Sarcoidosis

Question 1

what is it

Answer 1

multi system granulomatous disorder of unknown cause

Question 2

epidemiology

Answer 2

age 20-40 years, female more, afro Caribbean more

Question 3

how often is it found incidentally

Answer 3

in 20-40% on a CXR

Question 4

what is the finding on CXR

Answer 4

bilateral hilar lymphadenopathy +- pulmonary infiltrates or fibrosis

Question 5

what are the symptoms in pulmonary disease

Answer 5

dry cough, progressive dyspnoea, decr exercise tolerance, chest pain

Question 6

what are the non pulmonary haem signs

Answer 6

lymphadenopathy, hepato spleno megaly,

Question 7

what are the non pulmonary eye signs

Answer 7

uveitis, conjunctivitis, keratoconjunctivitis sicca, glaucoma

Question 8

what are the non pulmonary ENT signs

Answer 8

enlargement parotid and lacrimal glands, Bells palsy

Question 9

what are the non pulmonary neuro signs

Answer 9

bells palsy, neuropathy, meningitis, brainstem and spinal syndromes, SOL

Question 10

what are the non pulmonary derm signs

Answer 10

erythema nodosum, lupus pernio

Question 11

what are the non pulmonary cardio and homeostatic signs

Answer 11

cardiomyopathy, arrhythmias, hypercalcaemia, hypercalcuria, renal stones, pituitary dysfunction

Question 12

tests

Answer 12

bloods, 24 urine incr Ca, tuberculin skin test, CXR, ECG, lung function tests, tissue biopsy, bronchoalveolar lavage, US, bone x rays, CT/MRI, opthal assessment

Question 13

what do the bloods show

Answer 13

incr ESR, lymphopenia, incr LFT, incr ACE, incr Ca, incr Ig

Question 14

what does tissue biopsy show

Answer 14

of lung, liver, lymph nodes, skin nodules or lacrimal glands is diagnostic and shows NON CASEATING GRANULOMATA

Question 15

what does BAL show

Answer 15

incr lymphocytes in active disease, incr neutrophils in pulmonary fibrosis

Question 16

management if just BHL

Answer 16

don’t need treatment as most recover spontaneously

Question 17

management acute sarcoidosis

Answer 17

bed rest, NSAIDs

Question 18

management- indications for corticosteroids

Answer 18

parenchymal lung disease, uveitis, hypercalcaemia, neuro or cardiac. pred for 4-6w then decr dose over a year

Question 19

other therapy in management

Answer 19

if severe- IV methylpred or immunosuppressants, anti TNF, lung transplant

Question 20

prognosis

Answer 20

60% patients with thoracic resolve over 2y. 20% respond to steroid treatment

Question 21

differentials of bilat hilar lymphadenopathy

Answer 21

sarcoidosis, infection eg TB, mycoplasma, malignancy eg lymphoma, organic dust disease, extrinsic allergic alveolitis, histiocytosis X

Question 22

staging of sarcoidosis from the CXR

Answer 22

0-normal. 1- BHL. 2- BHL + peripheral pulmonary infiltrates. 3- peripheral pulmonary infiltrates alone. 4- progressive pulmonary fibrosis, bulla formation (honeycombing), pleural involvement