QBDOTW: A 50-year-old African American Female, SOB & Fatigue
Welcome back to MedSmarter’s USMLE Style Question of the Week. Here’s the breakdown of a high-yield Respiratory question for those preparing for your USMLE Step 1 or just to gain some knowledge. As always you want to begin with reading the last sentence of the vignette first to get an understanding of what the question is asking for.
Question Break Down of the Week:
A 50-year-old African-American woman presents to your office because of shortness of breath and fatigue that has worsened over the past 4 weeks. Over the past week, she has noticed the appearance of subcutaneous nodules on her lower extremities. Physical examination reveals flat, elevated lesions on the lower extremities bilaterally. Chest auscultation shows dry rales with a chest x-ray showing bilateral hilar lymphadenopathy. Lab tests are performed. Which result, although not diagnostic, is most commonly associated with this patient’s condition?
A) Elevated angiotensin-converting enzyme level
B) Elevated cardiac enzyme levels
C) Elevated serum amylase levels
The correct answer choice is A: This patient has sarcoidosis involving the lungs and skin. Sarcoidosis is characterized by noncaseating granulomas, and hilar lymphadenopathy is one of the most common findings in this condition. Skin involvement occurs in approximately 25% of patients. Angiotensin-converting enzyme levels are elevated in sarcoidosis due to its overproduction by immune cells comprising the granulomas. The lab values in sarcoidosis are characterized by elevated ACE levels, as well as hypercalcemia. You can also see an elevation of the CD4/CD8 ratio in the bronchoalveolar lavage.
Did you think the answer was different?
Did you think that the correct answer choice was other than D? You can view this video for a deeper discussion of why B, C, D, and E were not the correct answer choices.
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