Respiratory System
TODAY'S EXIT EXAM Q - 13/10/22
During the coronavirus disease 2019 (COVID-19) pandemic, a 27-year-old woman in her 35th week of pregnancy was admitted with cough and dyspnoea of one month duration. She had no medical history or allergies. At the time of admission, she had a body temperature of 37.2°C, pulse rate of 110 beats/min, blood pressure of 104/64 mmHg, and respiratory rate of 30 breaths/min. while in the hospital she developed respiratory failure and was immediately transferred to the intensive care unit. She was administered 5 L/min of oxygen with a face mask; however, her respiratory condition worsened, and she was ventilated. On admission, the COVID-19 antigen and antibody test results were negative. Mycoplasma antibody, Aspergillus antigen and β-D-glucan test, and HIV antibody test were negative. Her chest radiography at the time of admission is shown below. Which is the most likely diagnosis?
a. COVID-19
b. Tuberculosis
c. Pulmonary fungal disease
d. Mycoplasma pneumonia
e. Hypersensitivity pneumonitis
Answer
Ans – b
Chest x-ray shows infiltrative shadows in the upper lobe of the right lung and diffuse miliary tuberculosis in both lungs. She developed acute respiratory distress syndrome (ARDS) associated with miliary tuberculosis. In miliary tuberculosis, the presence or absence of infection in the placenta and amniotic fluid, which are the sources of exposure for the neonates, is important for the diagnosis of congenital tuberculosis. Tuberculosis can spread from the placenta to the umbilical vein, infect the placenta or genitals, and be transmitted to the fetus via inhalation or ingestion of contaminated amniotic fluid.