رجل عمره ٤٥ سنة دخل الطوارئ بسعال منذ ٣ أسابيع، وتعرّق ليلي، ونقص وزن، وبلغم فيه دم، والأشعة تظهر تجويفاً في قمة الرئة اليمنى. ما الإجراء الأولوية؟

A 45-year-old man presents with a 3-week cough, night sweats, weight loss and blood-streaked sputum; the chest X-ray shows a right apical cavity. What is the priority action?

1. Collect three sputum samples first, then decide on isolation from the results
2. Move him to a single room with the door closed and wear a surgical mask
3. Start four-drug TB therapy, then isolate him if the sputum smear is positive
4. Move him to a negative-pressure airborne isolation room and wear a fit-tested N95

Answer: D) Move him to a negative-pressure airborne isolation room and wear a fit-tested N95. This picture suggests infectious active pulmonary TB, and airborne isolation starts at suspicion, not after results. TB spreads by fine airborne particles that a surgical mask does not block, so an N95 and a negative-pressure room are needed.