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Pulmonary 2


Pulmonary 2


حالة سريرية

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

Fouad's picture
by
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!!!!!!!!11111

qusei


معقول متلازمة لوفغرين = حمامى عقدة confused

qusei

be careful....it's tricky question.... Laughing out loud Laughing out loud Laughing out loud
Fouad's picture
Fouad
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I'm thinking of Sarcoidosis, if it's the diagnosis, then I'll go with C the Erythema nodosum

ola-s
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I think that there should be something related to Mexico, but I don't know it

ola-s
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Bilateral anterior uveitis

a.m.a's picture
a.m.a
طبيب مقيم

anybody else wanna add an answer?
Fouad's picture
Fouad
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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

the best's picture
the best
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Why do you think so a.m.a

ola-s
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good job the best....i was writing that all are weong
(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.

Fouad's picture
Fouad
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Oops, I didn't understand the question this way, but it's a really nice case, thanks Fouad

ola-s
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بس توجهنا صحيح ..شكرا Very Happy

qusei


هي فرقت على كلمة systemic steroids.... لأن uveitis هو استطباب لاستخدام الستيروئيدات...

Fouad's picture
Fouad
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بس والله سؤال صعبEye-wink

the best's picture
the best
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Quote:
Patients with anterior uveitis are best treated first with topical corticosteroids rather than systemic corticosteroids

ليش انا مفكرة انو التهاب العنبة بد و ستيروئيدات بالطريق العام فورا ؟

a.m.a's picture
a.m.a
طبيب مقيم


هالسؤال نكشة :متل الاسئلة المخصصة لتنزبل العلامات بكلياتنا confused

a.m.a's picture
a.m.a
طبيب مقيم

again the age ,sarcoidosis is highest for individuals younger than 40 and peaks in the age-group from 20 to 29 years
Quote:
hypercalcemia in sacroidosis

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

----------

of interest:

Sarcoidosis has repeatedly been associated with celiac disease.

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