WBR0528

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Musculoskeletal/Rheumatology
Prompt	[[Prompt::34 year old female presents to the office with 1 month history of fatigue, low grade fever, joint pains. She says he has been having pain in the ankle early morning and feels better during the end of the day. Her past medical history is insignificant. She is a chronic smoker and alcoholic. She is sexually active. Physical examinations shows hyperemia and swelling of the ankle joints. Examination of the other joints is normal. Enlarged cervical lymph nodes are noted on examination. Cardiovascular and respiratory system examinations are normal. Biopsy of the cervical lymph node shows the following Which of the following most frequently occurs with the disease this patient has?]]
Answer A	AnswerA::Hypercalcemia
Answer A Explanation	[[AnswerAExp::Incorrect : Hypercalcemia occurs in 10 to 20 percent of sarcoidosis patients.]]
Answer B	AnswerB::Hypercalciuria
Answer B Explanation	[[AnswerBExp::Correct : Abnormalities related to calcium metabolism are the most common renal and electrolyte abnormalities observed among patients with sarcoidosis. The defect in calcium metabolism is due to extrarenal production of calcitriol by activated macrophages. Hypercalciuria occurs in up to 50 percent of cases causing nephrocalcinosis.]]
Answer C	AnswerC::Hepatospleenomegaly
Answer C Explanation	[[AnswerCExp::Incorrect : Hepato-spleenomegaly is seen in 20-25 % of the patients.]]
Answer D	AnswerD::Anterior uveitis
Answer D Explanation	[[AnswerDExp::Incorrect : Ocular involvement occurs in up to 20 percent of patients with sarcoidosis and is the presenting symptom in 5 percent. Lesions include anterior uveitis (iridocyclitis or iritis), posterior uveitis (chorioretinitis), retinal vasculitis, keratoconjunctivitis, conjunctival follicles, secondary glaucoma, cataract formation and blindness.]]
Answer E	AnswerE::Maculopapular rash
Answer E Explanation	[[AnswerEExp::Incorrect : Cutaneous involvement is seen in approximately 25 percent of patients with sarcoidosis, and is often an early finding. A maculopapular rash is the most common subacute lesion. It usually involves the alae nares, lips, eyelids, forehead, rear of neck at the hairline, and/or previous trauma sites.]]
Right Answer	RightAnswer::B
Explanation	[[Explanation::The image shows non-caseating granuloma in a lymphnode suggestive of sarcoidosis. Sarcoidosis, also called sarcoid or Besnier-Boeck disease, is an immune system disorder characterised by non-caseating granulomas (small inflammatory nodules) that most commonly arises in young adults. The cause of the disease is still unknown. Virtually any organ can be affected; however, granulomas most often appear in the lungs or the lymph nodes. Sarcoidosis most frequently involves the lung; thus, common presenting symptoms include cough, dyspnea, and chest pain. The classic chest roentgenogram reveals bilateral hilar adenopathy. Common extrapulmonary abnormalities on presentation include eye and skin lesions. Other features of sarcoidosis include fatigue, malaise, fever, and weight loss. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Sarcoidosis
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::