Hilar and Mediastinal fullness - harry206

[ArchivalUser]

28-year-old woman
c/o- persistent cough
never smoked
travels to Mexico to vacation yearly
p/e- normal
Plain chest radiograph- mild interstitial abnormalities with associated hilar and mediastinal fullness.
Pulmonary physiology - normal spirometry (FVC, FEV1, and FEV1/FVC ratio) and a normal DLCO
PPD- negative.

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

[ArchivalUser]

...A...
Pt is symptomatic.

[ArchivalUser]

will go with A too.

[ArchivalUser]

will post answers in few minutes

[ArchivalUser]

Even I marked A

but answer is B

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.

[ArchivalUser]

Patients with anterior uveitis are best treated first with topical corticosteroids rather than systemic corticosteroids.

[ArchivalUser]

my ans: B
indications for steroids.. uveitis, high Ca, CNS symptoms

[ArchivalUser]

therapy of pulmonary sarcoidosis are: Worsening pulmonary symptoms, including: cough, shortness of breath, chest pain or discomfort, and hemoptysis. Deteriorating lung function, as assessed by serial testing at three to six month intervals that demonstrates one or more of the following: a fall in total lung capacity of 10 percent or more; a fall in forced vital capacity of 15 percent or more; a decrease in diffusing capacity of 20 percent or more; or worsened gas exchange at rest or with exercise. Progressive radio graphic changes, including: worsening of interstitial opacities, development of cavities, progression of fibrosis with honeycombing, or development of signs of pulmonary hypertension.

severe discomfort or inability to work as a result of fever, weakness, fatigue, arthralgia, neuropathy, disfiguring skin disease, upper airway disease, or hepatic insufficiency. Treatment of ocular, neurologic, myocardial, or renal sarcoidosis or hypercalcemia is indicated even when symptoms are slight, because severe loss of vision, fatal arrhythmias, or insidious renal damage may ensue