128 Questions
What is the characteristic feature of sarcoidosis?
Granulomatous inflammation
What is theorized to be the cause of sarcoidosis?
Hyperactivation of the immune system
At what age is disease onset most common for sarcoidosis?
Third decade of life
Where does sarcoidosis have a higher incidence?
Greater distance from the equator
What condition has replaced syphilis as the great mimicker for dermatologists?
Sarcoidosis
What is the characteristic color change seen in the papular form of sarcoidosis when a glass slide is pressed to the skin?
Translucent red-brown color
What feature of sarcoidosis lesions can be appreciated with diascopy?
Nodular quality
What is a distinguishing dermoscopic finding associated with cutaneous sarcoidosis?
Pink homogenous background
Where do papular lesions of sarcoidosis occur most commonly?
Face and neck
What reflects mild epidermal atrophy in the lesions of sarcoidosis?
Waxy appearance
What condition may exhibit similar diascopic properties to sarcoidosis?
Lupus vulgaris
What is the characteristic feature of lupus pernio?
Symmetric violaceous plaques and nodules on the nose and digits
What was the initial misunderstanding regarding the name 'lupus pernio'?
It was mistaken to be related to lupus vulgaris and cold injury
What is a potential consequence of lupus pernio lesions extending into the nasal sinus?
It causes nasal crusting and epistaxis
What is the association between angiolupoid lesions and lupus pernio?
Angiolupoid lesions are a variant of lupus pernio
What is a potential manifestation of cutaneous sarcoidosis at traumatized skin sites?
Inflammation and infiltration with sarcoidal granulomas
What may be the only finding in a patient with significant systemic involvement of sarcoidosis?
Infiltrated scars
What does the presence of sarcoidal granulomas surrounding foreign material NOT do?
Establish the diagnosis of sarcoidosis
What is a common characteristic of scar tissue affected by cutaneous sarcoidosis?
Inflammation and granuloma infiltration
Where does cutaneous sarcoidosis occur preferentially?
Around embedded foreign material such as silica and tattoo ink
What may infiltrated scars be in a patient with significant systemic involvement?
Tender or pruritic
What is a potential cutaneous manifestation of sarcoidosis that may occur on the extremities?
Subcutaneous nodules
Which cutaneous manifestation of sarcoidosis is associated with induration upon careful palpation?
Hypopigmented macules
In cutaneous sarcoidosis, what manifestation may occur on hair-bearing skin like the face and scalp?
Alopecia
What characterizes the reversibility of alopecia in cutaneous sarcoidosis?
The degree of fibrosis and destruction of the hair follicle
What rare manifestation of cutaneous sarcoidosis may lead to nail changes?
Granulomas in the nail matrix
Which type of cutaneous sarcoidosis may present as persistent subcutaneous nodules?
Darier-Roussy sarcoid
What may be appreciated upon careful palpation of the hypopigmented macules in darkly pigmented persons with sarcoidosis?
Induration
In cutaneous sarcoidosis, where may alopecia occur?
Face and scalp
What rare nail changes may occur in cutaneous sarcoidosis?
Subungual hyperkeratosis
What may infiltrate the gingiva and mimic Wegner granulomatosis in sarcoidosis?
Sarcoidal granulomas
What is one cause of Mikulicz syndrome, the bilateral enlargement of the lacrimal, parotid, sublingual, and submandibular glands?
Sarcoidosis
What is the characteristic feature of Mikulicz syndrome?
Bilateral enlargement of the lacrimal, parotid, sublingual, and submandibular glands
What is the main nonspecific cutaneous manifestation of sarcoidosis?
Erythema nodosum
What condition is frequently the initial manifestation of sarcoidosis, characterized by erythema nodosum, bilateral hilar adenopathy, arthralgia, and fever?
Lofgren syndrome
What is a potential consequence of sarcoid lesions infiltrating the parenchyma of the lungs?
Pulmonary fibrosis
Which of the following may occur due to fibrotic disease in sarcoidosis?
Pulmonary hypertension
What can be a consequence of lesions distorting the airways in sarcoidosis?
Obstructive lung disease
When are pulmonary function tests more likely to be abnormal in sarcoidosis?
When chest radiographs reveal abnormal lung parenchyma
What is the most common organ involved with sarcoidosis?
Lung
What are the usual findings on pulmonary examination in patients with sarcoidosis?
Absent findings
What is the typical symptomatology of patients with sarcoidosis?
Asymptomatic
What is the most common symptom associated with ocular involvement in sarcoidosis?
Dryness and itching
Which syndrome is a classic presentation of sarcoidosis involving fever, parotid gland enlargement, facial palsy, and anterior uveitis?
Heerfordt syndrome
What is the main cause of clinical problems related to cardiac involvement in sarcoidosis?
Arrhythmias
What percentage of patients with sarcoidosis exhibit clinical evidence of cardiac involvement?
5%
What part of the nervous system may be affected by neurosarcoidosis?
Both central and peripheral nervous system
How does nephrolithiasis occur in renal sarcoidosis?
Due to direct granulomatous inflammation in the kidney
What is the common characteristic of liver involvement in hepatic sarcoidosis?
Histologic evidence of sarcoidal granulomas
What condition is commonly associated with nasal sarcoidosis of the upper respiratory tract?
Severe epistaxis and nasal crusting
What may lead to leukopenia in sarcoidosis?
Spleen involvement
Which manifestation is associated with bone marrow involvement in sarcoidosis?
Thrombocytopenia
What is the usual cause of liver biopsy in patients with sarcoidosis?
Histologic evidence of granulomas
What is the most common symptom associated with ocular involvement in sarcoidosis?
Redness, burning, itching, and dryness
Which part of the eye is most commonly involved in sarcoidosis?
Uvea
What can result from activated sarcoidal macrophages having increased 1-hydroxylase activity?
Hypercalcemia, hypercalciuria, and nephrolithiasis
What is the recommended diagnostic test for every patient diagnosed with sarcoidosis?
Electrocardiogram
What might happen when the myocardium is massively infiltrated with granulomas?
Cardiogenic shock and heart failure
What is the triggering factor for sarcoidosis?
Exposure to an antigen(s)
Which cells recognize, process, and present the processed sarcoid-inducing antigen to CD4+ T cells?
Macrophages
What do activated macrophages produce that induces lymphocytes to shift toward a Th1 profile?
Interleukin (IL)-12
What cytokine is released by activated T cells that recruits monocytes and macrophages to the site of disease activity?
Interleukin (IL)-2
What is the putative antigen(s) triggering the immunologic cascade?
Unknown
What plays a role in the development of sarcoidosis lesions in addition to CD4+ T cells of the Th1 subtype?
(Th17) subtype and Th17 cytokines
What is a common risk factor associated with sarcoidosis?
Genetic mutations related to the immune system
Which infectious agent is NOT associated with sarcoidosis according to the passage?
Streptococcus pyogenes
What is a documented environmental risk factor for developing sarcoidosis?
Exposure to mineral dusts such as silica and iron
Who is more likely to develop sarcoidosis based on smoking habits?
Non-smokers
What does the interplay of antigenic and genetic risk factors suggest about sarcoidosis?
It has multiple causes
What is the association between relatives of an affected person and the development of sarcoidosis?
"Relatives of an affected person are more likely to develop disease than is the general population"
What is associated with the development of sarcoidosis?
Mycobacteria
What is associated with increased risk of sarcoidosis?
Firefighters
What plays a major role in determining susceptibility to sarcoidosis?
Genetics
Which genetic factor is associated with different presentations of sarcoidosis?
TNF
What is thought to be the cause of sarcoidosis?
Specific interaction between exposures and genetic programming
What is associated with different phenotypic expressions of sarcoidosis?
Mutations in genes related to the immune system
What is required for the diagnosis of sarcoidosis?
Presence of noncaseating granulomas in a single organ system
In what scenario can the diagnosis of sarcoidosis be accepted without a tissue biopsy?
A patient with asymptomatic bilateral hilar adenopathy noted on chest radiograph
What does the presence of noncaseating granulomas in a single organ system indicate?
Requires histologic confirmation in the second organ
What is necessary for confirmation of sarcoidosis?
Histologic confirmation in two separate organs
When can the diagnosis of sarcoidosis be assumed without a tissue biopsy?
When the clinical presentation is typical for the disease
What is true about isolated skin granulomas in relation to sarcoidosis?
They should not be assumed to represent sarcoidosis
What is the recommended test for evaluating the total granuloma burden in sarcoidosis?
Serum angiotensin-converting enzyme (SACE) levels
Which test is abnormal in more than 90% of patients with sarcoidosis?
Posteroanterior chest radiograph
What is the clinical role of computed tomography in the management of pulmonary sarcoidosis?
Insufficient evidence for a clinical role
What is the mechanism of gallium-67 uptake in sarcoidosis?
Increased capillary permeability of gallium
What is a highly specific sign for identifying sarcoidosis on gallium-67 scanning?
Bilateral hilar and right paratracheal uptake (lambda sign)
What is the role of fluorodeoxyglucose positron emission tomography scanning in sarcoidosis?
Revealing granulomatous inflammation and monitoring treatment response
What type of cells are commonly present within the sarcoidal granuloma?
Epithelioid cells
What should be routinely performed to consider alternative diagnoses to sarcoidosis?
Stains and cultures for mycobacteria and fungi
What is a characteristic feature of cutaneous granulomas that may help in differential diagnosis?
Epithelioid cells surrounded by lymphocytes ('naked granulomas')
What is a potential role of magnetic resonance imaging in sarcoidosis?
Revealing extrathoracic disease involvement
What is necessary for the diagnosis of sarcoidosis?
Confirmation of granulomatous involvement in at least 2 separate organs
When can isolated skin granulomas be assumed to represent sarcoidosis?
When no alternative diagnoses are apparent
What does confirmation of sarcoidosis require?
Proof of granulomatous involvement in at least 2 separate organs
In which scenario can the diagnosis of sarcoidosis be accepted without a tissue biopsy?
When cutaneous manifestations are typical for the disease
What is the significance of serum angiotensin-converting enzyme (SACE) levels in the diagnosis of sarcoidosis?
Elevated SACE levels are insufficiently specific for the diagnosis of sarcoidosis and are also insufficiently sensitive to exclude the diagnosis.
What is the role of posteroanterior chest radiograph in diagnosing sarcoidosis?
It is abnormal in more than 90% of patients with sarcoidosis.
What is the characteristic feature of gallium-67 scanning in identifying sarcoidosis?
Gallium uptake in thoracic and extrathoracic sites is typically absent in areas of skin involvement in sarcoidosis.
What is the significance of gadolinium enhancement on nuclear magnetic resonance imaging in sarcoidosis?
It plays a major role in detecting neurosarcoidosis and monitoring therapeutic response.
What is the role of fluorodeoxyglucose positron emission tomography scanning in sarcoidosis?
It is more sensitive in revealing granulomatous inflammation than gallium-67 scanning.
What percentage of cases show pulmonary parenchymal infiltrates in sarcoidosis?
25% to 60%
What is noted in 50% to 85% of sarcoidosis cases?
Asymptomatic hilar adenopathy
What stage of sarcoidosis is characterized by pulmonary infiltrates only?
Stage III
Which of the following is associated with a more than 80% rate of spontaneous remission within 4 to 6 weeks?
Erythema nodosum with fever and arthralgia
Which cutaneous manifestation of sarcoidosis indicates chronic disease and is associated with upper respiratory tract involvement, pulmonary fibrosis, and bony cysts?
Lupus pernio
Which of the following is associated with a worse prognosis in sarcoidosis?
Forced vital capacity less than 1.5 L
What is the general prognosis of sarcoidosis?
Favorable prognosis for all types of sarcoidosis
What causes almost all significant impairment from sarcoidosis?
Hyalinization of fibrotic response
What is the likely cause of the propensity for a brisk fibrotic response in sarcoidosis?
Host response
Which part of the body accounts for most of the remaining deaths related to sarcoidosis in the United States?
Central nervous system involvement
What is the characteristic feature of skin lesions from fibrosis in sarcoidosis?
Ulceration or destruction of adjacent bone and cartilage
What is the typical remission period for sarcoidosis after diagnosis?
2-5 years
What is the usual prognosis for liver and peripheral lymph node sarcoidosis?
Favorable
What is the main cause of significant impairment from sarcoidosis?
Development of fibrosis
What may resolve in cutaneous sarcoidosis with or without scarring or pigmentary changes?
Skin lesions
Which topical medication may be effective for cutaneous sarcoidosis without causing skin atrophy and hypopigmentation?
Tacrolimus ointment
What is the recommended initial dose of prednisone equivalent for the treatment of pulmonary sarcoidosis?
20 to 40 mg/day
When should an attempt be made to taper the corticosteroid dose for sarcoidosis treatment?
Within 9 to 12 months of therapy initiation
What is the most reliable immediate initial therapy for sarcoidosis?
Systemic corticosteroids
What is the usual range for tapering the corticosteroid dosage over a few months for sarcoidosis treatment?
0.1 to 0.2 mg/kg
What is the recommended initial dose of prednisone equivalent for the treatment of cutaneous sarcoidosis?
$40$ to $60$ mg/day
Which medication is considered the most studied steroid-sparing agent for the treatment of sarcoidosis?
Methotrexate
Which drug, used for sarcoidosis, has a higher potential of causing retinal damage?
Chloroquine
Which medication has been reported to improve skin sarcoidosis in case series and may take up to 2 years to be effective?
Doxycycline
Which regimen has shown some effectiveness for the treatment of sarcoidosis, with clinical trials currently ongoing to better assess its usefulness?
CLEAR (combined levofloxacin, ethambutol, azithromycin, and rifampin) regimen
Which medication is reserved for severe or potentially life-threatening disease due to its significant side effect profile, including carcinogenic potential?
Cyclophosphamide
Which medication is effective for many forms of sarcoidosis but should be carefully monitored due to liver function tests and blood cell counts?
Cyclophosphamide
Test your knowledge about the treatment options for cutaneous sarcoidosis, including the use of class I topical steroids, intralesional injections, and topical tacrolimus. Explore the effectiveness and potential adverse effects of these treatment modalities.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
