What number of sputum specimens are collected to diagnose Tuberculosis in DOTS?

Appeared in: UPUMS Nsg.Officer-2024

Explanation

Under the current National Tuberculosis Elimination Program (NTEP) guidelines, two sputum specimens are collected for the initial diagnosis of pulmonary TB.
The collection schedule involves one 'spot' sample collected at the healthcare facility and one 'early morning' sample collected by the patient at home the next day.
This 2-sample strategy was revised from the older 3-sample regimen to improve patient compliance and program efficiency, as it reduces the number of required clinic visits.

Option B: This represents the outdated 'Spot-Morning-Spot' protocol, which was part of the older Revised National Tuberculosis Control Programme (RNTCP) guidelines.
Option C: A single sample has a lower diagnostic yield and a higher risk of false-negative results due to the intermittent nature of bacterial shedding in sputum.
Option D: Collecting four samples is not part of any standard national or international TB diagnostic protocol and provides no additional benefit.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Sputum specimen collection protocol for Tuberculosis diagnosis under NTEP/DOTS as background academic context rather than a clinical decision trigger.
Nurses are central to TB diagnosis. They must be aware of the current 2-sample guideline to provide correct instructions and manage patient expectations.
A key nursing role is educating patients on how to produce a good quality sputum sample (deep cough from the lungs, not saliva) to maximize the chances of an accurate diagnosis.
Patient adherence is critical. The shift to a 2-sample protocol reduces the patient's travel burden, which a nurse can use as a positive point to encourage them to complete the diagnostic process.

How to Approach the Question

Identify the core of the question: It asks for the number of sputum samples for TB diagnosis under the DOTS strategy.
Recognize that DOTS is implemented through the National Tuberculosis Elimination Program (NTEP) in India, and its guidelines are periodically updated.
Access your knowledge of the current diagnostic protocol. The key is to differentiate between the old (3-sample) and the current (2-sample) guideline.
Evaluate the options: '2' matches the current guideline. '3' matches the old guideline, making it a strong distractor. '1' and '4' are incorrect based on standard protocols.
Select the option that reflects the most up-to-date clinical practice.

Concept Tested & Keywords

Concept Tested: Sputum specimen collection protocol for Tuberculosis diagnosis under NTEP/DOTS.
Stem keywords: sputum specimens, diagnose, Tuberculosis, DOTS
Lead-in keywords: What number
Negative lead-in flag: false

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E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart B (pp 202-403 of 604) p. 23-25

E6 Microbiology Essentials Sastry 4e Part 2 p. 157-159

Practise the full UPUMS Nsg.Officer-2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.