Non-tuberculous mycobacterial pulmonary disease — SCE Respiratory MCQ

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HardRespiratory InfectionsNon-tuberculous mycobacterial pulmonary diseaseSCE Respiratory

A 66-year-old thin woman has chronic cough, fatigue and nodular bronchiectasis in the right middle lobe and lingula. Two sputum cultures grow Mycobacterium avium complex. She is not acutely unwell. What is the most likely diagnosis?

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Correct answer: C — Non-tuberculous mycobacterial pulmonary disease

The best answer is “Non-tuberculous mycobacterial pulmonary disease”. The clinical pattern, physiology and imaging described are most consistent with Non-tuberculous mycobacterial pulmonary disease. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Relapsed pulmonary tuberculosis, after specialist assessment”, “Invasive aspergillosis, with clinical reassessment”, “Acute bacterial bronchitis, within a respiratory pathway”, “Pulmonary embolism, after safety review”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for bronchiectasis in adults: https://thorax.bmj.com/content/74/Suppl_1/1