Asbestos lung disease and sarcoid

Question 1

what is the MRC dyspnoea scale?

Answer 1

Grade 1:
“I only get breathless with strenuous exercise”

grade 2: “I get short of breath when hurrying on the level or walking up a slight hill”

grade 3: “I walk slower than most people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level”

grade 4: “I stop for breath after walking about 100 yards or after a few minutes on the level”

grade 5: “I am too breathless to leave the house” or “I am breathless when dressing”

Question 2

who gets sarcoid?

Answer 2

young men and old women

and they get it in spring, apparently

Question 3

what are the clinical manifestations of sarcoid?

Answer 3

it can present in any way, but particular issues:

erythema nodosum
granuloma annulare
lupus pernio

uveitis and parotid (also consider Sjogren’s)

Question 4

what are the tests of sarcoid?

Answer 4

elevated ACE (also elevated in fatty and etoh liver disease)

CD4 Th on BAL (CD4 driven disease!)

high urinary and serum calcium

high Vit D

Question 5

what is the pathogenesis of sarcoid?

Answer 5

it is a largely Th driven pathology

the initial response is asymmetrically Th1 focussed

After T cell recognition of antigen(s), CD4+ T cells secrete Th1-type cytokines such as interleukin (IL)-2, interferon (IFN) gamma, and tumour necrosis factor (TNF) alpha. The release of IFN gamma and TNF alpha promotes macrophage accumulation, activation, and aggregation, resulting in the development of granulomatous inflammation

Question 6

what is the staging of sarcoid?

Answer 6

Stage 0 - normal CxR
StageI - BHL
Stage II - BHL & pulmonary
Stage III - Pulmonary
Stage IV - Fibrotic usually upper lobe contraction

NOTE: UPPER LOBE

Question 7

what are the treatment options for sarcoid?

Answer 7

watching closely

consider ‘roids - this can be topical, intralesional, or systemic (oral)

plaquenil

MTX

Question 8

Which one of the following asbestos-related diseases requires the greatest exposure to asbestos fibres for its development?

A. Bronchogenic carcinoma. 
B. Pleural plaques.
C. Mesothelioma.
D. Pulmonary fibrosis.
E. Diffuse pleural thickening.

Answer 8

bronchogenic ca - not that common
pleural plaques can occur with minimal
meso - can get incidental exposure
pulm fibrosis/asbestosis - needs significant exposure

Answer: D