Tuberculosis Pathology MCQ — NEET PG Practice Question | NEETPGAI
Tuberculosis Pathology
medium
microscope Pathology
A 38-year-old man from rural Maharashtra presents with a 3-month history of productive cough, fever, and night sweats. Chest X-ray shows cavitary lesions in the right upper lobe. Sputum smear microscopy is positive for acid-fast bacilli (AFB). He has no prior TB history and no known HIV exposure. What is the most appropriate next step in management?
A. Perform drug susceptibility testing (DST) before initiating ATT
B. Obtain CT chest to assess extent of disease before starting treatment
C. Refer to TB specialist for bronchoscopy to confirm diagnosis
D. Start anti-tuberculous therapy (ATT) with HRZE regimen immediately
Explanation
Clinical Context
This is a smear-positive, cavitary pulmonary TB case with classic presentation (fever, night sweats, productive cough, cavitation on imaging). The diagnosis is already confirmed microbiologically.
Why Start ATT Immediately
Key Point
In smear-positive TB with radiological confirmation, starting standard first-line ATT (HRZE) immediately is the standard of care. Delaying treatment increases transmission risk and disease progression.
High-YieldNEET PG
According to NTEP (National TB Elimination Programme) and WHO guidelines, confirmed TB cases should begin ATT within 2 weeks of diagnosis. Sputum smear positivity + cavitary disease = confirmed TB; no further diagnostic confirmation needed.
When DST is Indicated
Table
Scenario
DST Timing
New smear-positive TB (no prior TB)
Not mandatory before starting ATT; baseline DST can be done in parallel
TB treatment failure or relapse
Mandatory before ATT
MDR-TB suspected or confirmed
Mandatory; use LPA (Line Probe Assay) or culture-based DST
HIV co-infection
Recommended baseline DST
Clinical Pearl
DST can be sent in parallel with starting ATT in new cases; it does not delay initiation of standard therapy.
Role of Imaging and Specialist Referral
CT chest is not required for diagnosis or initial management of straightforward cavitary TB; CXR is sufficient for staging.
Bronchoscopy is unnecessary when sputum smear microscopy is already positive and diagnosis is confirmed.
Specialist referral is reserved for drug-resistant TB, treatment failure, or diagnostic uncertainty.
