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Question 1

Sarcoidosis Pathophysiology

Answer 1

Chromosome 6 - MHC gene
unknown antigen interacts with CD4 T Helper cell -> cytokine release -> noncaseating granuloma - (epithelioid histiocytes - macrophage)
macrophage in granuloma -> synthesis 1alpha hydroxylase -> activates 25 VitD to 1,25 VitD –> increase Ca absorption in kidney and GIT –> hyperCa+ -> kidney stones

Question 2

Ix in Sarcoidosis

Answer 2

High ACE, Hypercalcemia, SPEP - polyclonal gammopathy
BAL CD4> CD8 ~ 4:1 ratio
CXR: reticular densities, reticulonodular densities
Biopsy
1. epithelioid histiocytes, multinucleated giant cells(langerhans)
2. schaumann bodies (laminated calcium concretions)
asteroid bodies (stellate inclusions) (these are in the giant cells)

Question 3

What is hypertrophic pulmonary osteoarthropathy

Answer 3

triad of periostitis, digital clubbing and painful arthropathy of large joints
in cancer considered as paraneoplastic syndrome
most common with squamous cell lung ca