🩻 TOACS FCPS Station · Chest X‑ray: Miliary Tuberculosis
📷 Chest X‑ray (PA view)
🔍 Key radiographic features:
- ✓ Diffuse, bilateral 1‑2 mm nodules – “millet seed” appearance
- ✓ Fine nodular opacities throughout both lung fields
- ✓ Ground‑glass opacification – with discrete nodules
- ✓ No cavitation (unlike reactivation TB)
- ✓ May have mediastinal lymphadenopathy (primary TB component)
📋 Clinical scenario (examiner prompt)
A 2‑year‑old infant presents with prolonged fever (3 weeks), cough, and lethargy. He has poor weight gain and hepatosplenomegaly on examination. Fundoscopic examination reveals choroid tubercles. The chest X‑ray (PA view) is shown.
🧑⚕️ Examiner tasks · TOACS
1. Identify the diagnosis from the X‑ray and clinical context.
2. Describe the X‑ray findings (diffuse miliary nodules, hematogenous spread).
3. Explain the pathophysiology (disseminated TB, risk of CNS involvement).
4. Discuss management (urgent treatment, LP for meningitis, DOT).
🎯 Expected answers (for examiners)
- • Diagnosis: Miliary tuberculosis (disseminated TB)
- • X‑ray findings: Diffuse bilateral 1‑2 mm nodules (millet seed pattern)
- • Pathophysiology: Hematogenous dissemination from primary or reactivation focus
- • Management: Urgent HRZE (isoniazid, rifampin, pyrazinamide, ethambutol), LP (exclude meningitis), corticosteroids if CNS involvement, DOT
⚡ Quick FCPS‑style MCQ
A child with fever, hepatosplenomegaly, and choroid tubercles on fundoscopy. CXR shows diffuse miliary nodules. The most appropriate next step is:
A. Start HRZE and perform lumbar puncture B. Observe and repeat CXR in 2 weeks C. Start antibiotics for pneumonia D. CT chest only📌 Topic summary ·
Disseminated TB (hematogenous)
1‑2 mm diffuse nodules (“millet seeds”)
Choroid tubercles (fundoscopy)
CNS involvement (meningitis)
HRZE + corticosteroids (if meningitis)
Directly observed therapy
| Feature | Miliary TB |
|---|---|
| Nodule size | 1‑2 mm |
| Distribution | Diffuse, bilateral |
| Cavitation | Absent |
| Extrapulmonary | Common (CNS, liver, spleen, eye) |
| Urgency | Medical emergency |