QuestionSBA
QuestionChoice
Although sarcoidosis may rarely cause a pleural effusion, it typically has little pleural involvement, making this finding unlikely. Patients with a pleural effusion are also likely to present with chest pain which is absent in this patient. CXR in pleural effusion would show blunting of the costophrenic angles or white-out of one hemifield if large.
10006827
b
Pleural effusion
QuestionChoice
Kerley B lines are horizontal lines in the peripheries of the lung which extend to the pleura. They may be present in pulmonary/interstitial oedema, and represent thickened interlobular septa. They are not associated with sarcoidosis.
10006828
c
Kerley B lines
QuestionChoice
This patient is likely suffering from sarcoidosis, which can present acutely with fever, polyarthralgia, erythema nodosum, and bilateral hilar lymphadenopathy (known collectively as Lofgren syndrome). It is a multisystem disease which is characterised by the formation of granulomas which result in widespread inflammation and complications. A tissue biopsy is diagnostic which would show non-caseating granulomas, however bilateral hilar lymphadenopathy is classically seen on chest X-ray.
10006826
a
Bilateral hilar lymphadenopathy
QuestionChoice
A lung nodule may be a sign of lung cancer, which may present with similar symptoms as this patient. However, the patient's age and lack of risk factors make this an unlikely diagnosis. It would also not explain the presence of erythema nodosum, which is a key feature of sarcoidosis.
10006830
e
Lung nodule
QuestionChoice
Hyperinflation is a sign often seen in patients suffering from COPD. A patient with COPD may present with symptoms similar to this patient. However, the systemic involvement and age of this patient make this an unlikely diagnosis.
10006829
d
Lung hyperinflation
Concept
Chapter
2693
3694
Sarcoidosis
Topic
132
Respiratory
13912
A 33-year-old black woman presents to her GP complaining of a dry cough and worsening shortness of breath for the last two months. She reports feeling fatigued and that she has lost some weight recently. She denies chest pain. Upon examination, you note nodules on her shins bilaterally, and swollen lymph nodes in the patient's neck. She drinks approximately six units of alcohol each week, does not smoke, and denies any recent international travel.
Her temperature is 37.9 degrees, pulse 89 bpm, BP 126/78, and CRT < 2.
Blood tests show raised ESR, raised calcium, and reduced lymphocytes. Blood, urine and sputum cultures are all negative.
Given the likely diagnosis, what would most likely be present on a chest X-ray?
a