Rosh Emergency Medicine Practice Test

What radiological finding is consistent with a history of pulmonary tuberculosis and presents with cough and night sweats?

1. Apical and posterior segment patchy consolidation of the upper lobes

2. Diffuse fine nodular opacities throughout bilateral lungs

3. Hilar lymphadenopathy and ipsilateral perihilar consolidation

4. Lobar consolidation of the right upper lobe

The correct answer is: Apical and posterior segment patchy consolidation of the upper lobes

The radiological finding consistent with a history of pulmonary tuberculosis, particularly in the presence of cough and night sweats, is patchy consolidation of the upper lobes, especially in the apical and posterior segments. Pulmonary tuberculosis often leads to upper lobe involvement due to the distribution of blood flow and the propensity of Mycobacterium tuberculosis to thrive in areas where oxygen tension is highest. In particular, the apices of the lungs are more affected because they are less perfused, allowing the bacilli to survive longer in these areas. The presence of night sweats and a chronic cough further supports the likelihood of active tuberculosis, as these symptoms are classic presentations of this disease. While other options describe various pulmonary conditions, they do not specifically correlate with the typical radiologic and clinical manifestations associated with tuberculosis. The diffuse fine nodular opacities suggest a different process, such as interstitial lung disease or silicosis, while hilar lymphadenopathy points to conditions like sarcoidosis or lymphoma. Lobar consolidation typically indicates pneumonia, which would not present with the historical context provided. Thus, the choice reflecting apical and posterior segment patchy consolidation aligns with the characteristic clinical and historical features of pulmonary tuberculosis.