Oral Tuberculosis — SCE Infectious Diseases MCQ

Correct answer: E — Send biopsy material for mycobacterial culture and molecular testing because smear negativity and non-caseating morphology do not exclude extrapulmonary TB after review with follow-up

The best answer is “Send biopsy material for mycobacterial culture and molecular testing because smear negativity and non-caseating morphology do not exclude extrapulmonary TB after review with follow-up”. Extrapulmonary specimens are often paucibacillary; culture and molecular testing are needed to establish active disease and susceptibility. “Exclude TB solely because the granulomas are non-caseating” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Diagnose aphthous ulceration without microbiology” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use a positive Mantoux test as proof of active oral TB” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Treat candidiasis without fungal or mycobacterial testing” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

Reference: NICE NG33 tuberculosis recommendations: https://www.nice.org.uk/guidance/ng33/chapter/Recommendations