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Bronchiectasis due to antibody deficiency — SCE Respiratory MCQ

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HardRespiratory InfectionsBronchiectasis due to antibody deficiencySCE Respiratory

A 48-year-old man with bronchiectasis has recurrent infections with Haemophilus influenzae and Streptococcus pneumoniae. He has chronic sinusitis and two admissions for pneumonia. Full blood count is normal, HIV is negative and CT confirms diffuse bronchiectasis. What is the most appropriate investigation?

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Correct answer: B — Serum immunoglobulins and assessment of specific antibody responses

The best answer is “Serum immunoglobulins and assessment of specific antibody responses”. Serum immunoglobulins and assessment of specific antibody responses is the investigation that most directly resolves the remaining diagnostic or staging uncertainty at this point in the pathway. The alternatives address different questions, have lower expected yield, or would be premature before this result. The remaining choices—“Serum angiotensin-converting enzyme, after safety review, after safety review”, “PET-CT for occult lung cancer, after specialist assessment”, “Bronchial challenge testing, with clinical reassessment, with clinical reassessment”, “Sweat chloride testing as the first investigation in every adult”—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