Sarcoidosis

Question 1

What are the dermatological manifestations of sarcoidosis?

Answer 1

Erythema nodosum (inflammation of subcutaneous fat leading to tender nodules especially on the shins)
Lupus pernio (red/purple plaques and nodules on the face)
Hyper or hypopigmentation of the skin

Question 2

What are the neurological manifestations?

Answer 2

Meningitis
Peripheral neuropathy
Facial nerve palsy

Question 3

What are the ocular manifestations?

Answer 3

Uveitis
Glaucoma

Question 4

What are the cardiac manifestations?

Answer 4

Restrictive cardiomyopathy
Syncope

Question 5

What is Lofgren’s syndrome?

Answer 5

Fever
Polyarthralgia
Erythema nodosum
Bilateral hilar lymphadenopathy

Question 6

What is Heerfordt’s syndrome?

Answer 6

Fever
Uveitis
Parotid swelling
Facial nerve palsy

Question 7

What are the diagnostics on the FBC?

Answer 7

High ACE and calcium

Question 8

What is the diagnostic imaging?

Answer 8

High resolution CT

Question 9

What is god standard diagnosis?

Answer 9

Biopsy for noncaseating granuloma

Question 10

What will bronchoalveolar lavage show?

Answer 10

Sudden cardiac death
Aspergillomas in the cavities
Pulmonary hypertension

Question 11

What is first line treatment?

Answer 11

Prednisolone

Question 12

What is second line treatment?

Answer 12

Immunosuppressant

Question 13

What is third line treatment?

Answer 13

Biologic therapy like infliximab

Question 14

What ae the complications fo sarcoidosis?

Answer 14

Sudden cardiac death
Aspergillomas in the cavities
Pulmonary hyperteniosn

Question 15

What is lupus pernio?

Answer 15

Purplish raised rash

Question 16

What is stage 0 of sarcoidosis?

Answer 16

Normal

Stage 0 indicates no signs of sarcoidosis.

Question 17

What characterizes stage 1 of sarcoidosis?

Answer 17

Bilateral hilar lymphadenopathy (BHL)

This stage involves enlargement of lymph nodes in both sides of the chest.

Question 18

What is the defining feature of stage 2 of sarcoidosis?

Answer 18

BHL + interstitial infiltrates

In this stage, there are both enlarged lymph nodes and lung tissue involvement.

Question 19

What does stage 3 of sarcoidosis involve?

Answer 19

Diffuse interstitial infiltrates only

This stage has no lymphadenopathy, just lung infiltration.

Question 20

What is the characteristic of stage 4 of sarcoidosis?

Answer 20

Diffuse fibrosis

This stage indicates severe lung damage and scarring.

Question 21

What onset is associated with a poor prognosis in sarcoidosis?

Answer 21

Insidious onset, symptoms > 6 months

A gradual onset and prolonged symptoms indicate a worse outcome.

Question 22

What absence is linked to poor prognosis in sarcoidosis?

Answer 22

Absence of erythema nodosum

Erythema nodosum is often a sign of a better prognosis.

Question 23

What are some extrapulmonary manifestations of sarcoidosis associated with poor prognosis?

Answer 23

Examples include:
* Lupus pernio
* Splenomegaly

These conditions indicate more extensive disease involvement.

Question 24

What CXR features indicate a poor prognosis in sarcoidosis?

Answer 24

Stage III-IV features

Advanced stages on chest X-ray show severe lung involvement.

Question 25

Which ethnicities are associated with poor prognosis in sarcoidosis?

Answer 25

Black African or African-Caribbean ethnicity ## Footnote There is a higher prevalence and severity of sarcoidosis in these populations.

Question 26

What are the indications of corticosteroid treatment?

Answer 26

parenchymal lung disease, uveitis, hypercalcaemia and neurological or cardiac involvement

Question 27

When are steroids indicated in sarcoidosis?

Answer 27

Steroids are only indicated in patients with stage 2/3 disease who are symptomatic, have hypercalcaemia, or who have heart, eye, or neuro involvement

Question 28

What electrolyte imbalance is seen in sarcoidosis?

Answer 28

Hypercalcaemia

Question 29

What to consider with highly suggestive history of sarcoidosis but absence of raised ACE?

Answer 29

ACE is not specific to sarcoidosis

Question 30

Why is calcium increased in sarcoidosis!

Answer 30

nhanced conversion of vitamin D to its active form by macrophages in granulomas, leading to increased calcium absorption from the gut.

Question 31

How does silicosis present,

Answer 31

silicosis can cause bilateral hilar lymphadenopathy on chest X-ray, it typically presents with a more characteristic pattern of upper lobe fibrosis with nodules compared to sarcoidosis