 Welcome back to the MedSmarter question of the week. Let's get right to our question. As always, let's look at the question first, which is the last sentence of the vignette, and then we will go back and read the rest of the vignette so we know what we're looking for. Which result, although not diagnostic, is most commonly associated with the patient's condition? A 50-year-old African-American woman presents to your office because of shortness of breath and fatigue that has worsened over the past four weeks. Over the past week, she has noticed the appearance of subcutaneous nodules on her lower extremities. Physical exam reveals flat, elevated lesions on the lower extremities bilaterally. Chest auscultation shows dry rails with a chest x-ray showing bilateral hyalur lymph adenopathy. Lab tests are performed, so which result, although not diagnostic, is most commonly associated with this patient's condition? Take a minute, read the question, come up with an answer, and write it in the comments below. So first of all, there are some things that I would point out that are key things to be able to answer this question that you need to pay attention to. There are some things that you can ignore, but then there are also some things that are important for this question. First off, this is an African-American female that can give us some clues as to who might be more susceptible to certain diseases. Those subcutaneous nodules are flat, elevated lesions on her lower extremities bilaterally. And then we see dry rails, bilateral hyalur lymph adenopathy. Putting all of these symptoms together makes me believe that we're dealing with something like sarcoidosis. So now, let's look at our answer choices. I'm going to start at the bottom. Hypoeurosemia doesn't have anything to do with sarcoidosis. That's more something that we deal with as far as hypereurosemia and gout. But I don't know anything that has anything to do with hypoeurosemia and sarcoidosis, which I believe this answer is referring to. So I'm going to mark out E. D, hypocalcemia. I'm not seeing any classic symptoms or signs that would lead me to hypocalcemia. I do remember that sarcoidosis does affect calcium, but I believe that calcium is increased with sarcoidosis, not decreased. Therefore, I'm going to mark D out. Elevated amylase levels are most certainly not associated with sarcoidosis. We have nothing to do with the pancreas. So C is out. Elevated cardiac enzyme levels. There is some chance of some heart involvement with sarcoidosis. So I'm not going to rule this one out just yet. And then A, elevated angiotensin converting enzyme levels. I do remember that ACE, or angiotensin converting enzyme, is elevated in sarcoidosis. So this would be a great answer here. So something that is most commonly associated while we can see B, that's not going to be the most commonly associated one. So I'm going to say A is my answer for this question, not B. And A is the correct answer as angiotensin converting enzyme levels are elevated in sarcoidosis, which is what this question is referring to. Sarcoidosis, if you can remember, does involve the skin and the lungs mostly. There are some other potential involvements in sarcoidosis as well. But those are going to be our two main organs that are affected. With sarcoidosis, we will have increase in ACE levels. We will have an increase in calcium levels, or hypercalcemia. And we can see an increase CD4 and CD8 levels in the bronchi alleolar lavages. What other things are associated with sarcoidosis? We can see Bell's palsy, uveitis, lupus pernio, erythemenodosum, and rheumatoid arthritis like arthropathy. The treatment for sarcoidosis is steroids.