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Pulmonary nodule risk stratification — SCE Respiratory MCQ

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HardLung CancerPulmonary nodule risk stratificationSCE Respiratory

A sputum nucleic-acid test detects Mycobacterium tuberculosis and a rifampicin-resistance mutation. The patient is clinically stable and has received no treatment. What is the best immediate plan?

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Correct answer: C — Urgent MDR-TB service referral for comprehensive resistance testing

Molecular rifampicin resistance is a proxy for multidrug-resistant TB until proven otherwise. Management requires immediate isolation and public-health action, rapid expanded molecular and phenotypic susceptibility testing, and an expert-designed multidrug regimen. Adding a single drug or using a latent-TB regimen would amplify resistance.

Reference: NICE NG33 recommendations for tuberculosis (Updated 15 February 2024): https://www.nice.org.uk/guidance/ng33/chapter/Recommendations; UKHSA guidance and surveillance for tuberculosis drug resistance (Current UKHSA resource, accessed 30 July 2026): https://www.gov.uk/government/publications/tuberculosis-drug-resistance-in-england