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 BOF 141

 

   

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BOF: 141

A 26 year old male is admitted with a history of cough, fever and loss of weight. He had been previously well and had not been on any regular medication. He smoked 40 cigarettes a day and consumed approximately 40 units of alcohol per week. His father had a chest problem and had been on treatment for some time but he did not know what the problem was. He was unemployed and lived at home with his parents.

On examination he looked unwell. He was underweight and febrile. Pulse rate 110 beats per minute, BP 120/80, JVP not elevated, heart sounds were normal there were scattered rhonchi and crepitations throughout both lungs.

Chest X-ray showed hilar lymphadenopathy and diffuse nodular shadowing

Hb 9.2 g/dL

WBC 20.2 x109/L

Platelets 75 x109/L

ESR 120 mm in 1st hour

Urea 7.9 mmol/L

Creatinine 72 Ámol/L

Calcium (corrected) 3.39 mmol/L

Phosphate 1.28 mmol/L

Alkaline phosphatase 92 U/L

Parathyroid hormone 0.5 pmol/L (normal 0.9-5.4 pmol/L)

In this patient the investigation that is most likely to lead to a diagnosis is:

a)   Bone marrow examination

b)   Sestambi scanning

c)    Mediastinoscopy

d)   Bone scan

e)   Sputum for AAFB

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