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Pulmonary tuberculosis — SCE Respiratory MCQ

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HardRespiratory InfectionsPulmonary tuberculosisSCE Respiratory

A patient with cavitating pulmonary TB is unable to expectorate. Which initial microbiological strategy best supports rapid diagnosis and susceptibility planning?

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

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Correct answer: D — Induced sputum for smear, NAAT and culture before bronchoscopy if needed

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

B is correct. Active pulmonary TB requires respiratory material for rapid molecular detection, microscopy and culture/drug susceptibility. Induced sputum is less invasive and precedes bronchoscopy when feasible. IGRA detects immune sensitisation and cannot confirm active disease. Routine throat culture and serology do not provide the required evidence. Imaging may justify immediate treatment and isolation, but it does not remove the need for microbiological confirmation.

Reference: NICE NG33 tuberculosis recommendations: https://www.nice.org.uk/guidance/ng33/chapter/Recommendations