View source for WBR0528

 {{WBRQuestion
|QuestionAuthor= {{M.P}}
|ExamType=USMLE Step 3
|MainCategory=Primary Care Office
|SubCategory=Musculoskeletal/Rheumatology
|MainCategory=Primary Care Office
|SubCategory=Musculoskeletal/Rheumatology
|MainCategory=Primary Care Office
|SubCategory=Musculoskeletal/Rheumatology
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Musculoskeletal/Rheumatology
|MainCategory=Primary Care Office
|SubCategory=Musculoskeletal/Rheumatology
|MainCategory=Primary Care Office
|SubCategory=Musculoskeletal/Rheumatology
|MainCategory=Primary Care Office
|SubCategory=Musculoskeletal/Rheumatology
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Musculoskeletal/Rheumatology
|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
[[File:Sarcoidosis (1) lymph node biopsy.jpg|centre|500px]]  Which of the following most frequently occurs with the disease this patient has?
|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.
|AnswerA=Hypercalcemia


|AnswerAExp='''Incorrect''' : [[Hypercalcemia]] occurs in 10 to 20 percent of sarcoidosis patients.
|AnswerB=Hypercalciuria

|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.
|AnswerC=Hepatospleenomegaly

|AnswerCExp='''Incorrect''' : [[Hepato-spleenomegaly]] is seen in 20-25 % of the patients.
|AnswerD=Anterior uveitis

|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]].
|AnswerE=Maculopapular rash
|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.
|RightAnswer=B
|WBRKeyword=Sarcoidosis
|Approved=Yes
}}