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Suspected pulmonary embolism — SCE Respiratory MCQ

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HardPulmonary Vascular DiseaseSuspected pulmonary embolismSCE Respiratory

A former smoker with COPD has five sputum-producing exacerbations yearly despite optimised inhalers, vaccination and pulmonary rehabilitation. Before prophylactic azithromycin, which investigation bundle is essential?

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Correct answer: A — Sputum including NTM culture, ECG and baseline hearing assessment

Long-term macrolide treatment requires exclusion of NTM and resistant pathogens with sputum culture, assessment of QTc and interacting medicines, and baseline hearing or balance assessment. Starting macrolide monotherapy in unrecognised NTM disease risks selecting macrolide resistance.

Reference: NICE NG115 recommendations for COPD (Updated 26 July 2019): https://www.nice.org.uk/guidance/ng115/chapter/Recommendations; BTS guideline for long-term macrolide use in adults (Published 2020): https://thorax.bmj.com/content/75/5/370