A 32-year-old man who recently emigrated from Somalia comes to the physician because of a 4-week history of fever, cough, and chest pain. He has had a 5-kg (11-lb) weight loss over the last 3 months despite no changes in appetite. His temperature is 38.1°C (100.6°F). Physical examination shows enlarged cervical lymph nodes. The lungs are clear to auscultation. The results of an interferon-γ release assay are positive. An x-ray of the chest shows bilateral mediastinal lymphadenopathy. A transbronchial needle aspiration biopsy of a mediastinal lymph node is performed; a photomicrograph of the specimen is shown. The structure indicated by the arrow is most likely comprised of which of the following types of cells?
ANatural killer cells
BB cells
CFibroblasts
DNeutrophils
EMacrophages
A 24-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has type 1 diabetes mellitus. His only medication is insulin. He immigrated from Nepal 2 weeks ago . He lives in a shelter. He has smoked one pack of cigarettes daily for the past 5 years. He has not received any routine childhood vaccinations. The patient appears healthy and well nourished. He is 172 cm (5 ft 8 in) tall and weighs 68 kg (150 lb); BMI is 23 kg/m2. His temperature is 36.8°C (98.2°F), pulse is 72/min, and blood pressure is 123/82 mm Hg. Examination shows a healed scar over his right femur. The remainder of the examination shows no abnormalities. A purified protein derivative (PPD) skin test is performed. Three days later, an induration of 13 mm is noted. Which of the following is the most appropriate initial step in the management of this patient?
AAdminister isoniazid for 9 months
BCollect sputum sample for culture
CPerform interferon-γ release assay
DObtain a chest x-ray
EPerform PCR of the sputum
A 68-year-old man presents to the physician with fever, cough, weakness, night sweats, and poor appetite for the past 6 months. Medical records suggest that he has lost 7.5 kg (16.5 lb) of weight during this period. There is no history of breathlessness, nasal discharge, nasal obstruction, palpitations, chest pain, or symptoms related to digestion. He was released from prison 9 months ago after serving a 2-year sentence. His temperature is 38.1°C (100.6°F), pulse is 84/min, respirations are 16/min, and blood pressure is 122/80 mm Hg. Physical examination shows hepatomegaly and generalized lymphadenopathy, and auscultation of the chest reveals diffuse crackles throughout the lung fields bilaterally. On direct ophthalmoscopy, three discrete, yellow-colored, 0.5 mm to 1.0 mm lesions with indistinct borders are seen in the posterior pole. A chest X-ray is shown in the image. Tuberculin skin test with purified protein derivative is negative. What is the most likely diagnosis?
ABronchoalveolar carcinoma
BTuberculosis
CChronic histoplasmosis
DLangerhans cell histiocytosis
ESarcoidosis
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