Snapshot A 52-year-old African American woman presents to her primary care physician for worsening cough accompanied by fatigue, fever, and malaise. Physical exam is remarkable for an erythematous, nonulcerated, and tender nodule over the bilateral shins. A chest radiograph is obtained, which demonstrate bilateral hilar adenopathy without any appreciable pulmonary parenchymal infiltrates. Introduction Definition a systemic inflammatory disease that is characterized by the presence of non-caseating granulomas Sarcoidosis staging stage 1 bilateral hilar adenopathy stage 2 bilateral hilar adenopathy with parenchymal infiltrates stage 3 diffuse parenchymal infiltrates in the absence of hilar adenopathy stage 4 pulmonary fibrosis demonstrating honeycombing Epidemiology Incidence the lung is most commonly involved most common in African Americans Etiology Unknown Pathogenesis macrophages present antigens to T-cells Th1 cells are recruited and produce IFN-y, TNF, and IL-2 results in granulation formation Associated conditions neurosarcoidosis dilated and restrictive/infiltrative cardiomyopathy myocarditis hypercalcemia erythema nodosum uveitis acute interstitial nephritis lupus pernio restrictive lung disease rheumatoid-lie arthropathy Presentation Symptoms constitutional symptoms (e.g., fever, malaise, and anorexia) dyspnea arthralgias Physical exam erythema nodosum anterior uveitis cranial nerve VII involvement (worrisome for neurosarcoidosis) Imaging Chest radiograph indication initial imaging study in the evaluation of sarcoidosis findings hilar adenopathy (hallmark) reticular opacities parenchymal nodules High-resolution CT indication to further evaluate abnormalities demonstrated on chest radiography Studies Laboratory abnormalities hypercalcemia and hypercalciuria elevated angiotensin-converting enzyme (ACE) levels (~60% of cases) Biopsy of the affected organ preferred site of biopsy is the lesion that is most superficial non-caseating granuloma Differential Lymphoma differentiating factor a biopsy would not demonstrate noncaseating granuloma Treatment Medical oral corticosteroids indication considered first-line treatment Complications Pulmonary fibrosis Pulmonary hypertension Heart failure Prognosis Generally good in most patients
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.PL.17.4728) A 30-year-old woman presents to the clinic for evaluation of chronic dry cough of 3-months duration. She denies shortness of breath, hemoptysis, night sweats, or weight loss but does endorse occasional subjective fevers, joint discomfort, and recurrent crops of painful nodules on her legs. Her temperature is 99.2°F (37.3°C), pulse is 60/min, blood pressure is 112/74 mmHg, respirations are 14/min, and oxygen saturation is 98% on room air. Her laboratory test results are shown below:Leukocyte count: 7,200/mm^3Hemoglobin: 12.1 g/dLPlatelet count: 400,000/mm^3Serum:Na+: 135 mEq/LK+: 5 mEq/LCl-: 100 mEq/LHCO3-: 24 mEq/LBUN: 20 mg/dLCreatinine: 1.1 mg/dLGlucose: 105 mg/dLCa2+: 11.5 mg/dLMg2+: 2.0 mg/dLPhosphorus (inorganic): 3.2 mg/dLWhich of the following chest radiographs would most likely be present in this patient? QID: 108591 FIGURES: A B C D E Type & Select Correct Answer 1 Figure A - Chest radiograph 1 5% (2/37) 2 Figure B - Chest radiograph 2 76% (28/37) 3 Figure C - Chest radiograph 3 3% (1/37) 4 Figure D - Chest radiograph 4 3% (1/37) 5 Figure E - Chest radiograph 5 14% (5/37) M 6 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (M2.PL.17.4686) A 40-year-old woman presents to the clinic for malaise. She has been in her usual state of health until 2 weeks ago, when she noticed weakness and dyspnea upon exertion. She denies any orthopnea, paroxymal noctural dyspnea, or weight loss. She endorses occasional fevers but has not checked her temperature at home. She also reports worsening pain in her eyes that occasionally causes headaches and occasional joint pain. Her temperature is 98.6°F (37°C), blood pressure is 120/70 mmHg, pulse is 70/min, and respirations are 15/min. Physical exam shows injected sclera bilaterally. She denies pain with eye movement. Her lungs are clear to auscultation bilaterally. Cardiac auscultation reveals an S3 with an occasionally split S2. A chest radiograph is obtained and shown in Figure A. Her lower extremities reveal skin findings shown in Figure B. Which of the following is the most likely diagnosis? QID: 107433 FIGURES: A B Type & Select Correct Answer 1 Atypical pneumonia 12% (33/286) 2 Pulmonary hypertension 9% (25/286) 3 Rheumatoid arthritis 9% (26/286) 4 Sarcoidosis 60% (171/286) 5 Viral pneumonia 8% (24/286) M 6 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
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