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الوصف الكامل Background
A 28-year-old woman is evaluated for persistent cough. She has never smoked and travels to Mexico to vacation yearly. Physical examination is normal. Plain chest radiograph shows mild interstitial abnormalities with associated hilar and mediastinal fullness. Pulmonary physiology reveals normal spirometry (FVC, FEV1, and FEV1/FVC ratio) and a normal DLCO. A PPD is negative.
كتابة حرة وطرح موضوع النقاش!
Which additional findings in this patient would warrant oral corticosteroid therapy?
A. Bilateral anterior uveitis
B. Hypercalcemia
C. Tender red nodules over the anterior shins
D. Abnormal liver function tests
Tue, 2009-01-13 20:37
Fouad
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معقول متلازمة لوفغرين = حمامى عقدة
I'm thinking of Sarcoidosis, if it's the diagnosis, then I'll go with C the Erythema nodosum
I think that there should be something related to Mexico, but I don't know it
Bilateral anterior uveitis
بعد البحث والتمحيص وجدت
# Oral corticosteroids are usually the treatment of choice for patients with neurologic, cardiac, or ocular involvement not responding to topical corticosteroids; hypercalcemia; and symptomatic stage II and all stage III
pulmonary disease.
وهكذا اعتقد أن الجواب هو B
لأننا نطبق السيترويدات موضعياً في إصابة العين بالساركوئيد
Why do you think so a.m.a
(Correct Answer = B)
Sarcoidosis is an idiopathic systemic illness characterized by tissue infiltration with well-formed noncaseating granulomata. More than 90% of patients have pulmonary involvement, which manifests radiographically as hilar and mediastinal lymphadenopathy, with or without parenchymal involvement. Many patients are asymptomatic and the disease is identified on routine chest radiographs. Treatment for sarcoidosis is controversial and is generally reserved for those with disabling symptoms, evidence for progressive lung disease, symptomatic extrapulmonary disease (for example, cardiac or neurologic disease), or complications such as hypercalcemia.
The cornerstone of therapy is corticosteroids for 6 to 12 months. Although this treatment reduces symptoms and improves radiographic abnormalities and pulmonary function tests, it is of unproven benefit in altering long-term outcome. Spontaneous remissions of disease are common and related to the stage of disease as defined by the Siltzbach radiographic stage. Patients with radiographic stage 1 disease (hilar and/or mediastinal lymphadenopathy without parenchymal infiltrate) and no systemic symptoms have spontaneous remission rates of 50% to 90%.
Patients with anterior uveitis are best treated first with topical corticosteroids rather than systemic corticosteroids. Löfgren's syndrome is defined by fever, erythema nodosum, and bilateral hilar lymphadenopathy. Patients with this syndrome also have a benign course and may be managed with observation alone.
Oops, I didn't understand the question this way, but it's a really nice case, thanks Fouad
بس توجهنا صحيح ..شكرا
هي فرقت على كلمة systemic steroids.... لأن uveitis هو استطباب لاستخدام الستيروئيدات...
بس والله سؤال صعب
ليش انا مفكرة انو التهاب العنبة بد و ستيروئيدات بالطريق العام فورا ؟
هالسؤال نكشة :متل الاسئلة المخصصة لتنزبل العلامات بكلياتنا
remember that hypercalcemia caused by hypervitaminosis ( vitamin D )is extrarenal in origin
i mean vitamin D activation occurs via the epithiloid macrophages in the granuloma ( outside the kidney )
the body will physiologically compensate by suppressing parathormone release which means that hypercalcemia might not b frank
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of interest:
Sarcoidosis has repeatedly been associated with celiac disease.