This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'Tuberculosis in children true is \nSelect and explain. \nA. Commonly sputum negative, B. Incidence < 5% of all TB cases, C. Clinically child does not show sign of florid TB, D. All of the above', 'role': 'user'}, {'content': "Answer: D \nExplanation: Tuberculosis in children :\n\nTuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis.\nCases of tuberculosis represent 5 - 15 percent of all tubercular cases.\n\nClinical manifestations of TB in children :\n\nThe majority of children with tuberculosis infection develop no signs or symptoms at any level.\nOccasionally.\n\nInfection is marked by low - grade fever, mild cough, malaise and u - like symptoms.\nA) Primary pulmonary disease the lung is the portal of entry in >\xa0 98% of cases.\n\nThe primary complex of tuberculosis includes local infection at the portal of entry and regional lymph nodes that drain the area.\nThe combination of the parenchymal pulmonary\xa0- lesion and corresponding lymph node is called Ghon complex.\nAsymptomatic pleural effusion is so frequent in primary - tuberculosis that it is basically a component of the primary complex.\nNelson, It may have one of the following course : - Heating by brosis and calcification.\nProgressive primary > tuberculosis. Cavity\xa0Obstructive emphysema\xa0If the incomplete obstruction is caused by lymph nodes.\nResorption atelectasis If the complete obstruction is caused by lymph nodes.\nTubercular bronchitis & bronchiectasis Hematogenous dissemination During early bacteremia seeding may occur at apex Simon's focus.\nMiliary tuberculosis Collapse consolidation (segmental lesion) A combination of pneumonitis and atelectasis.\n\nB) Chronic pulmonary tuberculosis :\n\nInfrequent in young children.\nChildren above the age of seven years, especially girls are more vulnerable.\n\nThe commonest site of chronic pulmonary tuberculosis is the apex of lung Puhl's lesion.\n\nInfraclavicular lesion of chronic pulmonary tuberculosis is called Assman's focus.Regional lymph nodes are not involved in chronic pulmonary TB (in contrast to primary TB). Lab investigations of pediatric TB.\nESR and blood counts : No value in diagnosis or follow up of TB.\nDemonstration of AFB.\nChildren don't expectorate out sputum, but swallow it.\n\nTherefore sputum is not available for examination.\n\nA laryngeal swab may be obtained for smear and culture examination for mycobacteriaIt is customer\xa0to examine the gastric lavage in children for bacteriological examination on 3 consecutive days, Aspiration of early morning gastric contents (before breakfast) is done with a Ryle's tube and sent for bacteriological examination. Adding vancomycin to the sample improves the yield of mycobacterium. The CSF, Pleural did or bronchial aspirate, urine and discharges from tuberculous sinuses are examined for tubercle bacilli. Histopathology : Material for histopathology may be obtained by biopsy or FNAC.\nPCR : High sensitivity and specificity for pleural uid and low for gastric aspirate. CXR and CT may show characteristic features.\nUSG may be helpful for the detection of enlarged abdominal lymph nodes,\nSerology : Elisa or other methods have no utility in pediatric TB. Antitubercular drugs used in children.\nFirst line drugs : Isoniazid, Rifampicin, EthambutoL Streptomycin, Pyrazinamide.\nSecond line drugs : Cycloserine, Ethionamide, PAS, Capreomycin, Kanamycin.\nOther drugs. Quinolones Ooxacin, Rifamycin, Amikacin, Imipenem, Ampicillin.", 'role': 'assistant'}]