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Active pulmonary tuberculosis — MCCQE Part 1 MCQ

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HardCoughActive pulmonary tuberculosisMCCQE Part 1

A 41-year-old man who recently arrived from the Philippines presents with 6 weeks of cough, night sweats, and weight loss. Chest radiograph shows upper-lobe cavitation. He is stable and lives with two young children. What is the most appropriate investigation?

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Correct answer: E — Sputum acid-fast bacilli smear, culture, and nucleic acid amplification testing

Chronic cough, constitutional symptoms, and cavitary upper-lobe disease suggest active pulmonary tuberculosis; sputum mycobacterial testing is required with airborne precautions. Spirometry and bronchodilator testing do not address infection control or diagnosis. Procalcitonin is not adequate to diagnose or exclude TB. Allergy testing is irrelevant to cavitary pulmonary disease.

Reference: Canadian Tuberculosis Standards