Latent tuberculosis infection — RACGP Fellowship MCQ

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

HardInfectious diseaseLatent tuberculosis infectionRACGP Fellowship

A 27-year-old man from a country with high tuberculosis prevalence presents for new-patient screening. He is asymptomatic, HIV-negative, and chest X-ray is normal. Interferon-gamma release assay is positive. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: D — Assess for latent tuberculosis treatment after excluding active disease

A positive IGRA in an asymptomatic patient with normal CXR and no risk factors for severe progression still requires structured assessment for preventive therapy eligibility. Australian practice (RACGP, NTAC) mandates exclusion of active disease (done: asymptomatic, normal imaging), then systematic evaluation for LTBI treatment candidacy. This includes baseline bloods, assessment of risk factors for reactivation, drug interactions, and patient suitability. Option B is unsafe (ignores positive test). Option A treats active disease (not present). Option E is incorrect (BCG is prevention, patient infected). Option C is inefficient (sputum culture not first-line when active TB already clinically excluded).

Reference: RACGP. Latent tuberculosis in the general practice context. AJGP 2020. https://www1.racgp.org.au/getattachment/b7a8e239-a357-4324-ad82-13bfe436a286/Latent-tuberculosis.aspx; Department of Health and Aged Care / NTAC. Position statement on interferon-γ release assays for detection of latent TB infection. https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdi4104-c