QuestionSBA
QuestionChoice
This describes a pneumothorax, which does not fit with the clinical presentation as it would typically cause sudden onset shortness of breath with pleuritic chest pain.
10028330
e
Absence of lung markings at the right apex
QuestionChoice
This may be seen in a lung malignancy (some of which can also cause hypercalcaemia). This would be less common in a younger patient with no mention of smoking history and unlikely to cause erythema nodosum.
10028328
c
Unilateral spiculated mass
QuestionChoice
This describes chest X-ray changes that may be seen in acute heart failure. Whilst this also may present with shortness of breath and a dry cough, it would be less likely to occur in a younger patient with no other past medical history, or cause erythema nodosum or hypercalcaemia.
10028329
d
Cardiomegaly and pleural effusions
QuestionChoice
This question describes a case of sarcoidosis, a granulomatous disease which can affect multiple systems. It commonly affects women aged 20-40 and can present with progressive dyspnoea and a dry cough. The tender nodules mentioned describe erythema nodusum. Hypercalcaemia can also be seen in sarcoidosis, which is thought to be due to increased active vitamin D production. Bilateral hilar lymphadenopathy is a classic chest X-ray finding of sarcoidosis.
10028326
a
Bilateral hilar lymphadenopathy
QuestionChoice
Sarcoidosis typically causes an upper zone pulmonary fibrosis rather than lower zone.
10028327
b
Lower zone pulmonary fibrosis
QuestionComment
why not tb
56874
QuestionComment
Hypercalcaemia + erythema nodosum + dry, non-productive cough = sarcoid. Also typical in women of this age 
57776
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Cystic Monoclonal
User
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Malignant Syndrome
Concept
Chapter
2693
6052
Bilateral hilar lymphadenopathy
Topic
132
Respiratory
18063
Bilateral hilar lymphadenopathy is a characteristic chest X-ray finding in sarcoidosis, often associated with hypercalcaemia and respiratory symptoms.
A 35-year-old female has bilateral raised, tender nodules on her shins. She also complains of shortness of breath and a dry cough for the last 6 months.

She has no past medical history. A routine blood test shows hypercalcaemia.

Given the likely diagnosis, what is most likely to be seen on chest X-ray?
a