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A 23-year-old woman has an 8-month history of dyspnea and dry cough. Medical history is unremarkable, and her only medication is an oral contraceptive agent.

On physical examination, vital signs are normal. Crackles are heard in both lung fields. Cardiac examination is normal. Abdominal examination discloses mild hepatomegaly.

Laboratory Studies
Complete blood count

Normal
Serum aspartate aminotransferase

42 U/L
Serum alanine aminotransferase

53 U/L
Serum alkaline phosphatase

432 U/L
Urinalysis

Normal

A chest radiograph shows mild diffuse pulmonary infiltrates. Heart size is normal. A tuberculin skin test is negative. Abdominal ultrasonography shows mild hepatomegaly without bile duct dilatation.

Which of the following is the most likely diagnosis?

A Amyloidosis
B Tuberculosis
C Sarcoidosis
D Primary biliary cirrhosis
E Oral contraceptive“induced cholestasis

Elev. alk po4ase suggest either increase in osteoblastic activity or billiary obst.
seems like RHF, IS IT AMYLOIDOSIS B/C OF CHR. INF.
B. CANT BE NO SPUTUM, LOW FEVER, WT.LOSS CXR- diffuse infilt.
C. NO POTATO NODES
D. JAUNDICE & WILL PRESENT AS PRURITUS.
E. WILL CAUSE THROMBOSIS IN VEIN, PORTAL HTN, HEPATOMA

pt has
1).pul infiltrates
2).Inc Alk Ph
3).Mild hepatomagaly.
the rest LFTs r bormal.

confused between A And E

I will go with EE

Correct Answer = C
Key Point
Pulmonary infiltrates, hepatomegaly, and a high alkaline phosphatase value are indicative of hepatic sarcoidosis.

A high serum alkaline phosphatase level is commonly associated with an infiltrative liver disorder, and the presence of pulmonary infiltrates and hepatomegaly are suggestive of sarcoidosis. Liver biopsy showing noncaseating granulomas will confirm the diagnosis of sarcoidosis.

Amyloidosis also causes hepatomegaly and cholestasis but is usually accompanied by evidence of other organ involvement, such as the nephrotic syndrome or neuropathy. In addition, amyloidosis is rare in patients this young. Tuberculosis is usually associated with fever and a positive tuberculin skin test. Primary biliary cirrhosis is a disease of middle-aged women and generally does not cause pulmonary findings. Although oral contraceptive agents may rarely cause cholestasis, this would not be associated with pulmonary findings.

what a tricky question! hope the real exam is more straight forward.

nice qq docheart!!

gud q

good one