USCIS Risk Assessment & Management 2 — Questions and Answers
Question 1: A civil surgeon finds an applicant has a history of latent TB infection (LTBI) previously treated with 9 months of isoniazid. What is the correct risk management step?
- Require repeat treatment before completing Form I-693
- Document the completed treatment and classify as no longer requiring follow-up (Correct answer)
- Refer to the CDC for additional review
- Defer the medical exam until chest X-ray is repeated
Correct answer: Document the completed treatment and classify as no longer requiring follow-up
An applicant who has completed an adequate course of treatment for LTBI does not require further treatment and should be documented accordingly on Form I-693.
Question 2: During a USCIS medical exam, an applicant discloses a history of methamphetamine use that ended 3 years ago with no relapse. How should the civil surgeon classify this?
- Class A condition requiring inadmissibility finding
- Class B condition as a substance use disorder in remission (Correct answer)
- No notation required since use ended years ago
- Automatic referral to a substance abuse specialist
Correct answer: Class B condition as a substance use disorder in remission
A substance use disorder in sustained full remission (typically 1+ year) is classified as a Class B condition, not Class A, reflecting reduced but still noted risk.
Question 3: Which of the following findings would prompt a civil surgeon to place an applicant in a Class A inadmissible category under USCIS medical grounds?
- Controlled hypertension with medication
- Active pulmonary tuberculosis confirmed by sputum culture (Correct answer)
- A healed syphilis infection with documented treatment
- Obesity with BMI of 32
Correct answer: Active pulmonary tuberculosis confirmed by sputum culture
Active pulmonary TB is a quarantinable communicable disease that renders an applicant inadmissible (Class A) under INA Section 212(a)(1).
Question 4: An applicant's tuberculin skin test (TST) reads 12mm induration and they report no prior BCG vaccination. The chest X-ray is normal. What is the appropriate next step?
- Classify as active TB and refer for treatment before completing the exam
- Refer to a health department for LTBI evaluation and possible treatment (Correct answer)
- Document as a negative finding since chest X-ray is clear
- Repeat the TST in 4 weeks to confirm the result
Correct answer: Refer to a health department for LTBI evaluation and possible treatment
A positive TST with no active disease on chest X-ray indicates LTBI, which requires referral for evaluation and possible prophylactic treatment before Form I-693 can be completed.
Question 5: What is the purpose of the follow-up examination requirement for certain Class B tuberculosis conditions on Form I-693?
- To ensure the applicant pays outstanding medical fees
- To monitor and confirm resolution or management of the condition after arrival in the US (Correct answer)
- To allow USCIS to deny the application if the condition worsens
- To satisfy state health department licensing requirements for civil surgeons
Correct answer: To monitor and confirm resolution or management of the condition after arrival in the US
Class B TB follow-up conditions require monitoring after arrival to protect public health and confirm that the condition is appropriately managed.
Question 6: A civil surgeon suspects an applicant may have untreated syphilis based on clinical findings but the RPR result is non-reactive. What is the best risk management approach?
- Dismiss the suspicion since serology is negative
- Order a confirmatory test such as FTA-ABS and consider clinical staging (Correct answer)
- Treat empirically with penicillin and document on I-693
- Refer immediately to USCIS without completing the exam
Correct answer: Order a confirmatory test such as FTA-ABS and consider clinical staging
A non-reactive RPR does not fully rule out syphilis; a treponemal test like FTA-ABS should be used to confirm or exclude the diagnosis when clinical suspicion exists.
Question 7: Under USCIS medical examination protocols, which mental disorder finding constitutes a Class A inadmissible condition?
- Any documented history of depression
- A mental disorder accompanied by harmful behavior or a history of harmful behavior (Correct answer)
- Anxiety disorder requiring medication
- A childhood diagnosis of ADHD
Correct answer: A mental disorder accompanied by harmful behavior or a history of harmful behavior
Only a mental disorder associated with harmful behavior, or a history of such behavior likely to recur, meets the Class A threshold for mental health inadmissibility.
USCIS Risk Assessment & Management 2
A civil surgeon finds an applicant has a history of latent TB infection (LTBI) previously treated with 9 months of isoniazid.
What is the correct risk management step?