The Question is from neet-zoology breathing-and-exchange-of-gases disorders-of-respiratory-system, and it was created by the author T SAILAJA

Question

A patient presents with chronic cough, dyspnea, and weight loss.  A lung biopsy reveals granulomas containing epithelioid cells and multinucleated giant cells.  Further tests rule out infections like tuberculosis. Which of the following is the MOST likely diagnosis?

T SAILAJA · Accepted Answer

## CORE INFORMATION
✓ **Answer**: A
## CONCEPT FRAMEWORK
 **Primary Concept**: Differential diagnosis of granulomatous lung disease
 **Related Topics**: Pulmonary pathology, inflammatory lung diseases, granulomas
 **Prerequisites**: Understanding of common causes of granulomatous lung disease, microscopic features of granulomas.
## SOLUTION PATHWAY
**Given Information**:
  Chronic cough, dyspnea, weight loss
  Lung biopsy showing granulomas with epithelioid cells and multinucleated giant cells
  Tuberculosis ruled out
**Method & Steps**:
 1. Identify key features: The presence of granulomas containing epithelioid cells and multinucleated giant cells is a hallmark of several granulomatous diseases.
  Reasoning: These cellular components are characteristic of a type of immune response involved in the formation of granulomas.
  Formula/Rule:  None directly applicable, this is a diagnostic reasoning problem.
 2. Consider differential diagnosis: Given the clinical presentation and biopsy findings, several conditions need to be considered, including sarcoidosis, tuberculosis, fungal infections, and other less common granulomatous diseases.
  Working:  The question explicitly states that tuberculosis is ruled out.  The other options are considered and eliminated below.
  Key Point:  The clinical picture (chronic cough, dyspnea, weight loss) and histological findings (granulomas with epithelioid cells and giant cells) are crucial in narrowing down the possibilities.
 3. Evaluate the options: 
  Result: Sarcoidosis is the most likely diagnosis given the information provided.  Asbestosis, hypersensitivity pneumonitis, and idiopathic pulmonary fibrosis typically present differently.
  Verification:  The classic presentation of sarcoidosis aligns with the given symptoms and biopsy findings.  The absence of exposure to asbestos, organic dusts, or other known risk factors for the other options makes sarcoidosis the most probable diagnosis.
 ## OPTION ANALYSIS
A ✓: Sarcoidosis is characterized by non-caseating granulomas in various organs, including the lungs.  The clinical presentation of cough, dyspnea, and weight loss is common.  The histological findings perfectly match sarcoidosis.
B :x: Asbestosis is associated with asbestos exposure and typically presents with interstitial lung disease, not necessarily with granulomas.
C :x: Hypersensitivity pneumonitis is an allergic reaction to inhaled antigens, often presenting with acute or subacute symptoms, rather than the chronic presentation described.
D :x: Idiopathic pulmonary fibrosis is a progressive lung disease characterized by scarring, not granulomatous inflammation.
 ## LEARNING AIDS
 **Common Mistakes**:
  1.Overlooking the importance of the histological findings:  The presence of granulomas is a key diagnostic clue.
  2.Failing to consider the differential diagnosis systematically:  Many conditions can cause granulomatous lung disease.
 **Quick Tips**:
  1.Remember the key features of sarcoidosis: non-caseating granulomas, systemic involvement, and a variable clinical presentation.
  2.Use a systematic approach to differential diagnosis, considering the clinical presentation and histological findings.

T SAILAJA · Answer

The correct Option is "Sarcoidosis"

T SAILAJA · Answer

Asbestosis

T SAILAJA · Answer

Hypersensitivity Pneumonitis

T SAILAJA · Answer

Idiopathic Pulmonary Fibrosis

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