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3: MED1 Y3 - Respiratory [18] > [9] Sarcoidosis > Flashcards

[9] Sarcoidosis Flashcards

(52 cards)

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1
Q

What is sarcoidosis?

A

Multisystem granulomatous disorder of an unknown cause

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2
Q

What age is sarcoidosis most common?

A

20-40 years

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3
Q

What gender is sarcoidosis more common in?

A

Female

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4
Q

What ethnicity is sarcoidosis more common in?

A

Afro Caribbean

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5
Q

What genes are associated with sarcoidosis?

A

HLA-DRB1 and DQB1

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6
Q

What % of cases of sarcoidosis present incidentally on CXR?

A

20-40%

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7
Q

What are the symptoms of acute sarcoidosis?

A

Erythema nodosum
Fever
Polyarthralgia
Bilateral hilar lymphadenopathy

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8
Q

What pneumonic can be used to remember the clinical features of sarcoidosis?

A 
GRANULOMAS 
G = General
R = Respiratory
A = Arthralgia
N = Neurological
U = Urine
L = Low hormones
O = Opthalmological
M = Myocardial
A = Abdominal
S = Skin
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9
Q

What are the general features of sarcoidosis?

A

Fever
Anorexia and weight loss
Fatigue
Lymphadenopathy and hepatosplenomegaly

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10
Q

What are the upper respiratory features of sarcoidosis?

A

Otitis

Sinusitis

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11
Q

What are the lower respiratory features of sarcoidosis?

A

Dry cough
Chest pain
Decreased lung function

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12
Q

What % of people with sarcoidosis have lower respiratory features?

A

90%

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13
Q

What can the lower respiratory features of sarcoidosis be divided into?

A

Stage 1-4

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14
Q

What are the stage 1 lower respiratory features of sarcoidosis?

A

Bilateral hilar lymphadenopathy

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15
Q

What are the stage 2 lower respiratory features of sarcoidosis?

A

BHL + peripheral infiltrates

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16
Q

What are the stage 3 lower respiratory features of sarcoidosis?

A

Peripheral infiltrates alone

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17
Q

What are the stage 4 lower respiratory features of sarcoidosis?

A

Progressive mid-zone fibrosis with bullae

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18
Q

What are the arthralgia features of sarcoidosis?

A

Polyarthralgia

Dactylitis

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19
Q

What are the neurological features of sarcoidosis?

A

Peripheral and cranial polyneuropathy, especially Bell’s palsy
Meningitis, transverse myelitis, or space-occupying-lesions

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20
Q

What are the urine features of sarcoidosis?

A

Increased calcium, leading to renal stones, nephrocalcinosis, and diabetes insipidus

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21
Q

What are the hormonal features of sarcoidosis?

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A

Pituitary dysfunction, e.g. amenorrhoea

22
Q

What are the ophthalmological features of sarcoidosis?

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A

Uveitis
Keratoconjunctivitis
Sicca/Mikulicz/Sjorgen’s syndrome

23
Q

What are the myocardial features of sarcoidosis?

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A

Restrictive cardiomyopathy

Pericardial effusion

24
Q

What are the abdominal features of sarcoidosis?

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A

Hepatomegaly and cholestatic LFTs

Splenomegaly

25
What are the skin features of sarcoidosis?
Erythema nodosum | Lupus pernio
26
What is erythema nodosum?
Painful erythematous nodules in shins
27
What is lupus pernio?
Raised, dusky purple plaque on nose, cheek, fingers
28
What investigations should be done in sarcoidosis?
``` Bloods Imaging Tuberculin skin test Lung function tests Tissue biopsy Ophthalmology assessment ```
29
What may be found on bloods in sarcoidosis?
``` Increased ESR Increased calcium Lymphopenia Increased serum ACE Increased Ig Increased LFTs ```
30
What imaging should be done in sarcoidosis?
CXR CT MRI
31
What proportion of people with sarcoidosis have a positive tuberculin skin test?
1/3
32
What might be found on lung functioning testing in sarcoidosis?
Restrictive pattern with decrease FVC | Decreased transfer factor
33
What tissue biopsies should be taken in sarcoidosis?
Lung Lymph nodes Skin nodules Liver
34
What finding on tissue biopsy is diagnostic for sarcoidosis?
Non-caseating granulomas
35
Do patients who are asymptomatic with BHL require management?
No
36
How is acute sarcoidosis managed?
Bed rest | NSAIDs
37
What is the prognosis of acute sarcoidosis?
Usually resolve spontaneously
38
What is the first line management for chronic sarcoidosis?
Preg 40mg/day for 4-6 weeks
39
What additional immunosuppression can be used in chronic sarcoidosis?
Methotrexate Ciclosporin Cyclophosphamide
40
What % of cases of thoracic sarcoidosis resolve over 2 years?
60%
41
What % of cases of chronic sarcoidosis respond to steroids?
20%
42
What % of cases of chronic sarcoidosis have no improvement despite management?
20%
43
What are the differential diagnoses for BHL?
Sarcoidosis Infection Malignancy Interstitial disease
44
What infections can cause BHL?
TB | Mycoplasma
45
What cancers can cause BHL?
Lymphoma | Carcinoma
46
What forms of interstitial disease can cause BHL?
EAA | Silicosis
47
What are the differential diagnoses for granulomatous disease?
``` Infections Autoimmune Vasculitis Idiopathic Interstitial lung disease ```
48
What infections can cause granulomatous disease?
``` TB Leprosy Syphilis Cryptosporidium Schistosomiasis ```
49
What autoimmune conditions can cause granulomatous disease?
Primary biliary cholangitis
50
What vasculitic conditions can cause granulomatous disease?
Giant cell arteritis Polyarteritis nodosa Wegener's Takayasu's
51
What are the idiopathic causes of granulomatous disease?
Crohn's | Sarcoid
52
What are the interstitial lung causes of granulomatous disease?
Extrinsic allergic alveolitis | Silicosis

3: MED1 Y3 - Respiratory [18] (15 decks)

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