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  #1  
Old 10-12-2011
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Lungs Most common X ray presentation of Tuberculosis?

You are on the infectious disease service and feel very confident because you already aced the USMLE. Your first patient is a 13 year old girl who has just immigrated from Somalia. She was fine until recently but for the past 3 weeks she has not been feeling good. She developed a hacking cough and general malaise. Initially she was treated for an URTI with an antibiotic but this did not change her symptoms. She continues to have a low grade fever. She has no weight loss, chills, runny nose or chest pain. She denies any past medical problems and does not take any medications. Her vital signs are stable and the physical exam is unremarkable. You order a chest x ray to determine if there is any lesion.
What is the most common presentation of primary pulmonary tuberculosis on a chest x ray?


a. upper lobe infiltrate
b. pleural effusion
c. pneumothorax
d. atlectasis
e. mediastinal adenopathy
f. pleural based mass

g. lower lobe infiltrate


Which of the following is not a complication of tuberculosis?

a. hemoptysis
b. pneumothorax
c. bronchiectasis
d. emphysema
e. pleural fibrosis
f. pleural effusion
g. lung destruction
h. bony rib destruction


Please answer with explanation!
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  #2  
Old 10-13-2011
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e. mediastinal adenopathy
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  #3  
Old 10-13-2011
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d. emphysema
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Old 10-14-2011
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a ,upper lobe infiltrate & b, pneumothorax is not a complication of TB
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  #5  
Old 10-15-2011
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About the first q i m with e...because it speaks about
primary pulmonary tuberculosis in children



ABout the second q..we could have hemoptysis
pneumothorax
. bronchiectasis
emphysema
pleural effusion
lung destruction

i dont know all seems correct to me i m btw e and h
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  #6  
Old 10-15-2011
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oh boy... ok I say 1. A - upper lobe, and I don't think you should get a pneumothorax..
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Old 10-15-2011
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E then D
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  #8  
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A- upper lobe infilterate,
B-pneumothorax.
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  #9  
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I go with

Question 1: g. lower lobe infiltrate

Since it's primary tuberculosis where we get the Ghon complex (Ghon focus [lower lobe] + lobar and perihilar lymph nodes).

Question 2: b. pneumothorax
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  #10  
Old 10-15-2011
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mediastinal adenopathy(my answer is lower lobe infiltrates in adults) and pneumothorax
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  #11  
Old 10-15-2011
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Quote:
Originally Posted by PJasinski View Post
I go with

Question 1: g. lower lobe infiltrate

Since it's primary tuberculosis where we get the Ghon complex (Ghon focus [lower lobe] + lobar and perihilar lymph nodes).

Question 2: b. pneumothorax

If TB like oxygen, its suppose to be upper lobe, right?
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mediastinal adenopathy as primary t.b presents with ghon complex,
confused between E & G, but option E sounds more appropriate.

and emphysema, a guess as T.B ends in "-osis"
and emphysema is an obstructive pathology!
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  #13  
Old 10-15-2011
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first answer a and second ans d.
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Quote:
Originally Posted by USMLE2011m View Post
If TB like oxygen, its suppose to be upper lobe, right?
I agree that M. tuberculosis is an facultative aerobe organism which needs oxygen. But did you hear about Ghon complex and that it is present during primary tuberculosis and it usually infilitrates the lower lobe + hilar lymphnodes? Or did I learn something wrong?
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Old 10-15-2011
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ok m82 _gameshi... ANSWEEERRRRR:confuse d:
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  #16  
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Quote:
Originally Posted by USMLE2011m View Post
ok m82 _gameshi... ANSWEEERRRRR:confuse d:
Please...I'd love to know the correct answer :-)
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  #17  
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Quote:
Originally Posted by m82_ghasemi View Post
You are on the infectious disease service and feel very confident because you already aced the USMLE. Your first patient is a 13 year old girl who has just immigrated from Somalia. She was fine until recently but for the past 3 weeks she has not been feeling good. She developed a hacking cough and general malaise. Initially she was treated for an URTI with an antibiotic but this did not change her symptoms. She continues to have a low grade fever. She has no weight loss, chills, runny nose or chest pain. She denies any past medical problems and does not take any medications. Her vital signs are stable and the physical exam is unremarkable. You order a chest x ray to determine if there is any lesion.
What is the most common presentation of primary pulmonary tuberculosis on a chest x ray?


a. upper lobe infiltrate
b. pleural effusion
c. pneumothorax
d. atlectasis
e. mediastinal adenopathy
f. pleural based mass

g. lower lobe infiltrate


Which of the following is not a complication of tuberculosis?

a. hemoptysis
b. pneumothorax
c. bronchiectasis
d. emphysema
e. pleural fibrosis
f. pleural effusion
g. lung destruction
h. bony rib destruction


Please answer with explanation!
I think the correct answers are a and d
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  #18  
Old 10-15-2011
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I believe the correct answer is 'g: lower lobe infiltrate' and 'pneumothorax'.
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  #19  
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Quote:
Originally Posted by USMLE2011m View Post
If TB like oxygen, its suppose to be upper lobe, right?

Isn't it secondary TB that prefers the upper lobes ?
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  #20  
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Quote:
Originally Posted by doc Mm View Post
Isn't it secondary TB that prefers the upper lobes ?
Yes, according to the books :-D
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  #21  
Old 10-17-2011
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Correct Answer Answer

Answer
Primary tuberculosis is usually a self-limited infection seen in children in endemic regions. As many as 60% of children and 5% of adults with primary tuberculosis are asymptomatic. Patients with primary pulmonary tuberculosis may be minimally symptomatic, with minimal constitutional symptoms. Children may present with fever, malaise, weight loss, cough, and occasional hemoptysis.

Progressive primary tuberculosis occurs in the setting of acute infection in patients with minimal or marked immune compromise. Patients with progressive primary tuberculosis become acutely ill, and they may have extensive lung parenchymal opacities and cavitation. Hypoxia and death may occur. One of the most common presentation of TB in primary tuberculosis is mediastinal Adenopathy.

Patients with postprimary tuberculosis often manifest disease within 2 years of the initial infection or many years later, often as a result of comorbid states: old age, malnutrition, and/or neoplasm. These patients experience indolent clinical symptoms that include lethargy, anorexia, weight loss, low-grade fever, cough, hoarseness, and hemoptysis. Airway involvement in postprimary tuberculosis may be observed.

Tracheobronchial stenosis may not be directly visualized on conventional chest radiographs. Airway stenosis may result in atelectasis in the segments of the lung supplied by that bronchus.

Bronchiectasis may be visualized on radiographs as dilated air-containing structures, with a tram-track appearance representing the parallel walls of the dilated airway. Dilated bronchi may be irregular in caliber and varicoid in appearance or may be cystic. Traction bronchiectasis may occur as well, as a consequence of fibrosis.

Pleural involvement is seen more commonly in postprimary tuberculosis than in primary infection.

Pleural effusions may occur and may progress to empyema. An empyema may require emergent surgical intervention because the infection is maintained within a closed space and because it may result in rapid destruction of surrounding structures (eg, lung parenchyma, osseous structures of the thorax).

If infection extends from the pleural space to involve the chest wall, it is called empyema necessitans.

Osseous destruction and, possibly, air within subcutaneous tissues may be identified radiographically, or the empyema may present as a palpable soft-tissue mass. (From www.emedicine.com)

Emphysema is a complication of smoking not TB
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