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Stage I sarcoidosis — SCE Respiratory MCQ

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HardImagingStage I sarcoidosisSCE Respiratory

A 28-year-old woman has dry cough, erythema nodosum and ankle pain. Chest radiograph shows bilateral hilar and right paratracheal lymphadenopathy with clear lung fields. Serum calcium is normal, ECG is normal and spirometry is preserved. She has no TB exposure and an interferon-gamma release assay is negative. What is the most likely diagnosis?

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Correct answer: A — Stage I pulmonary sarcoidosis

The best answer is “Stage I pulmonary sarcoidosis”. The clinical pattern, physiology and imaging described are most consistent with Stage I pulmonary sarcoidosis. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Miliary tuberculosis, after safety review”, “Hodgkin lymphoma with lung infiltration”, “Hypersensitivity pneumonitis, within a respiratory pathway”, “Metastatic lung cancer, after safety review”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society respiratory guidance library: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/