Sarcoidosis

Question 1

Define sarcoidosis

Answer 1

Multisystem granulomatous inflammatory disorder

Question 2

Aetiology of sarcoidosis

2

Answer 2

UNKNOWN
Transmissible agents (e.g. viruses), environmental triggers & genetic factors have all been suggested

Question 3

Pathogenesis of sarcoidosis

2

Answer 3

UNKNOWN antigen is presented on MHC class 2 complexes on macrophages to CD4+ T lymphocytes
These accumulate & release cytokines —> formation of non caseating granulomas in organs

Question 4

Epidemiology of sarcoidosis

ethnicity, age

Answer 4

Most common in Africans & Scandinavians

Can occur at any age but tends to be in adults > 50 yrs

Question 5

Presenting symptoms & signs of sarcoidosis - general

6

Answer 5

Fever
Malaise
Weight loss
Bilateral parotid swelling
Lymphadenopathy
Hepatosplenomegaly

Question 6

Presenting symptoms & signs of sarcoidosis - pulmonary

4

Answer 6

Breathlessness
Dry cough
Chest discomfort
Minimal clinical signs

Question 7

Presenting symptoms & signs of sarcoidosis - musculoskeletal
(3)

Answer 7

Bone cysts (e.g. dactylitis)
Polyarthralgia
Myopathy

Question 8

Presenting symptoms & signs of sarcoidosis - eye

3

Answer 8

Keratoconjunctivitis sicca
Uveitis
Papilloedema

Question 9

Presenting symptoms & signs of sarcoidosis - skin

3

Answer 9

Lupus pernio
Erythema nodosum
Maculopapular eruptions

Question 10

Presenting symptoms & signs of sarcoidosis - neurological

6

Answer 10

Lymphocytic meningitis 
Space occupying lesions
Pituitary infiltration 
Cerebellar ataxia
Cranial nerve palsies
Peripheral neuropathy

Question 11

Presenting symptoms & signs of sarcoidosis - cardiac

5

Answer 11

Arrhythmia
Bundle branch block
Pericarditis
Cardiomyopathy
Congestive cardiac failure

Question 12

Define keratoconjunctivitis sicca

Answer 12

inflammation of the conjunctiva & surrounding tissues due to eyes being dry

Question 13

Define lupus pernio

Answer 13

red blue infiltrations of nose, cheeks, ears & terminal phalanges

Question 14

Investigations for sarcoidosis

8 types

Answer 14

Bloods
24 hr urine collection 
CXR
High resolution CT scan
Gallium scan
Pulmonary function tests
Bronchoscopy & bronchoalveolar lavage
Transbronchial lung biopsy (or lymph node biopsy)

Question 15

Investigations for sarcoidosis - bloods

6

Answer 15

High serum ACE
High calcium
High ESR
FBC - WCC may be low due to lymphatic sequestration in lungs
Immunoglobulins - polyclonal hyperglobulinaemia
LFTs - high ALP & GGT

Question 16

Investigations for sarcoidosis - 24hr urine collection

Answer 16

Hypercalciuria

Question 17

Investigations for sarcoidosis - CXR

4

Answer 17

Stage 0 - may be clear
Stage 1 - bilateral hilar lymphadenopathy
Stage 2 - also pulmonary infiltration & paratracheal node enlargement
Step 3 - pulmonary infiltration & fibrosis

Question 18

Investigations for sarcoidosis - high resolution CT

Answer 18

Check for diffuse lung involvement

Question 19

Investigations for sarcoidosis - gallium scan

Answer 19

Shows areas of inflammation

Question 20

Investigations for sarcoidosis - pulmonary function tests

2

Answer 20

Low FEV1

FVC shows restrictive picture

Question 21

Investigations for sarcoidosis - bronchoscopy & bronchoalveolar lavage
(2)

Answer 21

High lymphocytes

High CD4:CD8 ratio

Question 22

Investigations for sarcoidosis - transbronchial lung biopsy

3

Answer 22

Shows non-caseating granulomas consisting of:
epithelioid cells (activated macrophages)
multinucleate Langerhans cells
mononuclear cells (lymphocytes)