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  #1  
Old 07-27-2011
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Lungs Hilar & Peripheral Pulmonary Node with negative sputum culture!

A 9-year-old girl has complained of difficulty breathing for the past week. Her vital signs include T 37.9 C, P 80/minute, RR 25/minute, and BP 110/60 mm Hg. On physical examination, her lung fields are clear to auscultation. Her heart rate is regular and no murmurs or gallops are heard. A chest radiograph shows prominent hilar lymphadenopathy along with a 1 cm peripheral right lung nodule in the middle lobe. No infiltrates or masses are present. A sputum gram stain shows normal flora and routine bacterial culture reveals no pathogens. Which of the following conditions is she most likely to have?

A Hypersensitivity pneumonitis
B Mycobacterium tuberculosis infection
C Bronchial carcinoid tumor
D Infective endocarditis
E Goodpasture syndrome
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  #2  
Old 07-27-2011
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A Hypersensitivity pneumonitis = clear to auscultation & chest radiograph without pneumonitis

B Mycobacterium tuberculosis infection = she does not have the classic symptoms ( and the lesion is in the middle lobe)

C Bronchial carcinoid tumor

D Infective endocarditis = no murmur - no general symptoms.

E Goodpasture syndrome = she does not have hemoptysis / kidney disease
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  #3  
Old 07-27-2011
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but in carcinoid tumors there may be wheezing and also right side mumurs..
pt has a low grade fever too. it's not even typical TB too. i would choose TB.
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  #4  
Old 07-27-2011
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Quote:
Originally Posted by dr_lizard View Post
but in carcinoid tumors there may be wheezing and also right side mumurs..
pt has a low grade fever too. it's not even typical TB too. i would choose TB.
yup...but in the Ghon's complex the lymphadenopathy are not prominent...and crearly she does not have an active TB...

btw, I choose option C because I think the other options are bizarre....hahaha
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Old 07-27-2011
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Quote:
Originally Posted by bebix View Post
yup...but in the Ghon's complex the lymphadenopathy are not prominent...and crearly she does not have an active TB...

btw, I choose option C because I think the other options are bizarre....hahaha
yes but if it's metastasis to lymph nodes don't u think it must be more than a week?since this pt has symptoms from 1 week ago.this kinda questions always confusing!u cannot never be sure which is completely correct
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  #6  
Old 07-27-2011
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Originally Posted by dr_lizard View Post
yes but if it's metastasis to lymph nodes don't u think it must be more than a week?since this pt has symptoms from 1 week ago.this kinda questions always confusing!u cannot never be sure which is completely correct
hahahaha...i'm w/ u....
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  #7  
Old 07-27-2011
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if i get such a question ill go for c but i would never be sure of the answer
like in real life how can u diagnose someone like that hehe
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  #8  
Old 07-27-2011
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man... this one is interesting.

I would have to go with [B]Mycobacterium Tb bc the GRAM STAIN is normal and the bacterial culture shows no pathogens. Also bc hilar lymphadenopathy along with a 1 cm peripheral right lung nodule in the middle lobe.

I would think that Primary TB can be in the lower and middle lobe. And that Secondary TB would be found in the top lobe of the lung.

Bronchogenic carcinoid syndrome can be present with cardiac murmurs that have to do on the right side such as PS and TR.
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  #9  
Old 07-27-2011
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C.carcinoid tumor
-1cm of nodule in the middle lobe
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  #10  
Old 07-27-2011
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Looks like ghon Complex, i will go with B... Sometimes it goes asymptomatic and pte dont even notice he got TB. =)
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  #11  
Old 07-27-2011
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C is the answer i think so ...
carcinoid tumors brochial carcinoids has also possiblity to occur without symptoms of carcinoid syndrome(wheezing,flushingetc increased serotonin) .other regions of carcinoid tumors in the body are ileum and sigmoid colon and their metastasis into liver produces symptoms of carcinoid syndrome ..
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  #12  
Old 07-27-2011
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i'll go with b
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Old 07-27-2011
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B) Primary Tb infection with adenopathy

Not A) clear lung fields
Not C) age does not match
Not D) no murmurs/gallops and t is subfebrile
Not E) no kidney s/s
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  #14  
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i ll go with B...
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Old 07-27-2011
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Answer is Definitely B because Atypical presentation of TB with low grade fever and mediastinal lymphadenopathy is very common these days. Culture -ve and sputum -ve TB cases are also there. But the best way to diagnosing and confirming the diagnois is Trans Bronchial Needle Aspiration of the mediastinal lymphadenopathy.

TBNA gives an accurate tissue diagnosis of the patient's condition. Although, PCR and sputum can be used but PCR is not an accurate test for TB. Empiracally the treatment can be started if PCR is +ve and TBNA be done to confirm the diagnosis of TB.
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  #16  
Old 07-27-2011
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Quote:
Originally Posted by jahn77 View Post
B) Primary Tb infection with adenopathy

Not A) clear lung fields
Not C) age does not match
Not D) no murmurs/gallops and t is subfebrile
Not E) no kidney s/s
yup...I guess you are right....age does not match...
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  #17  
Old 07-27-2011
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Default tb?

By ruling out options, I'd probably be thinking of TB.
As for the carcinoid tumours, I though they produce symptoms outside the GI and not the other way round. Coz the liver metabolizes the serot and hence they cant exert their effects...
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  #18  
Old 07-27-2011
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Default Explanation

SOURCE : Webpath

(A) Incorrect. A hypersensitivity pneumonitis occurs in response to an inhaled antigen and produces small areas of interstitial inflammation throughout the lungs. Lymph nodes are not enlarged.

(B) CORRECT. This is a description of the typical 'Ghon complex' of an initial, or primary, TB infection. The peripheral granuloma does not produce symptoms, but the enlarged lymph nodes may impinge upon airways. Most persons with a primary infection, however, are asymptomatic and the infection goes unnoticed.


C) Incorrect. A carcinoid tumor could produce focal obstruction with a pneumonia, but pulmonary neoplasms in children are rare. Most bronchial carcinoids act in a benign fashion without metastases.

(D) Incorrect. In children, congenital heart disease is the most likely risk factor for infective endocarditis, and most of these lesions will involve the left heart, with systemic embolization. Even if right-sided vegetations embolize, there should be multiple abscesses present.

(E) Incorrect. Goodpasture syndrome is rare at this age, and the pattern is that of diffuse pulmonary hemorrhage with hemoptysis.
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  #19  
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Post B

B Mycobacterium tuberculosis infection

Primary TB, remains asymptomatic in 85% of times. Features suggesting Ghon complex!
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  #20  
Old 07-28-2011
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i'll go for B.....
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b is the correct one
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  #22  
Old 07-30-2011
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ill go with B middle lobe -ghon focus and hilar lymphadenopathy indicative of TB ahhh this is confusinggg !!
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  #23  
Old 07-31-2011
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I agree with B
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