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A 50-year-old woman has lived in Oslo, Norway all her life and worked as a seamstress. She is a non-smoker, but she has had increasing shortness of breath, fever, weight loss, and night sweats for the past 4 months. On physical examination her temperature is 37.6 C. There are fine rales auscultated in all lung fields. A chest radiograph reveals hilar lymphadenopathy and a reticulonodular pattern of small densities in all lung fields. She demonstrates anergy by skin testing to mumps and Candida antigens. A transbronchial biopsy is performed that microscopically shows numerous small pulmonary interstitial non-caseating granulomas. Which of the following is the most likely diagnosis?
A Histoplasmosis
B Adenocarcinoma
C Sarcoidosis
D Usual interstitial pneumonitis
E Berylliosis
F Tuberculosi
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| GoodGirl
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C, Sarcoidosis
Clues = nonsmoker, anergy, NCG with hilar lymphadenopathy.
Could be future Lofgren sy ( fever, bilater. lymphadenopathy, polyarthralgia ) common in North ( scandinavians ) .
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Because she has numerous non-caseating granulomas it should be D. or E. she was a
seamstress so it is D.
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| SILVER
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C
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yeah its c major clue was non-caseating granulomas,rest si/sx may confuse with TB .
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| keepgoing
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thanks GG for add-on "lofgren syndrome' 
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| GoodGirl
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I had it freshly in my head as I read about it couple of days ago . 
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Great  and lets add on few more..sarcoidosis also cause one endocrine disoder,an u recall it?
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| GoodGirl
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You mean hypercalcemia via increased synthesis of 1-a-hydroxylase.
Is this endocrine?
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nope i was talking about tertery hypothyroidism==>sarcoidosis destroys TRH)
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| GoodGirl
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Really, I just opened RRGoljan, and he states : DIABETES INSIPIDUS ( HYPOTH / HYPOPHYS ) , so it affects more hormonal systems like TSH ?
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GG it was in goljan tapes he mentioned in endocrine lect very beginning,its infiltrative due to sarcoidosis.
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| GoodGirl
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Thanks, so sarcoidosis infiltrates the hypoth/hypoph. and it will just '' knock out '' some hormones. Got it !
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yep exactly..i just read in wiki also..
"Endocrine
Granulomas in the pituitary gland, which produces numerous hormones, is rare but leads to any of the symptoms of hypopituitarism: amenorrhoea (cessation of the menstrual cycle), diabetes insipidus (dehydration due to inability to concentrate the urine), hypothyroidism (decreased activity of the thyroid) or hypocortisolism (deficiency of cortisol). "
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KG, check out this Q .
Attached Files:
Sarcoidosis2.JPG (39 KB, 16 downloads)
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its astroids,
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You would think .......
Attached Files:
sarc answer.JPG (141 KB, 14 downloads)
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oops! i didnt read granuloma..thats definatly epithiloid...no doubt about it,im too sleepy u can see now..hehe cool qn .
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| usmlekiller
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wat qbank is that? kaplan?
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usmlekiller u asked GG or me?well GG qn is from K i guess but mine WP.
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