Granulomatous lung disease

Question 1

What are some causes of non caseating granulomas disease?

Answer 1

Reaction to foreign body,
Sarcoidosis,
Leprosy,
Drug reaction,
Hypersensitivity pneumonitis,
Toxoplasmosis

Question 2

What are examples of caseating granuloma diseases

Answer 2

TB, tertiary syphilis

Question 3

What are the syndromes associated with sarcoidosis?

Answer 3

Lofgren’s syndrome,
Mikulicz syndrome - enlargement of parotid and lacrimal glands
Heerfordt’s syndrome - parotid enlargement, fever and uveitis

Question 4

What are the investigations for sarcoidosis?

Answer 4

Bloods: Serum ACE, hypercalcaemia and raised ESR
Chest x ray
Spirometry,
Tissue biopsy

Question 5

What are the stages of sarcoidosis on chest x ray?

Answer 5

Stage 0 = normal,
Stage 1 = bilateral hilar lymphadenopathy,
Stage 2 = BHL and interstital infiltrates,
Stage 3 = diffuse interstitial infiltrates only,
Stage 4 = diffuse fibrosis

Question 6

What are the indications for steroid treatment for sarcoidosis?

Answer 6

Chest x ray changes stage 2 or 3 and symptomatic,
Hypercalaemia,
Eye, heart or neuro involvement.

Question 7

What are the most common causes of bilateral hilar lymphadenopathy?

Answer 7

Sarcoidosis and tuberculosis

Question 8

What are the causes of clubbing?

Answer 8

Cardiac - cyanotic heart disease, bacterial endocarditis, atrial myxoma.

Respiratory - Lung cancer, CF, abscess, empyema, TB, asbestosis, mesothelioma, fibrosing alveolitis.

Others - Crohn’s, cirrhosis, PBC, Graves, Whipple’s disease

Question 9

What id Kartagener’s syndrome?

Answer 9

It is a primary ciliary dyskinesia with bronchiectasis, recurrent sinusitis, dextrocardia and subfertility

Question 10

What is Klebsiella?

Answer 10

Gram negative rod which can cause pneumonia and UTIs.