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MSRA respiratory > sarcoidosis > Flashcards

sarcoidosis Flashcards

1
Q

what is sarcoidosis?

A

Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology.

characterised by non-caseating granulomas. It is more common in young adults and in people of African descent

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2
Q

what are the features of sarcoidosis?

A

acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia, dactylitis

insidious: dyspnoea, non-productive cough, malaise, weight loss, anorexia

skin: lupus pernio

hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)

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3
Q

what are the syndromes associated with sarcoidosis?

A

lofgren’s syndrome
mikulicz syndrome
heerfordts syndrome

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4
Q

what is lofgren’s syndrome?

A

a form of sarcoidosis characterised by:

bilateral hilar lymphadenopathy BHL
erythema nodosum
fever
polyarthralgia

excellent prognosis

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5
Q

what is mikulicz syndrome?

A

enlargement of parotid + lacrimal glands due to sarcoidosis, tuberculosis or lymphoma

unhelpful as confusing overlap with sjogrens syndrome

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6
Q

what is heerfordt’s syndrome?

A

uveoparotid fever

there is paratod enlargement, fever + uveitis secondary to sarcoidosis

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7
Q

what are the features of acute sarcoidosis?

A

erythema nodosum
fever
polyarthralgia
bilateral hilar lymphadenopathy

GRAULOMAS

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8
Q

what are general features of sarcoidosis?

A

Fever
Anorexia and ↓ wt.
Fatigue
Lymphadenopathy and HSM

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9
Q

what are respiratory causes of sarcoidosis?

A

Upper: otitis, sinusitis

Lower (seen in 90%)
 Dry cough, SOB, chest pain, ↓ lung function
 Stage 1: BHL
 Stage 2: BHL + peripheral infiltrates
 Stage 3: Peripheral infiltrates alone
 Stage 4: Progressive mid-zone fibrosis ̄c bullae

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10
Q

what are the joint features of sarcoidosis?

A

polyarthraliga
dactylitis

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11
Q

what are the neurological features of sarcoidosis?

A

 Peripheral and cranial polyneuropathy (esp. Bell’s palsy)
 Meningitis, transverse myelitis, SOL

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12
Q

what are the renal features of sarcoidosis?

A

hypercalcaemia leads to
renal stones, nephrocalcinosis, DI

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13
Q

what are hormonal features of sarcoidosis?

A

pituitary dysfunction eg amenorrhoea

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14
Q

what are ophthalmological features of sarcoidosis?

A

uveitis
keratoconjunctivitis
sicca/mikulicz/sjogrens syndrome

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15
Q

what are cardiac features of sarcoidosis?

A

restrictive cardiomyopathy secondary to granulomas + fibrosis
pericardial effusion

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16
Q

what are gastro features of sarcoidosis?

A

hepatomegaly + cholestatic LFTs
splenomegaly

17
Q

what are dermatological features of sarcoidosis?

A

EN: painful erythematous nodules on shins (paniculitis)

Lupus pernio: raised, dusky purple plaque on nose, cheek, fingers

18
Q

what blood tests results suggest sarcoidosis?

A

raised ESR, calcium, serum ACE, Ig, LFTs
lymphopenia

19
Q

what are the lung function results of sarcoidosis?

A

restrictive pattern wiht reduced FVC
reduced TCLO

20
Q

what is the diagnostic tissue biopsy for sarcoidosis?

A

non=caseating granulomas

take from lung, lymph nodes, skin nodules, liver

21
Q

what team needs to review sarcoidosis?

A

ophthalmology

22
Q

what is the treatment of sarcoidosis?

A

asymptomatic- no rx

acute - spontaneously resolves, bed rest + NSAIDs

chronic: prednisolone 40mg for 4-6 weeks
additional immunsosuppression: methotrexate, ciclosporin, cyclophosphamide

23
Q

what is the prognosis of sarcoidosis?

A

 60% ̄c thoracic sarcoidosis resolve over 2yrs
 20% respond to steroids
 20% no improvement despite Rx

24
Q

what are differentials for bilateral hilar lymphadenopathy?

A

 Sarcoidosis
 Infection: TB, mycoplasma
 Malignancy: lymphoma, carcinoma  Interstitial disease: EAA, silicosis

25
Q

what are differentials for granulomatous disease?

A

 Infections: TB, leprosy, syphilis, crypto, schisto
 AI: PBC
 Vasculitis: GCA, PAN, Wegener’s, Takayasu’s
 Idiopathic: Crohns, Sarcoid
 Interstitial lung: EAA, silicosis

MSRA respiratory (14 decks)

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