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Tuberculosis — MCCQE Part 1 MCQ

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HardCoughTuberculosisMCCQE Part 1

37-year-old man recently arrived from a high-incidence country presents with chronic cough, night sweats and weight loss. Chest radiograph shows upper-lobe cavitation. Which of the following is the most appropriate next step?

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Correct answer: D — Use airborne precautions and obtain sputum AFB smear/culture and NAAT, with public health notification

Use airborne precautions and obtain sputum AFB smear/culture and NAAT, with public health notification is best because chronic constitutional symptoms and cavitary disease suggest infectious pulmonary TB. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. TB is a public-health diagnosis, not only an individual-patient diagnosis.

Reference: Canadian Tuberculosis Standards