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  #1  
Old 03-31-2010
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Question African American Woman with Dyspnea

A 32-year-old African American woman returns to the clinic for a follow-up visit. She was seen 2 weeks prior with complaints of dyspnea, dry cough, chest pain, and tightness of the chest. An electrocardiogram was within normal limits. A chest x-ray was performed a week later which showed bilateral hilar lymphadenopathy with pulmonary infiltrate. While in clinic now, she points out a rash on her nasal tip that has been present for a number of months. There is a 4 x 2 cm violaceous, indurated plaque involving the nasal tip extending to the bilateral ala. There are a few tiny button-like papules in the center of the plaque. In addition, there are waxy, translucent lesions with flat tops on the face, lids, around the orbits, and in the nasolabial folds. The most appropriate next step in evaluation is to

A. determine serum angiotensin-converting enzyme and serum calcium levels


B. determine serum CEA marker level


C. order a complete blood count


D. refer her for a bronchoscopy


E. send her for a lung biopsy
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  #2  
Old 03-31-2010
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I think its A ...... sarcoidosis ....
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Old 03-31-2010
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that s sarcoidoisis.A is correct. Hypercalcemia(5% patient) ,increase ACE(60-70%)
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Old 03-31-2010
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"A" is the answer in my opinion !!
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Old 03-31-2010
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Default I don't know the answer

I have another idea about this case.
This could be dermatomyositis (from the description of the rash) and in such case you should look for internal malignancies (lung biopsy)

Also another diagnosis popped up in my mind which is Churg Strauss syndrome !
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Old 03-31-2010
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I saw dermatomyositis as possible case ... and yes secondary malignancy is very possible, but "Choice B" "CEA" is only tumour marker "not a diagnostic test for malignany". So you can't go for this CEA as a next step ... If CT/MRI were available, you might think about that choice as next step ...
I don't know ... But that's my opinion !!
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good guys the correct answer is A. determine serum angiotensin-converting enzyme and serum calcium levels
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Dermatology-, Pulmonology-, Step-2-Questions

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