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Quizzes > Health & Medicine > Diseases & Conditions

Take the Mantoux Tuberculin Skin Test Quiz

Challenge yourself with TB skin test questions and boost your expertise!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration for TB knowledge quiz on dark blue background

Calling all healthcare pros and students! Our Tuberculosis Test Quiz: Master the Mantoux Skin Test is a fun, free way to tackle key tuberculosis test questions and sharpen your TB skin test questions skills. Dive into a thorough Mantoux test quiz that doubles as TB test practice and a refresher on tuberculosis quiz essentials. You'll challenge yourself, earn confidence interpreting results, and identify areas for improvement. Ready for more? Access a downloadable quiz PDF to quiz on the go or level up with an NCLEX-style challenge to fine-tune your prep. Let's get started - click play and prove you're a TB testing master!

What type of hypersensitivity reaction is assessed by the Mantoux tuberculin skin test?
Type IV (delayed)
Type II (cytotoxic)
Type III (immune complex)
Type I (immediate)
The Mantoux test assesses a Type IV delayed hypersensitivity reaction mediated by Th1 lymphocytes and macrophages. It measures cell-mediated immunity to tuberculin protein derivatives. A positive induration reflects T-cell–mediated inflammatory response. CDC TB Basics
Which of the following routes is used to administer the Mantoux tuberculin skin test?
Subcutaneous
Intramuscular
Intradermal
Intravenous
The Mantoux test is performed by injecting purified protein derivative (PPD) intradermally to form a small bleb. Intradermal administration ensures localized immune response in the skin. Subcutaneous or intramuscular injections will not produce the characteristic induration. CDC Skin Testing Methods
After administering the Mantoux test, within what time frame should the induration be measured?
24–48 hours
48–72 hours
72–96 hours
Immediately
Induration from the Mantoux test peaks between 48 and 72 hours post-injection. Reading outside this window can under- or overestimate the true induration. The CDC recommends measurement in this timeframe for accuracy. CDC Testing Guidelines
What component is injected in the Mantoux test?
Live attenuated Mycobacterium tuberculosis
Tuberculin purified protein derivative (PPD)
BCG vaccine
Mycobacterium bovis extract
The Mantoux test uses a purified protein derivative (PPD) from killed Mycobacterium tuberculosis. It contains proteins to elicit a delayed hypersensitivity response without live bacteria. BCG is a live vaccine and not used for skin testing. WHO TST Info
What is the standard dose of PPD used in the Mantoux skin test?
1 TU
5 TU
10 TU
20 TU
The standard dose for the Mantoux skin test is 5 Tuberculin Units (TU) of PPD. This dose balances sensitivity and specificity for detecting latent TB infection. Higher doses may increase false positives. CDC PPD Dosage
How is a positive reaction determined in the Mantoux test?
Diameter of erythema
Diameter of induration
Thickness of papule
Presence of vesicles
A positive Mantoux test is based on the diameter of induration, not erythema. Induration reflects the cellular immune response to PPD, whereas erythema is non-specific redness. Always measure the palpable, firm swelling. CDC Measurement Guide
Which of the following might cause a false-positive Mantoux test?
Immunosuppression
Recent live virus vaccination
BCG vaccination
HIV infection
Prior BCG vaccination can cause cross-reactivity to PPD and a false-positive Mantoux test. The immune response to BCG includes similar antigens that PPD tests detect. Other vaccinations or HIV typically cause false negatives. NCBI BCG Effects
Which factor can lead to a false-negative Mantoux test?
Prior BCG vaccine
Anergy due to HIV infection
NTM infection
Recent TB exposure
Immunosuppression from HIV can cause anergy, leading to a false-negative Mantoux test despite TB infection. Other causes include corticosteroid therapy or malnutrition. Anergy reduces T-cell response to PPD. CDC Anergy Factors
What is measured as part of the two-step tuberculin skin test?
Immediate and delayed readings
PPD and BCG reaction
Initial test and booster response
Comparison of induration and erythema
Two-step testing uses an initial Mantoux test and a second test 1–3 weeks later to identify boosted immune responses. It helps distinguish remote infection from a new conversion. A larger second induration indicates a boosted reaction. CDC Two-Step Testing
What is the primary purpose of the Mantoux skin test?
To diagnose active TB disease
To detect latent TB infection
To vaccinate against TB
To monitor antibiotic therapy
The Mantoux test screens for latent TB infection by detecting cell-mediated immunity to TB antigens. It is not diagnostic for active disease but indicates prior exposure or infection. Positive results merit further evaluation. WHO Latent TB Info
In high-risk individuals (such as HIV-positive persons), an induration of what size is considered positive?
?5 mm
?10 mm
?15 mm
?20 mm
For HIV-positive and other high-risk individuals, ?5 mm induration is considered a positive Mantoux test. This lower threshold accounts for immunosuppressed patients. It improves sensitivity in at-risk groups. CDC TST Guidelines
For recent immigrants from high-prevalence countries, what induration size equals a positive TST?
?5 mm
?10 mm
?15 mm
?20 mm
Recent immigrants from high-prevalence countries are considered moderate-risk; a ?10 mm induration is positive. This threshold balances specificity and sensitivity for this group. CDC Risk Categories
In persons with no known risk factors for TB, which induration threshold indicates a positive test?
?5 mm
?10 mm
?15 mm
?20 mm
For individuals with no known risk factors, ?15 mm induration is required for a positive test. This higher cut-off maintains specificity in low-risk populations. CDC Risk Thresholds
Which non-tuberculous mycobacteria infection can cause cross-reactivity in the Mantoux test?
Mycobacterium leprae
Mycobacterium avium complex
Mycobacterium bovis only
Mycobacterium tuberculosis var. bovis
Mycobacterium avium complex (MAC) shares antigens with PPD, causing false-positive TST reactions. Many environmental mycobacteria can cross-react, reducing specificity. CDC NTM Info
Why is the Mantoux test less specific in BCG-vaccinated individuals?
BCG causes immunosuppression
BCG contains PPD
BCG elicits a similar immune response to PPD
BCG interferes with test reading
The BCG vaccine contains live attenuated Mycobacterium bovis, which shares antigens with PPD. This cross-reactivity produces induration in PPD tests even without M. tuberculosis exposure. Specificity is reduced in vaccinated persons. NCBI BCG and PPD
A patient on long-term corticosteroids may have which Mantoux test result?
False-positive
False-negative
Exaggerated induration
No change
Long-term corticosteroid use suppresses cell-mediated immunity and may cause a false-negative Mantoux test. The reduced T-cell response fails to produce adequate induration. Alternate testing may be needed. CDC Immunosuppression
Which term describes the phenomenon where a second TST becomes positive due to a boosted immune response?
Window period
Booster phenomenon
Conversion
Reactivation
The booster phenomenon occurs when a second TST given 1–3 weeks after the first is positive due to recall of waned immunity. It helps distinguish true new infection from boosted old infection. CDC Booster Effect
What is the recommended action if an initial TST is negative but clinical suspicion for TB is high?
No further action
Perform an interferon-gamma release assay
Start empiric TB treatment
Repeat chest X-ray
If TST is negative yet suspicion is high, an interferon-gamma release assay (IGRA) can improve diagnostic accuracy, especially in immunosuppressed individuals. IGRA is less affected by BCG vaccination. CDC IGRA Info
Which alternative test measures interferon-gamma release in response to TB antigens?
Quantiferon-TB Gold
ELISA
Western blot
PCR
QuantiFERON-TB Gold is an IGRA that measures interferon-gamma release by T cells exposed to TB-specific antigens. It offers higher specificity than the Mantoux test in BCG-vaccinated individuals. CDC IGRA Methods
When performing a TST, what is the ideal angle for needle insertion?
90 degrees
45 degrees
15 degrees
30 degrees
Intradermal PPD injection is performed at a shallow angle (about 5–15 degrees) with the bevel up to create a small bleb. A 15-degree angle is often used in practice. Incorrect angle can deposit PPD too deep or too shallow. CDC Injection Technique
Which T cell subset primarily mediates the induration response in the Mantoux test?
CD8+ T cells
CD4+ Th2 cells
CD4+ Th1 cells
Regulatory T cells
The induration in the Mantoux test is mediated by CD4+ Th1 cells releasing interferon-gamma and recruiting macrophages. Th2 cells and CD8+ cells play lesser roles. The Th1 response is critical for type IV hypersensitivity. NCBI Immunology
What describes the 'window period' in TB skin testing?
Time before induration peak
Interval after exposure when test is negative
Time between readings
Booster phenomenon
The window period is the 2–8 week interval after TB exposure during which the TST may be falsely negative. The immune response has not yet matured. Repeat testing post-window improves sensitivity. CDC Window Period
What is the recommended interval between initial TST and the second step in two-step testing?
1 week
1–3 weeks
1 month
6 months
In two-step testing, the second TST is administered 1–3 weeks after the first to detect a booster response. Waiting too long increases risk of true conversion. This interval is recommended by the CDC. CDC Two-Step Timing
Which of the following is true regarding an induration measured 6 mm in a healthy adult with no risk factors?
Positive result
Negative result
Borderline result
Indeterminate result
In low-risk individuals, an induration must be ?15 mm to be positive. A 6 mm induration is considered negative. 'Borderline' and 'indeterminate' are not used in TST interpretation. CDC Interpretation
Which component of the immune system is essential for a positive Mantoux test?
Antibodies
Complement proteins
Macrophages and Th1 lymphocytes
Neutrophils
A positive Mantoux test requires macrophages and Th1 CD4+ lymphocytes to orchestrate a delayed hypersensitivity response. Antibodies and complement are not involved in type IV reactions. Neutrophils play a minor role. NCBI Immunology
Why might an elderly patient show a weaker Mantoux reaction?
Increased skin thickness
Reduced T cell function
Increased blood flow
Enhanced antibody response
Elderly patients often have reduced T-cell function due to immunosenescence, leading to weaker or false-negative TST reactions. Skin thickness and blood flow changes are less influential. NCBI Immunosenescence
A patient had a positive TST but a normal chest X-ray. What does this most likely indicate?
Active TB disease
BCG vaccination only
Latent TB infection
False-positive TST
A positive TST with a normal chest X-ray typically indicates latent TB infection rather than active disease. Active TB usually shows radiographic changes. Further evaluation may include IGRA or clinical assessment. CDC Diagnosis
What is the significance of measuring induration in millimeters rather than erythema?
Induration reflects cellular infiltration
Erythema indicates antibody response
Erythema persists longer
Induration measures blood flow
Induration represents the cellular immune response with T cells and macrophages accumulating, whereas erythema is simply redness from capillary dilation. Antibodies are not involved in delayed hypersensitivity. CDC Induration vs Erythema
Which condition could impair TST accuracy and require alternate testing?
Diabetes mellitus
HIV infection
Hypertension
Asthma
HIV infection causes immunosuppression and can lead to false-negative TST results. In such cases, IGRAs or clinical evaluation may be preferred. Diabetes may have minor effects, but HIV is the primary concern. CDC HIV and TST
Which statement best describes the booster effect?
It is a primary immune response
It occurs when initial TST is positive
It is a recall of waned immunity
It indicates recent infection
The booster effect is a recall of waned immunity from remote TB infection or BCG vaccination, manifesting as a positive reaction on a second TST administered 1–3 weeks later. It is not an indication of recent infection. CDC Booster Effect
What storage condition is recommended for PPD solution to maintain potency?
Room temperature
Refrigerated at 2–8°C
Frozen at ?20°C
Heated at 37°C
PPD solution should be stored refrigerated at 2–8°C to maintain antigen potency. Freezing or room-temperature storage can degrade proteins and reduce test sensitivity. Always check expiry and storage logs. CDC Storage Guidelines
How many antigens are commonly used in interferon-gamma release assays but not present in PPD?
0
1
2 (ESAT-6 and CFP-10)
5
IGRAs use specific antigens ESAT-6 and CFP-10, which are absent from BCG and most nontuberculous mycobacteria. PPD contains a broader mix of antigens. This specificity reduces false positives. CDC IGRA Antigens
Which injection technique error can lead to subepidermal rather than intradermal delivery?
Injecting at 15 degrees
Injecting too deep
Using a 27-gauge needle
Using 0.1 mL volume
Injecting too deep can place PPD in the subcutaneous tissue rather than intradermally, leading to poor or absent bleb formation and invalid test results. Proper technique uses a shallow angle. CDC Injection Technique
0
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Study Outcomes

  1. Understand immunological mechanisms -

    Describe how the T-cell mediated reaction to tuberculin underpins the Mantoux skin test and informs tuberculosis test questions.

  2. Apply standardized administration and reading techniques -

    Perform proper intradermal injection and accurately measure induration to ensure reliable results in the Mantoux test quiz.

  3. Interpret induration measurements across risk groups -

    Differentiate positive thresholds for various patient populations, enhancing accuracy in TB skin test questions.

  4. Analyze clinical case scenarios -

    Integrate patient history, risk factors, and induration data from the tuberculosis quiz to guide diagnostic decisions effectively.

  5. Evaluate factors affecting test accuracy -

    Assess the impact of BCG vaccination, immunosuppression, and technical variables on TB test practice outcomes.

  6. Reinforce mastery through immediate feedback -

    Use real-time quiz results to identify knowledge gaps and strengthen proficiency in tuberculosis test questions.

Cheat Sheet

  1. Intradermal Injection Technique -

    Accurate administration of 0.1 mL of 5 TU PPD intradermally on the volar forearm is the cornerstone of reliable TB skin test questions and CDC guidelines. Ensure the bevel is up, insert at a 5 - 15° angle, and look for a 6 - 10 mm wheal to confirm correct placement. Proper technique minimizes variability and boosts confidence when tackling tuberculosis test questions.

  2. Reading and Measuring Induration -

    Read the transverse induration in millimeters between 48 - 72 hours after injection by palpating borders, not erythema. For example, mark the edges with a pen, measure the widest diameter (e.g., 8 mm), and record accurately for your Mantoux test quiz practice. Consistent measurement techniques lead to more precise interpretations in any tuberculosis quiz.

  3. Interpretation Thresholds (5-10-15 Rule) -

    Use the "5-10-15" mnemonic: ≥5 mm is positive in high-risk (HIV+, recent TB contact), ≥10 mm for moderate-risk (recent immigrants, IV drug users), and ≥15 mm for low-risk individuals. This clear cutoff strategy simplifies TB test practice and helps you ace common tuberculosis test questions. Always factor in patient risk profiles per CDC and WHO guidance.

  4. False Positives and False Negatives -

    BCG vaccination or exposure to nontuberculous mycobacteria can yield false positives, while immunosuppressed patients, recent live vaccines, or malnutrition may cause false negatives in TB skin test questions. Recognizing these pitfalls improves your clinical reasoning and performance on a TB skin test quiz. Reference WHO and peer-reviewed studies to deepen your understanding.

  5. Two-Step Testing and Booster Phenomenon -

    Implement a second test 1 - 3 weeks after a negative initial result to detect boosted hypersensitivity in individuals with remote TB exposure. This two-step strategy is key for serial screening of healthcare workers and appears frequently in tuberculosis quiz scenarios. Mastering this concept ensures you can interpret long-term screening results accurately.

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