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Year 2 Resp Exam 2 > Sarcoidosis, D Linger, DSA > Flashcards

Sarcoidosis, D Linger, DSA Flashcards

1
Q

What is sarcoidosis

A

systemic granulomatous disease characterized by non-caseating granulomas

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2
Q

90% patients with sarcoidosis present with what

A

mediastinal hilar lymph node involvement or parenchymal lung disease

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3
Q

When is the peak incidence of sarcoidosis

A

between ages 20 and 39

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4
Q

demographic distribution of sarcoidosis

A

3.5x more common in black americans

women >men

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5
Q

What is Lofgrens syndrome

A

acute manifestation of the disease consisting of erythema nodosum, arthritis, and b/l hilar lymphadenopathy

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6
Q

prognosis of lofgrens syndrome

A

favorable

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7
Q

chronic sarcoidosis can lead to what

A

progressive pulmonary fibrosis and increased morbidity

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8
Q

What are the general Sx of sarcoidosis

A

fatigue, fever, night sweats and weight loss

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9
Q

what are Sx and signs of pulmonary involvement in sarcoidosis

A

cough, dyspnea with exertion, wheeze, chest discomfort

rales, expiratory wheezing

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10
Q

What are signs and Sx of skin involvement in sarcoidosis

A

rash, macules, papules, nodules, hyperpigmentation or hypopigmentation, erythema nodosum
infiltration of old scars and tattoos, maculopapular lesions of face, neck, upper back and extremities
lupus pernio of nose, cheeks, ears and lips. erythema nodosum

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11
Q

what are signs and Sx of ocular involvement in sarcoidosis

A

gritty or dry eyes, pain, redness and or blurred vision

uveitis, iritis, scleral plaques, enlarged lacrimal glands

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12
Q

what are signs and Sx of cardiac involvement in sarcoidosis

A

arrhythmia, palpitations, near-syncope, lower extremity edema
usually normal

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13
Q

what are signs and Sx of nervous system involvement in sarcoidosis

A

HA, blurred vision, numbness, weakness, instability, seizures
cranial nerves II VII VIII, neuropathies, gait instability, weakness

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14
Q

what are signs and Sx of GI involvement in sarcoidosis

A

epigastric pain, early satiety, RUQ pain, jaundice

HSM, jaundice

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15
Q

What are signs and Sx of MSK involvement in sarcoidosis

A

swelling and joint stiffness, joint pain, muscle pain

arthralgias, arthritis

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16
Q

What are Signs of lymphatic involvement in sarcoidosis

A

common sites of palpable adenopathy: cervical, supraclavicular, axillae, inguinal regions

17
Q

how can you Dx sarcoidosis based of signs found around eye

A

yellow nodules of conjunctival involvement that can be biopsied to make Dx

18
Q

what are the cardiac manifestations that are rare in sarcoidosis

A

AV block, ventricular arrhythmias, L ventricular dysfunction and sudden death

19
Q

Most common CN involved in sarcoidosis

A

VII II and VIII

20
Q

most common joints affected by sarcoidosis

A

ankles and knees

21
Q

What occurs with Ca metabolism in sarcoidosis

A

disorders of vitamin D that may result in nephrolithiasis, nephrocalcinosis and hypercalcuria
sometimes symptomatic renal stone

22
Q

How do you Dx sarcoidosis

A

clinical, radiographic and histologic evidence of non-caseating granulomas in one or more organs

23
Q

what is pathoneumonic of sarcoidosis

A

lofgrens syndrome

24
Q

what is show up on a bronchoalveolar lavage in sarcoidosis

A

lymphocytosis and elevated CD4/8 ratio

25
Q

What enzyme will be elevated in sarcoid granulomas

A

ACE

26
Q

What is on DDx for sarcoidosis

A

mycobacteria, fungi, spirochetes, bacteria, parasites
lymphoma, carcinoma
extrinsic allergic alveolitis (bird fanciers lung and farmers lung)
chemical:silica and beryllium
Immuno: crohns disease, primary biliary cirrhosis, vasculitis

27
Q

What are the CXR staging for sarcoidosis

A

stage 0: normal
stage 1: b/l hilar adenopathy
stage 2: b/l hilar adenopathy and parenchymal infiltrates
stage 3: parenchymal infiltrates w/o lymphadenopathy
stage 4: advanced parenchymal disease with fibrosis

28
Q

how will sarcoidosis present on a PFT

A

restrictive ventilatory defect, concurrent obstruction and decreased DLCO

29
Q

What labs should you order if you suspect sarcoidosis

A 
CXR
PFT
opthalmic exam
EKG
CBC
CMP
24 urine
serum ACE
consider cardiac monitoring
30
Q

When do you initiate Tx for sarcoidosis

A

symptomatic patients only

31
Q

what is Tx for sarcoidosis

A

prednisone 20-40 mg daily for 3 mo
monitor for improvement in FVC and if improved wean 10-15mg daily for 6-9 mo then taper off
cytotoxic and immunosuppressives are used for those not responding to prednisone

32
Q

Prognosis of sarcoidosis

A

spontaneous remission in 50% patients at 3 yrs

less than 5% die from sarcoidosis

Year 2 Resp Exam 2 (33 decks)

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