Sarcoidosis

Question · easy

A 29-year-old woman of Scandinavian descent presents with 3 weeks of fever, painful red-brown nodules on her anterior shins, migratory ankle arthralgia, and bilateral hilar lymphadenopathy on chest radiograph. What is the most appropriate next step in management?

Measure serum ACE level to confirm the diagnosis Start high-dose systemic glucocorticoids immediately Perform transbronchial biopsy to confirm the diagnosis before initiating treatment Begin symptomatic treatment with an NSAID and observe

Question · medium

A patient with biopsy-confirmed pulmonary sarcoidosis develops hypercalcemia with a suppressed parathyroid hormone level. Which mechanism best explains this finding?

Unregulated 1-alpha-hydroxylase activity in activated macrophages increasing calcitriol production Increased osteoclastic bone resorption from granulomatous marrow infiltration Renal tubular calcium wasting from impaired vitamin D metabolism Ectopic secretion of parathyroid hormone by the granulomas

Question · medium

A patient with chronic sarcoidosis remains symptomatic despite glucocorticoids and methotrexate, and escalation to anti-TNF therapy is planned. Which of the following agents has been shown to be INEFFECTIVE in sarcoidosis and should NOT be used?

Cyclophosphamide Adalimumab Infliximab Etanercept

Question · hard

Which of the following statements about cardiac sarcoidosis is correct?

Clinically apparent cardiac sarcoidosis is present in the majority of U.S. patients at diagnosis Endomyocardial biopsy is highly sensitive because granulomas are diffusely distributed throughout the myocardium The severity of pulmonary disease does not predict the presence or severity of cardiac involvement Atrial fibrillation is the most frequent tachyarrhythmia in cardiac sarcoidosis

Question · hard

A patient with newly diagnosed sarcoidosis has parenchymal lung infiltrates on chest radiograph WITHOUT hilar lymphadenopathy (Scadding stage III). Assuming a typical course, the approximate likelihood of spontaneous radiographic resolution is:

40–70% 10–20% 0% — it never resolves spontaneously 55–90%