3: Sarcoidosis

Question 1

What is sarcoidosis

Answer 1

Systemic disease caused by chronic caesating granulomatous inflammation

Question 2

When is sarcoidosis more common

Answer 2

bimodal incidence: 25-35 and 45-65 years-old

Question 3

In which gender is sarcoidosis more common

Answer 3

females

Question 4

In which ethnicity is sarcoidosis more common

Answer 4

African American

Question 5

What alleles is sarcoidosis associated with

Answer 5

HLA DRB1, HLA DQB1

Question 6

How is 40% of sarcoidosis found

Answer 6

Incidentally on CXR

Question 7

what are the two manifestations of sarcoidosis if symptomatic

Answer 7

• Acute

- Chronic

Question 8

explain relationship between acute and chronic sarcoidosis

Answer 8

acute sarcoidosis does not have to happen before chronic sarcoidosis

Question 9

what is acute sarcoidosis also called

Answer 9

Lofgren syndrome

Question 10

what is the triad of symptoms in lofgren syndrome

Answer 10

1. Erythema nodosum
2. Bilateral hilar lymphadenopathy
3. Polyarthralgia

Question 11

what other symptom is present in lofgren syndrome

Answer 11

Swinging fevers

Question 12

describe time course of lofgren syndrome

Answer 12

Sudden-onset. Resolves in two-years

Question 13

explain onset of symptoms in chronic sarcoidosis

Answer 13

gradual onset

Question 14

what will be seen on CXR in chronic sarcoidosis

Answer 14

bilateral hilar lymphadenopathy, pulmonary infiltrates and fibrosis

Question 15

what are symptoms of sarcoidosis

Answer 15

• progressive dyspneoa
• dry cough
• chest pain

Question 16

what is most common extra-pulmonary manifestation of sarcoidosis

Answer 16

lymphadenopathy

Question 17

what may sarcoidosis cause if it affects the eyes

Answer 17

• Keratoconjunctivitis sicca
• Conjunctivitis
• Uveitis

Question 18

what skin condition is pathognomic for sarcoidosis

Answer 18

Lupus pernio

Question 19

how does lupus pernio present clinically

Answer 19

Purple discolouration of face, chin, ears

Question 20

what electrolyte abnormality is associated with sarcoidosis

Answer 20

Hypercalcaemia

Question 21

why does sarcoidosis cause Hypercalcaemia

Answer 21

Macrophages in granuloma convert vitamin D to its active form increasing calcium concentration

Question 22

what is a manifestation of sarcoidosis

Answer 22

Heerfordt syndrome

Question 23

what is the triad of symptoms in heerfordt syndrome

Answer 23

• Uveitis
• Parotitis
• Facial Palsy

Question 24

what investigation is first line for sarcoidosis

Answer 24

CXR

Question 25

what will be seen on CXR

Answer 25

• Bilateral hilar lymphadenopathy
• Ground glass opacities
• Fibrosis of upper-zone

Question 26

what is a mnemonic to remember conditions that cause fibrosis of upper lung zones

Answer 26

CHARTS

Question 27

what causes fibrosis of upper zones

Answer 27

Coal workers pneumoconiosis 
Histocytosis/ hypersensitivity pneumonitis 
Ank spondylitis 
Radiation
TB
Sillicosis/sarcoidosis

Question 28

what causes fibrosis of lower zones

Answer 28

• asbestosis
• Idiopathic pulmonary fibrosis
• Connective tissue disorders (SLE)
• drug-induced (Amiodarone, Belomycin, Methotrexate)

Question 29

what bloods are ordered in acute sarcoidosis

Answer 29

ESR: raised

Question 30

what important blood test is raised in chronic sarcoidosis only

Answer 30

ACE

Question 31

what is ACE

Answer 31

Released by T-lymphocytes in sarcoidosis

Question 32

what is gold standard for sarcoidosis

Answer 32

Bronchoscopy and biopsy

Question 33

how will sarcoidosis present in spirometry

Answer 33

restrictive defect

Question 34

how is acute sarcoidosis managed

Answer 34

bed-rest, analgesia

Question 35

what medication is given long-term to manage sarcoidosis

Answer 35

prednisolone