Case Study 2

Question 1

A 30 year old Afro-Caribbean woman presents to her GP with a six-month history of exertion dyspnoea and a painful red lesion on her shin. She also complains of dry itchy eyes. A clinical diagnosis of sarcoidosis is made. What condition is the painful lesion most likely to be?

Answer 1

Erythema nodosum

Question 2

Give 3 other extra-pulmonary areas which might present manifestations of sarcoidosis

Answer 2

• skin
• neurological
• eyes
• salivary and lacrimal glands
• joints
• abdomen
• renal
• lymph nodes
• cardiovascular system

Question 3

Give a manifestation of sarcoidosis on the skin

Answer 3

• lupus pernio

- sarcoid infiltration of the skin

Question 4

Give a neurological manifestation of sarcoidosis

Answer 4

• peripheral neuropathy
• cranial nerve palsies
• aseptic meningitis
• hypopituitarism

Question 5

Give a manifestation of sarcoidosis in the eyes

Answer 5

• anterior uveitis

- choroiretinitis

Question 6

Give a manifestation of sarcoidosis in the salivary and lacrimal glands

Answer 6

Sicca syndrome

Question 7

Give a manifestation of sarcoidosis on the joints

Answer 7

Arthralgia

Question 8

Give a manifestation of sarcoidosis on the abdomen

Answer 8

Hepatosplenomegaly

Question 9

Give a manifestation of sarcoidosis in the renal system

Answer 9

• renal stones

- hypercalciuria and associated nephrocalcinosis

Question 10

Give a manifestation of sarcoidosis in the lymph nodes

Answer 10

Lymphadenopathy

Question 11

Give a manifestation of sarcoidosis in the CVS

Answer 11

• cor pulmonale

- conduction system disease

Question 12

Give five essential investigations into sarcoidosis

Answer 12

• CXR
• transbronchial biopsy and broncho-alveolar lavage
• liver biopsy
• respiratory function tests
• serum ACE
• Kveim test
• tuberculin test

Question 13

What is sarcoidosis?

Answer 13

A common, multi-system granulomatous disorder which usually presents between 25-35 years of age

Question 14

In what race will sarcoidosis have a more severe presentation and malignant prognosis?

Answer 14

Afro-Caribbean

Question 15

Give a characteristic of sarcoidosis on CXR

Answer 15

Bilateral hilar lymphadenopathy

Question 16

The course and prognosis of sarcoidosis can be inferred by

Answer 16

the mode of presentation

Question 17

Acute onset in young adults with associated erythema nudosum usually signifies

Answer 17

a self-limiting disorder

Question 18

Later, more insidious onset in middle age leads to

Answer 18

a progressive disorder with multi system fibrosis

Question 19

Pulmonary sarcoid is classified by the radiological changes seen on CXR into four stages. What is the first stage?

Answer 19

Clear CXR

Question 20

What is the second stage of pulmonary sarcoid on CXR?

Answer 20

Bilateral hilar and mediastinal lymphadenopathy

Question 21

What is the third stage of pulmonary sarcoid on CXR

Answer 21

Bilateral hilar and mediastinal lymphadenopathy with associated pulmonary infiltration

Question 22

What is the fourth stage of pulmonary sarcoid on CXR?

Answer 22

Pulmonary infiltration without hilar lymphadenopathy

Question 23

When are steroids recommended for use in sarcoidosis?

Answer 23

For stage two and three of the pulmonary disease and for eye and cardiac involvement