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Asbestosis — SCE Respiratory MCQ

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HardInterstitial lung diseaseAsbestosisSCE Respiratory

A tunneller with chronic silicosis develops weight loss and new upper-lobe cavitation. Initial smear is negative. What complication must remain the priority and what test should follow?

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Correct answer: E — Investigate silicotuberculosis with molecular testing and culture

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · A = shown as D · B = shown as E

B is correct. Silicosis markedly increases TB risk; systemic symptoms and cavitation demand rapid molecular testing plus culture even when an initial smear is negative. Progressive massive fibrosis may cavitate but infection must be excluded. Asbestos has a different exposure/radiological pattern. ACE cannot exclude TB, and one negative smear neither excludes infectious TB nor justifies automatically ending infection-control assessment.

Reference: HSE silica and silicosis guidance: https://www.hse.gov.uk/lung-disease/silicosis.htm