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Old 09-15-2012
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Arrow Gyrus Daily Questions; Internal Medicine #3

A 29-year-old male is found on routine chest radiography for life insurance to have right hilar adenopathy. He is otherwise healthy. Besides biopsy of the lymph nodes, which of the following is indicated?


A. Angiotensin-converting enzyme (ACE) level
B. β-hCG
C. Thyroid stimulating hormone (TSH)
D. PSA
E. C-reactive protein
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Old 09-15-2012
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If it was sarcoidosis, they'd say that he is black...

Young man, balls out!

check B-hcg

Answer - B
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Ans is B -mts nonseminematous tt. it could be sarcoidosis only if b/l hilar ln
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Quote:
Originally Posted by cingulate.gyrus View Post
A 29-year-old male is found on routine chest radiography for life insurance to have right hilar adenopathy. He is otherwise healthy. Besides biopsy of the lymph nodes, which of the following is indicated?

A. Angiotensin-converting enzyme (ACE) level >>>>>For Sarcoidosis but unlikely since the lymphadenopathy is bilateral and the patient does not belong to the usual demographic.

B. β-hCG >>>>> most likely answer since young asymptomatic patient

C. Thyroid stimulating hormone (TSH)

D. PSA >>>>>unlikely at this young age

E. C-reactive protein>>>>>too non-specific
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The answer is B.

The patient is a young man with asymmetric hilar adenopathy. The differential diagnosis would include lymphoma, testicular cancer, and, less likely, tuberculosis or histoplasmosis. Because of his young age, testicular examination and ultrasonography would be indicated, as would measurement of β-hCG and AFP, which are generally markedly elevated. In men with carcinoma of unknown primary source, AFP and β-hCG should be checked as the presence of testicular cancer portends an improved prognosis compared with possible primary sources. Biopsy would show lymphoma.

The ACE level may be elevated but is not diagnostic of sarcoidosis. Thyroid disorders are not likely to present with unilateral hilar adenopathy. Finally, PSA is not indicated in this age category, and C-reactive protein would not differentiate any of the disorders mentioned above. Biopsy is the most important diagnostic procedure.
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Old 09-17-2012
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B, check BOTH b-hCG and AFP

Think Lance Armstrong ...=)
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