skip to main content

Tuberculous pleuritis — SCE Respiratory MCQ

Instant feedback + full explanation. One question, done properly.

HardPleural diseaseTuberculous pleuritisSCE Respiratory

A 44-year-old man born in Bangladesh presents with fever, weight loss and a unilateral pleural effusion. Pleural fluid is straw-coloured, lymphocyte-predominant and exudative; cytology is negative. CT chest shows pleural enhancement but no lung mass. Two sputum samples are smear-negative and HIV testing is negative. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Image-guided pleural biopsy for mycobacterial culture and histology

Tuberculous pleuritis remains likely, and pleural biopsy improves diagnostic yield for culture and histology when fluid is lymphocytic and cytology is negative. Negative sputum smears do not exclude pleural TB. Tissue diagnosis also helps distinguish TB from malignancy in a unilateral exudate.

Reference: NICE NG33 Tuberculosis; BTS Pleural Disease Guideline 2023