Pulmonary TB MCQS

Which of the following diagnstics tests is intended for latent tuberculosis
infection?
a. Sputum smear microscopy
b. Polymerase chain reaction (PCR)
c. Interferon-gamma release assay (IGRA)
d ELISA for TB antibodies
For a two year old child with suspected TB, the best clinical specimen for
pulmonary TB diagnosis is:
a. Blood
b. Sputum
c. Gastric aspirate
d. Bronchoalveolar lavage (BAL)
The commonest radiologic finding in TB is:

a. Pleural effusion
b. Upper lobe consolidation with or without cavities
c. Pericardial effusion
d. Lung nodule
A 55 year old 40 pack year smoker consults with you for a 2 month
history of cough and blood tinged sputum (no fever). He reports
that his sister had TB 10 years ago. The CXR shows a cavitary mass
in the RUL. What is the next step?
a. Obtain sputum AFB
b. Send sputum for cytology
c. Send patient for a bronchoscopy
d. Start treatment with an antibiotic
Which of the following is the correct drug regimen for a newly diagnosed
patient with pulmonary tuberculosis?
a. 2 months of Streptomycin, Rifampicin, Isoniazid, Pyrazinamide and Ethambutol
followed by 4 months of Rifampicin and Isoniazid
b. 8 months of Rifampicin, Isoniazid and Ethambutol
c. 2 months of Rifampicin, Isoniazid, Pyrazinamide and Ethambutol followed by
4 months of Rifampicin and Isoniazid
d. 6 months of Rifampicin, Isoniazid, Pyrazinamide and Ethambutol
Which of the following tests should be used to monitor the success of

treatment for a patient with pulmonary tuberculosis?
a. Chest radiograph
b. Sputum smear examination
c. TB IgG, IgM antibodies
d. TB Gold test (interferon-gamma release assay)
A patient presents with a 10 day history of high fever, cough and

purulent sputum. A CXR shows a dense consolidation in the RUL.
The next step is:
a. Obtain sputum specimens for AFB and start TB treatment
b. Start a course of moxifloxacin
c. Obtain sputum specimens for AFB and culture/sensitivity examination
and start azithromycin
d. Refer the patient to a TB hospital
Which of the following ATT drugs has no hepatotoxicity potential?
a. Rifampicin
b. Pyrazinamide
c. Isoniazid
d. Ethambutol
Pyridoxine deficiency can occur due to treatment of which anti-TB drug?

a. Rifampicin
b. Isoniazid
c. Ethambutol
d. Pyrazinamide
Which of the following is false regarding adverse reactions to TB drugs?

a. Jaundice is a common adverse effect and is always due to liver adaptation which
is self-limiting.
b) Drug induced neuropathy can be prevented by routine supplementation with
pyridoxine
c) Joint pains are an adverse reaction to pyrazinamide and usually respond well to
non-steroidal anti-inflammatory drugs
d) Females and those with pre-existing liver disease are more susceptible to drug
induced hepatitis
ANSWERS
1 answer C
2 ANSWER C
The correct answer is (c). Young children cannot expectorate sputum

but it is often swallowed overnight. The best specimen is, therefore,
a series of two to three consecutive, fasting gastric aspirates
3 ANSWER B
The correct answer is (b). Although TB can cause any of the

radiologic findings listed, upper lobe disease with or without cavitation
is the most common
4 ANSWER C
The answer is (c). Although TB must be suspected in anyone with an

upper lobe cavitary mass, in a heavy smoker with a 2 month history of
cough and bloody sputum, in the absence of infectious symptoms, lung
cancer must be suspected. A bronchoscopy can obtain specimens for
AFB but at the same time, can make the diagnosis of cancer.
5 ANSWER C
6 ANSWER B
7 ANSWER C
The answer is (c). CXR’s must be interpreted in the clinical context.

An acute presentation suggests acute bacterial infection. Sputum specimens
should be obtained before starting conventional antibiotics. Fluoroquinolones
should be avoided if TB is at all suspected as they will
result in temporary improvement because TB is sensitive to this class
of drugs, leading to delay in diagnosis
8 ANSWER D
The correct answer is (d). The propensity to produce hepatotoxicity is with PZA>
INH> RIF. Ethambutol, streptomycin and moxifloxacin do not have hepatotoxic potential
and they can be administered safely in patients with hepatotoxicity while discontinuing
those drugs with hepatotoxic potential and to accompany the individual
drugs on rechallenge to prevent monotherapy
9 ANSWER B
The correct answer is (b). Isoniazid interferes competitively with pyridoxine metabolism
by inhibiting the formation of the active form of the vitamin, and hence
often results in peripheral neuropathy. This is especially marked in malnutrition,
pregnancy, lactation, HIV infection, diabetes and hypertension. This effect can be
prevented by giving pyridoxine 10 mg per day
10 ANSWER A
The correct answer is (a). Jaundice is a sign of hepatitis and warrants stoppage
of all TB medications, and investigations for druginduced hepatitis. However, it can
also occur rarely due to drug induced hemolysis which is a life threatening complication.
Liver function tests and complete blood counts are to be requested to differentiate
drug induced hepatitis and hemolytic jaundice. Drug induced hepatitis is
diagnosed when serum aminotransferase level >5 times the upper limit of normal
[ULN] without symptoms or >3 times the ULN with symptoms

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Which of the following diagnstics tests is intended for latent tuberculosis

d ELISA for TB antibodies

d. Bronchoalveolar lavage (BAL)

The commonest radiologic finding in TB is:

Which of the following tests should be used to monitor the success of

A patient presents with a 10 day history of high fever, cough and

Pyridoxine deficiency can occur due to treatment of which anti-TB drug?

Which of the following is false regarding adverse reactions to TB drugs?

The correct answer is (c). Young children cannot expectorate sputum

The correct answer is (b). Although TB can cause any of the

The answer is (c). Although TB must be suspected in anyone with an

The answer is (c). CXR’s must be interpreted in the clinical context.

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