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DPD > Pulmonary sarcoidosis > Flashcards

Pulmonary sarcoidosis Flashcards

1
Q

What is sarcoidosis?

A

Systemic disorder of unknown causes characterised by formation of NON caseating granulomas

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2
Q

Which organ is most commonly involved?

A

Lung - over 90%

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3
Q

What cells are involved?

A

T cells accuumulate

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4
Q

What evidence suggests that sarcoidosis is caused by infections?

A

Other granulomatous diseases have infectious causes

Can be transmitted via transplanted organs

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5
Q

Which infectious organisms are linked to sarcoidosis?

A

Proponi bacteria acnes (but research was done in Japanese people)

Mycobacteria

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6
Q

Risk factors

A 
Agricultural exposures
Insecticides
Microbial bioaerosols
FH 
Northern europe, USA and India
African-americans
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7
Q

What is the strange thing about cigarettes and sarcoidosis?

A

Cigarette smoking is a protective factor !!

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8
Q

Sarcoid presentation differs by ethnicity. What is seen in Japanese?

A

Uveitis
Cardiac sarcoid
no ‘Lofgren’ ie bilateral hilar lymphadenopathy

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9
Q

Where are the sarcoid granulomas found?

A

Follow lymphatic pathways along interlobular septa and around the pleura

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10
Q

What are the characteristics of the pulmonary nodules?

A

bronchocentric

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11
Q

Signs

A

Erythema nodosum
Bilateral hilar lymphadenopathy
Calcified egg shell lymph nodes (bilateral) - note this is unilateral in TB

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12
Q

Staging name

A

Scadding staging on XRAY

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13
Q

Stage 1

A

Bilateral hilar lymphadenopathy + Right paratrachea

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14
Q

Classic signs of sarcoid on CT

A

Honeycomb - suggests end stage fibrosis
seen in UIP

usual interstitial pneumoniasis

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15
Q

Stage 3 signs

A

Parenchymal disease

WITHOUT Bilateral hilar lymphadenopathy + Right paratrachea (these have receded or never been present)

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16
Q

Stage 4 signs

A

Fibrosis

hilar being pulled up by hilar lymphosis

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17
Q

Diagnosis of stages 1-2

A

EBUS-TBNA

18
Q

Diagnosis of stages 3-4

A

???

19
Q

Stage 4 signs

A

Fibrosis
hilar being pulled up by hilar
lymph ??

20
Q

Predictors of mortality

A

Pulmonary HTN

More than 20% fibrosis on CT

21
Q

Within fibrotic disease, what do you have to look for?

A

Stable or progressive?

Therefore you have to try to measure disease activity

22
Q

Assessing disease activity

A 
HRCT
BAL 
Serum ACE 
Lung function
FDG-PET
23
Q

Nodules seen on HRCT are reversible or irreversible?

A

reversible

24
Q

Ground glass changes on HRCT is reversible or irreversible?

A

maybe reversible

25
Q

Complication of sarcoid

A

Chronic pulmonary aspergillosis

26
Q

Death in these patients with CPA is caused by?

A

Sarcoidosis rather than haemoptysis

27
Q

Treatment of sarcoidosis

A

NSAIDS for joint pain
Low dose prednisolone or hydroxychloroquine
+ ???

28
Q

Risks

A

Respiratory failure

Cardiac arrythmias

29
Q

What’s the problem with cardiac involvement?

A

Many patients are asymptomatic !!!!!!!!!!!!! Autopsy shows 25% of patients actually have cardiac involvement

30
Q

What questions would you ask to screen for cardiac involvement?

A

Palpitations
Syncope
SOB

31
Q

What would you look for on ECG to screen for cardiac involvement?

A 
AV block
Frequent premature vetnricular ectopics/tachycardia
LBBB/RBBb
Q waves
?
32
Q

Echo

A

??

33
Q

Treatment

A

Corticosteroids

Immunosuppressants

34
Q

What would you look for on ECG to screen for cardiac involvement?

A 
AV block
Frequent premature ventricular ectopics/tachycardia
LBBB/RBBb
Q waves
?
35
Q

Echo

A

Wall thinning, thickening etc

??

36
Q

Why are second line agents used

A

Osteoporosis

Diabetes

37
Q

What do you use

A

Biologics e.g. inflixmab

38
Q

Why are second line agents used

A

Pt often have comorbidities which means they can’t tolerate the corticosteroids
e.g.
Osteoporosis
Diabetes

39
Q

What do you use if the other treatments don’t work?

A

Biologics e.g. infliximab

40
Q

Symptoms

A

Ankle hurting
Fatigue
Resp symptoms

41
Q

What is eBUS-TBNA?

A

ultra sound guided endobronchial aspirate

DPD (38 decks)

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