Medical history A 66-year-old female, reporting diffuse abdominal pain, asthenia, recurrent fever, dyspnea and dry cough for the past 3 weeks. She was treated with amoxicillin for 7 days, with no improvement. Under treatment with adalimumab for Crohn’s disease. Contact with a co-worker with tuberculosis, but the tuberculin skin test from the previous year was negative. On examination: 38.2°C, SpO2 85%, RR 24 bpm, jaundice, normal pulmonary auscultation, palpable liver at 7 cm from the RHC. Chest radiographs were requested (images 1 and 2). Sputum smear microscopy was negative for BAAR and the rapid molecular test was positive for M. tuberculosis. Chest radiograph, posteroanterior projection.Chest radiograph, lateral projection. Question:Based on the clinical history and the examination, the most likely diagnosis is: Post-primary pulmonary tuberculosis Non-tuberculosis mycobacteria infection Miliary tuberculosis Pneumonia by atypical germs None Test question [Municipal Health Department of São José dos Pinhais - PR (Direct Access 1)] The diagnosis of Miliary Tuberculosis (TBM) can be suggested by chest CT and confirmed by biopsies.Question:Of the options mentioned below, which one has the highest yield for diagnosing TBM? Transbronchial biopsy Pleural biopsy Bone marrow biopsy Bronchial lymph node biopsy Bronchial biopsy None Time's up
