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Respiratory > Sarcoidosis > Flashcards

Sarcoidosis Flashcards

1
Q

which demographic is associated with sarcoidosis?

A 
Young adulthood
60s
Women>men
Black > other groups
E.g. 20-40 year old, black female, dry cough and SOB, nodules on shins
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2
Q

what is the cause of sarcoidosis?

A

unknown

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3
Q

what is the underlying pathology of sarcoidosis?

A

Granulomatous, inflammatory conditions

Multi-system involvement

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4
Q

what is the inflammatory process of sarcoidosis?

A

Granulomas nodules of inflammation full of macrophages (also activated T cells)
Therefore increased production of TNF, IFN-γ, IL-2, IL-8, IL-10, IL-12, IL-18, IL-23 and TGF-β = TH1 response
Periphery cells suppress IL-2 – allows for latent state

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5
Q

what are the systemic symptoms of sarcoidosis?

A

fever, fatigue, weight loss

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6
Q

what are the respiratory symptoms of sarcoidosis?

A

= interstitial lung disease
mediastinal lymphadenopathy
pulmonary fibrosis
pulmonary nodules

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7
Q

what are the liver symptoms of sarcoidosis?

A

liver nodules, liver cirrhosis, cholestasis

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8
Q

what are the eye symptoms of sarcoidosis?

A

uveitis, conjunctivitis, optic neuritis

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9
Q

what are the skin symptoms of sarcoidosis?

A

Erythema nodosum – tender red nodules on shins, inflammation of subcutaneous fat
Lupus pernio – raised purple leisions, tip of nose+across cheeks
Granulomas in scar tissue

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10
Q

what are the cardio symptoms of sarcoidosis?

A

Bundle branch block
heart block
granulomas can affecr muscle - HF

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11
Q

what are the renal symptoms of sarcoidosis?

A

Kidney stones (hypercalcaemia)
Nephrocalcinosis (calcium deposist in kidneys)
Interstitial nephrotis
CNS – nodules in brain, pituitary involvement (diabetes), encephalopty
PNS – bells palsy, mononeuritis multiplex

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12
Q

what are the skeletal symptoms of sarcoidosis?

A

arthralgia, arthritis, myopathy

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13
Q

what are the acute symptoms of sarcoidosis?

A 
o	Erythema nodosum
o	Bilateral hilar lymphadenopathy
o	Arthritis
o	Uveitis, parotitis
o	Fever
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14
Q

what are the chronic symptoms of sarcoidosis?

A 
o	Lung infiltrates (alvolitis) or fibrosis
o	Skin infiltrates 
o	Peripheral lymphadenopathy
o	Hypercalcaemia
o	Hepatomegaly
o	Splenomegaly
o	Neurological – bells palsy, neuropathy, meningitis
o	Renal stones
o	Pituitary dysfunction
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15
Q

what are the insidious symptoms of sarcoidosis?

A

dyspnoea, non-productuve cough, malaise, weight loss

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16
Q

what is Lofgrens Syndrome?

A

Triad of:
Erythema nodosum
Bilateral hilar lymphadenopathy
Polyarthralgia

17
Q

what is the gold standard test for sarcoidosis?

A

histology - biopsy

18
Q

what histological features will be seen in sarcoidosis?

A

non caseating granulomas with epithelioid cells

19
Q

what blood tests would be done in sarcoidosis?

A

Raised Serum ACE
Raised serum Calcium
Soluble IL-2 receptors (raised)
Inflam markers (raised)

20
Q

What imaging tests would be done in sarcoidosis?

A

Chest Xray - Hilar lymphatedopathy
CT – hilar lymphadenopathy and pulmonary nodules
MRI – CNS involvement
PET – active areas of inflammation

21
Q

what tests would be used to assess other organ involvement in sarcoidosis?

A 
U&E, urine dipstick, urine albumin creatinine ratio
LFTS
Opthalmology review
ECG + echo
Spirometry – RESTRICTIVE 
Abdomen US
Bone Xray – punched out leisons
22
Q

what is the staging of sarcoidosis?

A

Stage 0 – normal CXR
Stage 1 – BHL – bilateral hilar lymphadenopathy
Stage 2 – BHL + Infiltrates
Stage 3 – Peripheral pulmonary infiltrates alone
Stage 4 – Progressive pulmonary fibrosis ± bulla (honeycombing on CXR

23
Q

what is the treatment of stage 0 and 1 sarcoidosis?

A

no treatment

24
Q

what is the treatment of stage 2 and acute disease

A

NSAIDs and bed rest

25
Q

what is the steroid regime used in sarcoidosis?

A 
Oral Steroids (+bisphosphonates) – 6 to 24 months
Prednisolone 40mg for 4-6 wks, then reduce dose over 1yr depending on symptoms.
26
Q

what are the indications for starting steroids in sarcoidosis?

A 
o	Indications for steroid use include:
	Parenchymal lung disease – even if asymptomatic
	Uveitis
	Hypercalcaemia
	Neurological involvement
	Cardiac involvement
27
Q

what is the treatment of very severe cases of sarcoidosis?

A

IV methylprednisolone
Immunosuppressants – methotrexate and azathioprine
Anti-TNF, monoclonal antibody agents

Respiratory (12 decks)

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