Infectious diseases: rifampicin-resistant tuberculosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infectious diseases: rifampicin-resistant tuberculosis

Sample item

A 38-year-old man with sputum smear-positive pulmonary tuberculosis has a CBNAAT (Xpert) result showing Mycobacterium tuberculosis detected with rifampicin resistance. He has not had tuberculosis treatment before. What is the most appropriate next step under the national programme?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Manage as rifampicin-resistant tuberculosis and test for isoniazid and fluoroquinolone resistance by line probe assay

Rifampicin resistance is a proxy for multidrug resistance because most such strains are also resistant to isoniazid. Under NTEP, a rifampicin-resistant result triggers management as drug-resistant TB, with second-line LPA and culture drug susceptibility testing to detect fluoroquinolone and isoniazid resistance and tailor the regimen. Additional resistance affects regimen choice.

Option by option

  • A. Add a single second-line drug to the first-line regimen

    Adding one drug to a failing regimen risks further acquired resistance.

  • B. Disregard the result as a false positive in a new case

    Resistance can occur in new cases through transmission, and the result should not be disregarded.

  • C. Manage as rifampicin-resistant tuberculosis and test for isoniazid and fluoroquinolone resistance by line probe assay (correct)

    Rifampicin resistance needs a drug-resistant regimen and further susceptibility testing to guide it.

  • D. Continue the standard first-line regimen and repeat CBNAAT after two months

    The first-line regimen relies on rifampicin and will fail, amplifying resistance.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Manage as rifampicin-resistant tuberculosis and test for isoniazid and fluoroquinolone resistance by line probe assay. Rifampicin resistance is a proxy for multidrug resistance because most such strains are also resistant to isoniazid.

Why is "Add a single second-line drug to the first-line regimen" not the answer?

Adding one drug to a failing regimen risks further acquired resistance.

Why is "Disregard the result as a false positive in a new case" not the answer?

Resistance can occur in new cases through transmission, and the result should not be disregarded.

Why is "Continue the standard first-line regimen and repeat CBNAAT after two…" not the answer?

The first-line regimen relies on rifampicin and will fail, amplifying resistance.

What concept does this question test?

It tests Infectious diseases: rifampicin-resistant tuberculosis in General Medicine. Under NTEP, a rifampicin-resistant result triggers management as drug-resistant TB, with second-line LPA and culture drug susceptibility testing to detect fluoroquinolone and isoniazid resistance and tailor the regimen. Additional resistance affects regimen choice.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infectious diseases: rifampicin-resistant tuberculosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.