Respiratory medicine: chronic beryllium disease versus sarcoidosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: chronic beryllium disease versus sarcoidosis

Sample item

A 45-year-old man who has worked in a metal alloy factory for 15 years has dry cough and breathlessness. Chest imaging shows bilateral hilar lymphadenopathy and biopsy shows non-caseating granulomas. Which test best separates his condition from sarcoidosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Beryllium lymphocyte proliferation test on blood cells

Chronic beryllium disease is a granulomatous lung disease that closely mimics sarcoidosis. The beryllium lymphocyte proliferation test shows sensitisation to beryllium and, with granulomas and exposure history, confirms the diagnosis. Removal from exposure and corticosteroids are the mainstay of treatment.

Option by option

  • A. Serum angiotensin-converting enzyme level measurement

    Serum ACE reflects granuloma burden and is non-specific, so it does not identify the exposure.

  • B. Bronchoalveolar lavage CD4 to CD8 cell ratio

    A lymphocytic lavage with raised CD4 to CD8 ratio can occur in both conditions, so it does not separate them.

  • C. Beryllium lymphocyte proliferation test on blood cells (correct)

    Correct. A positive proliferation response to beryllium salts shows sensitisation and points away from sarcoidosis.

  • D. Kveim-Siltzbach intradermal skin test reaction

    The Kveim-Siltzbach test is an old skin test for sarcoidosis and not for beryllium disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Beryllium lymphocyte proliferation test on blood cells. Chronic beryllium disease is a granulomatous lung disease that closely mimics sarcoidosis.

Why is "Serum angiotensin-converting enzyme level measurement" not the answer?

Serum ACE reflects granuloma burden and is non-specific, so it does not identify the exposure.

Why is "Bronchoalveolar lavage CD4 to CD8 cell ratio" not the answer?

A lymphocytic lavage with raised CD4 to CD8 ratio can occur in both conditions, so it does not separate them.

Why is "Kveim-Siltzbach intradermal skin test reaction" not the answer?

The Kveim-Siltzbach test is an old skin test for sarcoidosis and not for beryllium disease.

What concept does this question test?

It tests Respiratory medicine: chronic beryllium disease versus sarcoidosis in General Medicine. The beryllium lymphocyte proliferation test shows sensitisation to beryllium and, with granulomas and exposure history, confirms the diagnosis. Removal from exposure and corticosteroids are the mainstay of treatment.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: chronic beryllium disease versus sarcoidosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.