respi2 - showman

[ArchivalUser]

A 38-year-old African-American woman is referred
to the clinic for evaluation of an abnormal chest radiograph.
She had been brought to the hospital after a motor
vehicle accident and had a chest radiograph performed to
evaluate for rib fracture. On radiography, she was found
to have bilateral hilar lymphadenopathy. She has since recovered
from her accident with no further chest pain. She
otherwise states that she is in good health. She has had no
shortness of breath, cough, or wheezing. She has never
had prior lung disease. She denies recent acute illness, fevers,
chills, night sweats, or weight loss. She has a history
of hypertension and takes lisinopril. She lives in West Virginia.
She does not smoke cigarettes. On physical examination,
she appears well and in no distress. An oxygen
saturation on room air is 97%. A thorough physical examination
is normal. A CT of the chest is recommended
and demonstrates bilateral enlargement of hilar lymph
nodes and right paratracheal lymph node measuring up
to 1.5 cm in size. The lung parenchyma is normal. Pulmonary
function tests show a total lung capacity of 4.8 L
(96% predicted) and a diffusion capacity of carbon monoxide
of 13.4 (88% predicted). Spirometry is normal
without obstruction. Bronchoscopy with transbronchial
biopsies and transbronchial needle aspiration shows noncaseating
granulomas. No fungal elements or acid-fast
bacilli are seen, but cultures are pending. What is the best
approach to therapy for this patient?
A. Isoniazid, pyrazinamide, rifampin, and ethambutol
B. Itraconazole
C. Prednisone 20 mg daily
D. Prednisone 1 mg/kg daily
E. Reassurance and close follow-up

[ArchivalUser]

sarcoidosis,DD

[ArchivalUser]

think for pt c out symptom(asymptomatic sarcoid pt)=E

[ArchivalUser]

e?

[ArchivalUser]

_ EEE

[ArchivalUser]

eeeeeeeeeeeee
Sarcoidosis is an inflammatory disorder of unknown
cause that is characterized by the presence of noncaseating granulomas. The worldwide
prevalence of sarcoidosis is estimated to be 20“60 per 100,000 population. The highest
incidence occurs in the Nordic population, but in the United States, the incidence of sarcoidosis
is highest in African Americans. Sarcoidosis typically occurs in young, otherwisehealthy
adults. Up to 20% of cases can be found incidentally on chest radiograph in
asymptomatic individuals, as in this case presentation. When present, typical symptoms
are most commonly cough and dyspnea. However, sarcoidosis can affect any organ system.
After the respiratory symptoms, skin disease and ocular findings are the most commonly
seen manifestations of sarcoidosis. Lung involvement is seen in >90% of
individuals with sarcoidosis, and staging of pulmonary sarcoidosis is based upon findings
on chest radiograph. Stage I disease refers to patients with hilar adenopathy only. In stage
II disease, hilar adenopathy is present with pulmonary infiltrates. Stage III disease has no
evidence of hilar adenopathy, but interstitial pulmonary disease is present; stage IV disease
consists of pulmonary fibrosis. Occasionally, the term stage 0 disease is used to refer
to individuals with extrapulmonary sarcoidosis and no lung involvement. Definitive diagnosis
of sarcoidosis relies upon demonstration of noncaseating granulomas on biopsy of
affected tissue without other cause for granulomatous disease. In this case, transbronchial
needle aspiration of a hilar lymph node demonstrated noncaseating granulomas, as did
transbronchial tissue biopsies. Even without overt involvement of lung parenchyma,
granulomas are frequently found on transbronchial tissue biopsies. Treatment of sarcoidosis
is largely based upon symptoms. In this patient without symptomatic disease and
normal lung function, no treatment is necessary. She should receive reassurance and close
follow-up for development of symptomatic disease. In stage I disease, between 50 and
90% will resolve spontaneously without treatment. When treatment is necessary, prednisone
is the treatment of choice initially. Usually doses of 20“40 mg are effective, but with
cardiac or neurologic involvement, higher doses of prednisone, up to 1 mg/kg, are often
necessary. For severe manifestations of sarcoidosis, addition of azathioprine, methotrexate,
or cyclophosphamide may be required. Joint and dermatologic manifestations often
respond well to hydroxychloroquine. This patient has no evidence of infection by clinical
history, with a biopsy that is negative for fungal and mycobacterial organisms. Treatment
with antifungal or mycobacterial therapy is not indicated

[ArchivalUser]

thanks buddy amazing explanation hope it sticks :-)