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ANKI Respiratory > [9] Sarcoidosis > Flashcards

[9] Sarcoidosis Flashcards

1
Q

What is sarcoidosis?

A

Multisystem granulomatous disorder of an unknown cause

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2
Q

What age is sarcoidosis most common?

A

20-40 years

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3
Q

What gender is sarcoidosis more common in?

A

Female

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4
Q

What ethnicity is sarcoidosis more common in?

A

Afro Caribbean

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5
Q

What genes are associated with sarcoidosis?

A

HLA-DRB1 and DQB1

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6
Q

What % of cases of sarcoidosis present incidentally on CXR?

A

20-40%

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7
Q

What are the symptoms of acute sarcoidosis?

A

Erythema nodosum
Fever
Polyarthralgia
Bilateral hilar lymphadenopathy

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8
Q

What pneumonic can be used to remember the clinical features of sarcoidosis?

A 
GRANULOMAS 
G = General
R = Respiratory
A = Arthralgia
N = Neurological
U = Urine
L = Low hormones
O = Opthalmological
M = Myocardial
A = Abdominal
S = Skin
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9
Q

What are the general features of sarcoidosis?

A

Fever
Anorexia and weight loss
Fatigue
Lymphadenopathy and hepatosplenomegaly

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10
Q

What are the upper respiratory features of sarcoidosis?

A

Otitis

Sinusitis

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11
Q

What are the lower respiratory features of sarcoidosis?

A

Dry cough
Chest pain
Decreased lung function

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12
Q

What % of people with sarcoidosis have lower respiratory features?

A

90%

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13
Q

What can the lower respiratory features of sarcoidosis be divided into?

A

Stage 1-4

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14
Q

What are the stage 1 lower respiratory features of sarcoidosis?

A

Bilateral hilar lymphadenopathy

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15
Q

What are the stage 2 lower respiratory features of sarcoidosis?

A

BHL + peripheral infiltrates

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16
Q

What are the stage 3 lower respiratory features of sarcoidosis?

A

Peripheral infiltrates alone

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17
Q

What are the stage 4 lower respiratory features of sarcoidosis?

A

Progressive mid-zone fibrosis with bullae

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18
Q

What are the arthralgia features of sarcoidosis?

A

Polyarthralgia

Dactylitis

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19
Q

What are the neurological features of sarcoidosis?

A

Peripheral and cranial polyneuropathy, especially Bell’s palsy
Meningitis, transverse myelitis, or space-occupying-lesions

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20
Q

What are the urine features of sarcoidosis?

A

Increased calcium, leading to renal stones, nephrocalcinosis, and diabetes insipidus

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21
Q

What are the hormonal features of sarcoidosis?

A

Pituitary dysfunction, e.g. amenorrhoea

22
Q

What are the ophthalmological features of sarcoidosis?

A

Uveitis
Keratoconjunctivitis
Sicca/Mikulicz/Sjorgen’s syndrome

23
Q

What are the myocardial features of sarcoidosis?

A

Restrictive cardiomyopathy

Pericardial effusion

24
Q

What are the abdominal features of sarcoidosis?

A

Hepatomegaly and cholestatic LFTs

Splenomegaly

25
Q

What are the skin features of sarcoidosis?

A

Erythema nodosum

Lupus pernio

26
Q

What is erythema nodosum?

A

Painful erythematous nodules in shins

27
Q

What is lupus pernio?

A

Raised, dusky purple plaque on nose, cheek, fingers

28
Q

What investigations should be done in sarcoidosis?

A 
Bloods
Imaging
Tuberculin skin test
Lung function tests
Tissue biopsy
Ophthalmology assessment
29
Q

What may be found on bloods in sarcoidosis?

A 
Increased ESR
Increased calcium
Lymphopenia
Increased serum ACE
Increased Ig
Increased LFTs
30
Q

What imaging should be done in sarcoidosis?

A

CXR
CT
MRI

31
Q

What proportion of people with sarcoidosis have a positive tuberculin skin test?

A

1/3

32
Q

What might be found on lung functioning testing in sarcoidosis?

A

Restrictive pattern with decrease FVC

Decreased transfer factor

33
Q

What tissue biopsies should be taken in sarcoidosis?

A

Lung
Lymph nodes
Skin nodules
Liver

34
Q

What finding on tissue biopsy is diagnostic for sarcoidosis?

A

Non-caseating granulomas

35
Q

Do patients who are asymptomatic with BHL require management?

A

No

36
Q

How is acute sarcoidosis managed?

A

Bed rest

NSAIDs

37
Q

What is the prognosis of acute sarcoidosis?

A

Usually resolve spontaneously

38
Q

What is the first line management for chronic sarcoidosis?

A

Preg 40mg/day for 4-6 weeks

39
Q

What additional immunosuppression can be used in chronic sarcoidosis?

A

Methotrexate
Ciclosporin
Cyclophosphamide

40
Q

What % of cases of thoracic sarcoidosis resolve over 2 years?

A

60%

41
Q

What % of cases of chronic sarcoidosis respond to steroids?

A

20%

42
Q

What % of cases of chronic sarcoidosis have no improvement despite management?

A

20%

43
Q

What are the differential diagnoses for BHL?

A

Sarcoidosis
Infection
Malignancy
Interstitial disease

44
Q

What infections can cause BHL?

A

TB

Mycoplasma

45
Q

What cancers can cause BHL?

A

Lymphoma

Carcinoma

46
Q

What forms of interstitial disease can cause BHL?

A

EAA

Silicosis

47
Q

What are the differential diagnoses for granulomatous disease?

A 
Infections
Autoimmune
Vasculitis 
Idiopathic
Interstitial lung disease
48
Q

What infections can cause granulomatous disease?

A 
TB
Leprosy
Syphilis
Cryptosporidium 
Schistosomiasis
49
Q

What autoimmune conditions can cause granulomatous disease?

A

Primary biliary cholangitis

50
Q

What vasculitic conditions can cause granulomatous disease?

A

Giant cell arteritis
Polyarteritis nodosa
Wegener’s
Takayasu’s

51
Q

What are the idiopathic causes of granulomatous disease?

A

Crohn’s

Sarcoid

52
Q

What are the interstitial lung causes of granulomatous disease?

A

Extrinsic allergic alveolitis

Silicosis

ANKI Respiratory (17 decks)

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