Master the board step 3

Pulmonology
Diagnostic Testing
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Chest x-ray: Shows bilateral patchy infiltrates
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Chest CT: Shows interstitial disease and alveolitis
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Most accurate diagnostic test: Open lung biopsy is the only definitive way
to make the diagnosis of BOOP/COP.
Treatment
Treat BOOP/COP with steroids. There is no response to antibiotics.
The following table compares BOOP/COP and ILD.
BOOP/COP
Fever, myalgias, malaise (clubbing
uncommon)
Presents over days to weeks
Patchy infiltrates
Steroids effective
ILD
No fever, no myalgias
Six months or more of symptoms
Interstitial infiltrates
Rarely responds to steroids
Sarcoidosis
This condition presents in an African-American woman under 40 with
cough, shortness of breath, and fatigue over a few weeks to months. Physical
examination shows rales. Although sarcoidosis can involve many organs, the
vast majority of cases present with lung findings only.
Rare physical findings and presentation include the following:
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Eye: Uveitis that can be sight threatening
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Neural: Seventh cranial nerve involvement is the most common.
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Skin: Lupus pernio (purplish lesion of the skin of the face), erythema
nodosum
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Cardiac: Restrictive cardiomyopathy, cardiac conduction defects
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Renal and hepatic involvement: Occurs without symptoms
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Hypercalcemia: This occurs in a small number of patients secondary to
vitamin D production by the granulomas of sarcoidosis.
Diagnostic Testing
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Best initial test: Chest x-ray, which always shows enlarged lymph nodes.
There may be interstitial lung disease in addition to the nodal involvement.
· · Most accurate diagnostic test: Lung or lymph node biopsy showing noncaseating
granulomas
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