American Board of Internal Medicine (ABIM) Certification Practice Exam

What clinical presentation of sarcoidosis does not warrant a biopsy?

1. Unilateral hilar lymphadenopathy

2. Bilateral hilar lymphadenopathy

3. Chest pain

4. Cough

The correct answer is: Bilateral hilar lymphadenopathy

Bilateral hilar lymphadenopathy is often associated with sarcoidosis, especially when found on chest imaging. In many cases, this radiographic finding can be enough to support a clinical diagnosis of pulmonary sarcoidosis without the need for a biopsy, particularly if the patient presents with characteristic clinical features such as respiratory symptoms, skin lesions, or systemic symptoms like fever, fatigue, or weight loss. The diagnosis can often be established based on the clinical presentation and imaging findings, especially if other causes of hilar lymphadenopathy have been excluded. In contrast, unilateral hilar lymphadenopathy typically raises suspicion for other conditions such as lung cancer or infection, necessitating further investigation through biopsy to determine the underlying cause. Symptoms like chest pain and cough can be related to a variety of issues in patients with sarcoidosis and are not specific enough to rule out malignancy or other conditions, thus pointing towards the need for a biopsy for accurate diagnosis. Therefore, in the presence of bilateral hilar lymphadenopathy with typical clinical features, a biopsy may not be required to confirm the diagnosis.