Respiratory 12 - Sarcoidosis

Question 1

define sarcoidosis

Answer 1

systemic granulomatous inflammation

granuloma = nodule full of macrophages

Question 2

textbook presentation of sarcoid

Answer 2

young black female with dry cough, SOB + nodules on shins

Question 3

3 lung features of sarcoidosis + 3 other main systems affected

Answer 3

hilar lymphadenopathy
pulmonary fibrosis
pulmonary nodules

liver, eyes, skin

Question 4

give the two main skin manifestations of sarcoid

Answer 4

e nodosum - tender red nodules on shin skin

lupus pernio - raised purple lesions on cheeks +nose

Question 5

Lofgren’s syndrome triad

Answer 5

commoner in caucasians

e nodosum
bilat hilar lymphad
polyarthralgia

Question 6

DDx for sarcoid x6

Answer 6

TB 
lymphoma
hypersensitivity pneumonitis 
HIV 
toxoplasmosis 
histoplasmosis

Question 7

4 blood tests for sarcoid

Answer 7

serum ACE (raised)
calcium (raised)
serum soluble IL2 receptor
CRP

Question 8

4 imaging modalities for sarcoid and why

Answer 8

CXR - hilar LNs
high res CT - LN+nodules
MRI - CNS involvement
PET scan - active inflammation where

Question 9

gold standard test for sarcoid

Answer 9

histology from bronchoscopic biopsy

Question 10

histology of sarcoid

Answer 10

non caseating granulomas

Question 11

screening panel for sarcoid organ involvement x6

Answer 11

UEs
urine dip ACR
LFTs
ophthalmology 
ECG, echo
USS

Question 12

treatment for sarcoid

Answer 12

majority spontaneously resolve in 6 months so if mild do nothing

otherwise: oral steroids + bisphosphonates (protect), methotrexate