Sarcoidosis

Question 1

What is sarcoidosis?

Answer 1

Disease which causes inflammation and granuloma formation throughout the body.

Question 2

What is a granuloma?

Answer 2

A nodule of inflammation which is full of macrophages.

Question 3

What is the cause of sarcoidosis?

Answer 3

Unknown

Question 4

Which 2 ages are there spikes in the incidence of sarcoidosis?

Answer 4

young adult hood
60yrs

Question 5

What are the risk factors for sarcoidosis?

Answer 5

Afrocaribbean ethnicity
Women
young adult (20-40)
60yrs

Question 6

How many people with sarcoidosis are asymptomatic?

Answer 6

50%

Question 7

What are the signs and symptoms in the lungs?

Answer 7

dry cough
reduced exercise tolerance
crepitations on examination
mediastinal lymphadenopathy
dyspnoea
pulmonary fibrosis
pulmonary nodules

Question 8

What are the systemic signs and symptoms of sarcoidosis?

Answer 8

Weight loss
fever
lymphadenopathy
fatigue
swollen parotid glands

Question 9

What are the signs and symptoms in the liver?

Answer 9

Cirrhosis
hepatomegaly
nodules
cholestasis

Question 10

What are the signs and symptoms in the eyes?

Answer 10

Uveitis
Optic neuritis
conjunctivitis

Question 11

Which condition is usually associated with optic neuritis?

Answer 11

Multiple sclerosis

Question 12

What are the signs and symptoms in the heart?

Answer 12

Heart failure (reduced myocardial function)
Arrhythmias
bundle branch block
heart block

Question 13

What are the signs and symptoms in the kidneys?

Answer 13

Splenomegaly
Kidney stones (due to hypercalcaemia)
Interstitial nephritis

Question 14

What can be seen in the nervous system?

Answer 14

BILATERAL bells palsy
nodules
meningitis
diabetes insipidus
encephalopathy

Question 15

What signs and symptoms can be seen in the bones?

Answer 15

Arthritis
Arthralgia
myopathy

Question 16

What is the name for acute sarcoidosis?

Answer 16

Lofgrens syndrome

Question 17

What 4 things are seen in lofgrens syndrome?

Answer 17

Fever
erythema nodosum
bilateral hilar lymphadenopathy
polyarthralgia

Question 18

What signs and symptoms are seen in the skin?

Answer 18

Erythema nodosum - very common
Lupus pernio (purple on tips of nose and cheeks)
granulomas in scar tissue

Question 19

What investigations can be done?

Answer 19

Serum ACE - raised
Serum calcium - raised
Soluble interlukin 2 - raised
CRP - raised
Immunoglobulins - raised
ESR - raised

Chest X ray
CT
Biopsy

Question 20

What is the gold standard investigation for diagnosis?

Answer 20

Biopsy - for histology

Question 21

Which cells are seen in histology?

Answer 21

Non-caseating granulomas with epitheliod cells

Question 22

How is a biopsy of the chest done?

Answer 22

Ultrasound guided bronchoscopy

Question 23

What is the 1st line treatment for those with none/mild symptoms?

Answer 23

no treatment
condition often resolves spontaneously

Question 24

how many people with sarcoidosis resolve spontaneously?

Answer 24

60% within 6 months

Question 25

what is the treatment for sarcoidosis with symptoms?

Answer 25

1st line - oral steroids 6-24 months
2nd line - immunosuppressants (methotrexate or azothiaprine)

Question 26

What is prescribed alongside oral steroids?

Answer 26

Bisphosphonates

Question 27

What is the treatment for severe pulmonary disease?

Answer 27

lung transplant

Question 28

What is the treatment for lofgrens syndrome?

Answer 28

NSAIDs
bed rest

Question 29

What is a common cause of death as a result of sarcoidosis?

Answer 29

CNS problems
Fatal heart arrhythmias