluation (chest X-ray, GeneXpert) but does not alone confirm active disease

Question Type

short_answer

Answer Structure

• Part 1: Define the Mantoux test and its purpose [1 mark]
• Part 2: Describe the procedure — intradermal PPD injection, reading at 48–72 hours [1 mark]
• Part 3: Describe interpretation — measure INDURATION (not redness), ≥10 mm positive, limitations (BCG, LTBI vs active TB) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating that the area of redness is measured — a critical error; only the induration (firmness) is measured
• Not specifying the 48–72-hour reading window
• Stating the test confirms active TB — the Mantoux only indicates infection/exposure
• Omitting the BCG vaccination limitation

Key Phrases To Include

• Mantoux
• tuberculin skin test
• PPD
• intradermal
• 48–72 hours
• induration
• NOT redness/erythema
• 10 mm
• BCG vaccination
• latent TB
• not confirmatory

Marks

1

Topic

Pneumonia — Fluoroquinolone Pharmacology

Difficulty

easy

Template Id

T15

Examiner Tip

Pharmacology 1-mark questions typically require two specific paired facts. Read the question carefully — 'two effects' means you must list exactly two. Naming only one earns zero on a 1-mark question that expects a pair.

Model Answer

The nurse must monitor for (1) tendon rupture (particularly the Achilles tendon), especially in elderly patients, and (2) QT prolongation, which can lead to serious cardiac arrhythmias. Blood glucose alterations are also a recognised effect.

Question Type

very_short_answer

Answer Structure

• Name two specific adverse effects of fluoroquinolones (levofloxacin) [1 mark for naming both correctly]

Scoring Breakdown

Common Mark Deductions

• Naming only one adverse effect — the question asks for two
• Listing generic antibiotic side effects (nausea, diarrhoea) without the specific fluoroquinolone toxicities
• Confusing macrolide side effects (GI upset) with fluoroquinolone effects

Key Phrases To Include

• levofloxacin
• fluoroquinolone
• tendon rupture
• Achilles tendon
• QT prolongation
• arrhythmia