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Latent TB screening — MCCQE Part 1 MCQ

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ModeratePreventive MedicineLatent TB screeningMCCQE Part 1

30-year-old health-care worker from a high-incidence country presents with pre-employment assessment. He is asymptomatic and CXR is normal. Which of the following is the most appropriate next step?

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Correct answer: D — Screen for latent TB infection and treat if positive after excluding active disease

Screen for latent TB infection and treat if positive after excluding active disease is best because risk-based LTBI screening applies to people from high-incidence settings/health-care exposure. Use a United States screening schedule instead of Canadian guidance is suboptimal because MCCQE questions expect Canadian preventive-care guidance; Defer all preventive care until symptoms develop is suboptimal because screening and immunisation aim to prevent disease before symptoms; Order the most invasive test as routine first-line screening is suboptimal because screening should balance benefit, harm and resource use; Screen at every visit regardless of interval or prior results is suboptimal because over-screening causes avoidable false positives and harm. Exclude active TB before LTBI therapy.

Reference: Canadian Tuberculosis Standards