Cutaneous Sarcoidosis Treatment Quiz

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Questions and Answers

What is the characteristic feature of sarcoidosis?

  • Bacterial infection
  • Granulomatous inflammation (correct)
  • Excessive bleeding
  • Viral replication

What is theorized to be the cause of sarcoidosis?

  • Genetic mutation
  • Metabolic disorder
  • Hyperactivation of the immune system (correct)
  • Environmental pollution

At what age is disease onset most common for sarcoidosis?

  • Third decade of life (correct)
  • First decade of life
  • Seventh decade of life
  • Fifth decade of life

Where does sarcoidosis have a higher incidence?

<p>Greater distance from the equator (B)</p> Signup and view all the answers

What condition has replaced syphilis as the great mimicker for dermatologists?

<p>Sarcoidosis (C)</p> Signup and view all the answers

What is the characteristic color change seen in the papular form of sarcoidosis when a glass slide is pressed to the skin?

<p>Translucent red-brown color (C)</p> Signup and view all the answers

What feature of sarcoidosis lesions can be appreciated with diascopy?

<p>Nodular quality (C)</p> Signup and view all the answers

What is a distinguishing dermoscopic finding associated with cutaneous sarcoidosis?

<p>Pink homogenous background (B)</p> Signup and view all the answers

Where do papular lesions of sarcoidosis occur most commonly?

<p>Face and neck (B)</p> Signup and view all the answers

What reflects mild epidermal atrophy in the lesions of sarcoidosis?

<p>Waxy appearance (C)</p> Signup and view all the answers

What condition may exhibit similar diascopic properties to sarcoidosis?

<p>Lupus vulgaris (D)</p> Signup and view all the answers

What is the characteristic feature of lupus pernio?

<p>Symmetric violaceous plaques and nodules on the nose and digits (B)</p> Signup and view all the answers

What was the initial misunderstanding regarding the name 'lupus pernio'?

<p>It was mistaken to be related to lupus vulgaris and cold injury (A)</p> Signup and view all the answers

What is a potential consequence of lupus pernio lesions extending into the nasal sinus?

<p>It causes nasal crusting and epistaxis (D)</p> Signup and view all the answers

What is the association between angiolupoid lesions and lupus pernio?

<p>Angiolupoid lesions are a variant of lupus pernio (D)</p> Signup and view all the answers

What is a potential manifestation of cutaneous sarcoidosis at traumatized skin sites?

<p>Inflammation and infiltration with sarcoidal granulomas (A)</p> Signup and view all the answers

What may be the only finding in a patient with significant systemic involvement of sarcoidosis?

<p>Infiltrated scars (C)</p> Signup and view all the answers

What does the presence of sarcoidal granulomas surrounding foreign material NOT do?

<p>Establish the diagnosis of sarcoidosis (D)</p> Signup and view all the answers

What is a common characteristic of scar tissue affected by cutaneous sarcoidosis?

<p>Inflammation and granuloma infiltration (B)</p> Signup and view all the answers

Where does cutaneous sarcoidosis occur preferentially?

<p>Around embedded foreign material such as silica and tattoo ink (A)</p> Signup and view all the answers

What may infiltrated scars be in a patient with significant systemic involvement?

<p>Tender or pruritic (C)</p> Signup and view all the answers

What is a potential cutaneous manifestation of sarcoidosis that may occur on the extremities?

<p>Subcutaneous nodules (D)</p> Signup and view all the answers

Which cutaneous manifestation of sarcoidosis is associated with induration upon careful palpation?

<p>Hypopigmented macules (A)</p> Signup and view all the answers

In cutaneous sarcoidosis, what manifestation may occur on hair-bearing skin like the face and scalp?

<p>Alopecia (A)</p> Signup and view all the answers

What characterizes the reversibility of alopecia in cutaneous sarcoidosis?

<p>The degree of fibrosis and destruction of the hair follicle (B)</p> Signup and view all the answers

What rare manifestation of cutaneous sarcoidosis may lead to nail changes?

<p>Granulomas in the nail matrix (B)</p> Signup and view all the answers

Which type of cutaneous sarcoidosis may present as persistent subcutaneous nodules?

<p>Darier-Roussy sarcoid (D)</p> Signup and view all the answers

What may be appreciated upon careful palpation of the hypopigmented macules in darkly pigmented persons with sarcoidosis?

<p>Induration (B)</p> Signup and view all the answers

In cutaneous sarcoidosis, where may alopecia occur?

<p>Face and scalp (D)</p> Signup and view all the answers

What rare nail changes may occur in cutaneous sarcoidosis?

<p>Subungual hyperkeratosis (A)</p> Signup and view all the answers

What may infiltrate the gingiva and mimic Wegner granulomatosis in sarcoidosis?

<p>Sarcoidal granulomas (A)</p> Signup and view all the answers

What is one cause of Mikulicz syndrome, the bilateral enlargement of the lacrimal, parotid, sublingual, and submandibular glands?

<p>Sarcoidosis (C)</p> Signup and view all the answers

What is the characteristic feature of Mikulicz syndrome?

<p>Bilateral enlargement of the lacrimal, parotid, sublingual, and submandibular glands (D)</p> Signup and view all the answers

What is the main nonspecific cutaneous manifestation of sarcoidosis?

<p>Erythema nodosum (C)</p> Signup and view all the answers

What condition is frequently the initial manifestation of sarcoidosis, characterized by erythema nodosum, bilateral hilar adenopathy, arthralgia, and fever?

<p>Lofgren syndrome (B)</p> Signup and view all the answers

What is a potential consequence of sarcoid lesions infiltrating the parenchyma of the lungs?

<p>Pulmonary fibrosis (A)</p> Signup and view all the answers

Which of the following may occur due to fibrotic disease in sarcoidosis?

<p>Pulmonary hypertension (B)</p> Signup and view all the answers

What can be a consequence of lesions distorting the airways in sarcoidosis?

<p>Obstructive lung disease (A)</p> Signup and view all the answers

When are pulmonary function tests more likely to be abnormal in sarcoidosis?

<p>When chest radiographs reveal abnormal lung parenchyma (C)</p> Signup and view all the answers

What is the most common organ involved with sarcoidosis?

<p>Lung (A)</p> Signup and view all the answers

What are the usual findings on pulmonary examination in patients with sarcoidosis?

<p>Absent findings (A)</p> Signup and view all the answers

What is the typical symptomatology of patients with sarcoidosis?

<p>Asymptomatic (D)</p> Signup and view all the answers

What is the most common symptom associated with ocular involvement in sarcoidosis?

<p>Dryness and itching (B)</p> Signup and view all the answers

Which syndrome is a classic presentation of sarcoidosis involving fever, parotid gland enlargement, facial palsy, and anterior uveitis?

<p>Heerfordt syndrome (B)</p> Signup and view all the answers

What is the main cause of clinical problems related to cardiac involvement in sarcoidosis?

<p>Arrhythmias (D)</p> Signup and view all the answers

What percentage of patients with sarcoidosis exhibit clinical evidence of cardiac involvement?

<p>5% (B)</p> Signup and view all the answers

What part of the nervous system may be affected by neurosarcoidosis?

<p>Both central and peripheral nervous system (C)</p> Signup and view all the answers

How does nephrolithiasis occur in renal sarcoidosis?

<p>Due to direct granulomatous inflammation in the kidney (C)</p> Signup and view all the answers

What is the common characteristic of liver involvement in hepatic sarcoidosis?

<p>Histologic evidence of sarcoidal granulomas (B)</p> Signup and view all the answers

What condition is commonly associated with nasal sarcoidosis of the upper respiratory tract?

<p>Severe epistaxis and nasal crusting (A)</p> Signup and view all the answers

What may lead to leukopenia in sarcoidosis?

<p>Spleen involvement (D)</p> Signup and view all the answers

Which manifestation is associated with bone marrow involvement in sarcoidosis?

<p>Thrombocytopenia (A)</p> Signup and view all the answers

What is the usual cause of liver biopsy in patients with sarcoidosis?

<p>Histologic evidence of granulomas (C)</p> Signup and view all the answers

What is the most common symptom associated with ocular involvement in sarcoidosis?

<p>Redness, burning, itching, and dryness (C)</p> Signup and view all the answers

Which part of the eye is most commonly involved in sarcoidosis?

<p>Uvea (A)</p> Signup and view all the answers

What can result from activated sarcoidal macrophages having increased 1-hydroxylase activity?

<p>Hypercalcemia, hypercalciuria, and nephrolithiasis (D)</p> Signup and view all the answers

What is the recommended diagnostic test for every patient diagnosed with sarcoidosis?

<p>Electrocardiogram (D)</p> Signup and view all the answers

What might happen when the myocardium is massively infiltrated with granulomas?

<p>Cardiogenic shock and heart failure (D)</p> Signup and view all the answers

What is the triggering factor for sarcoidosis?

<p>Exposure to an antigen(s) (B)</p> Signup and view all the answers

Which cells recognize, process, and present the processed sarcoid-inducing antigen to CD4+ T cells?

<p>Macrophages (A)</p> Signup and view all the answers

What do activated macrophages produce that induces lymphocytes to shift toward a Th1 profile?

<p>Interleukin (IL)-12 (A)</p> Signup and view all the answers

What cytokine is released by activated T cells that recruits monocytes and macrophages to the site of disease activity?

<p>Interleukin (IL)-2 (D)</p> Signup and view all the answers

What is the putative antigen(s) triggering the immunologic cascade?

<p>Unknown (A)</p> Signup and view all the answers

What plays a role in the development of sarcoidosis lesions in addition to CD4+ T cells of the Th1 subtype?

<p>(Th17) subtype and Th17 cytokines (A)</p> Signup and view all the answers

What is a common risk factor associated with sarcoidosis?

<p>Genetic mutations related to the immune system (B)</p> Signup and view all the answers

Which infectious agent is NOT associated with sarcoidosis according to the passage?

<p>Streptococcus pyogenes (A)</p> Signup and view all the answers

What is a documented environmental risk factor for developing sarcoidosis?

<p>Exposure to mineral dusts such as silica and iron (B)</p> Signup and view all the answers

Who is more likely to develop sarcoidosis based on smoking habits?

<p>Non-smokers (D)</p> Signup and view all the answers

What does the interplay of antigenic and genetic risk factors suggest about sarcoidosis?

<p>It has multiple causes (A)</p> Signup and view all the answers

What is the association between relatives of an affected person and the development of sarcoidosis?

<p>&quot;Relatives of an affected person are more likely to develop disease than is the general population&quot; (C)</p> Signup and view all the answers

What is associated with the development of sarcoidosis?

<p>Mycobacteria (B)</p> Signup and view all the answers

What is associated with increased risk of sarcoidosis?

<p>Firefighters (D)</p> Signup and view all the answers

What plays a major role in determining susceptibility to sarcoidosis?

<p>Genetics (B)</p> Signup and view all the answers

Which genetic factor is associated with different presentations of sarcoidosis?

<p>TNF (A)</p> Signup and view all the answers

What is thought to be the cause of sarcoidosis?

<p>Specific interaction between exposures and genetic programming (A)</p> Signup and view all the answers

What is associated with different phenotypic expressions of sarcoidosis?

<p>Mutations in genes related to the immune system (A)</p> Signup and view all the answers

What is required for the diagnosis of sarcoidosis?

<p>Presence of noncaseating granulomas in a single organ system (D)</p> Signup and view all the answers

In what scenario can the diagnosis of sarcoidosis be accepted without a tissue biopsy?

<p>A patient with asymptomatic bilateral hilar adenopathy noted on chest radiograph (A)</p> Signup and view all the answers

What does the presence of noncaseating granulomas in a single organ system indicate?

<p>Requires histologic confirmation in the second organ (B)</p> Signup and view all the answers

What is necessary for confirmation of sarcoidosis?

<p>Histologic confirmation in two separate organs (C)</p> Signup and view all the answers

When can the diagnosis of sarcoidosis be assumed without a tissue biopsy?

<p>When the clinical presentation is typical for the disease (D)</p> Signup and view all the answers

What is true about isolated skin granulomas in relation to sarcoidosis?

<p>They should not be assumed to represent sarcoidosis (A)</p> Signup and view all the answers

What is the recommended test for evaluating the total granuloma burden in sarcoidosis?

<p>Serum angiotensin-converting enzyme (SACE) levels (C)</p> Signup and view all the answers

Which test is abnormal in more than 90% of patients with sarcoidosis?

<p>Posteroanterior chest radiograph (D)</p> Signup and view all the answers

What is the clinical role of computed tomography in the management of pulmonary sarcoidosis?

<p>Insufficient evidence for a clinical role (D)</p> Signup and view all the answers

What is the mechanism of gallium-67 uptake in sarcoidosis?

<p>Increased capillary permeability of gallium (A)</p> Signup and view all the answers

What is a highly specific sign for identifying sarcoidosis on gallium-67 scanning?

<p>Bilateral hilar and right paratracheal uptake (lambda sign) (B)</p> Signup and view all the answers

What is the role of fluorodeoxyglucose positron emission tomography scanning in sarcoidosis?

<p>Revealing granulomatous inflammation and monitoring treatment response (B)</p> Signup and view all the answers

What type of cells are commonly present within the sarcoidal granuloma?

<p>Epithelioid cells (C)</p> Signup and view all the answers

What should be routinely performed to consider alternative diagnoses to sarcoidosis?

<p>Stains and cultures for mycobacteria and fungi (A)</p> Signup and view all the answers

What is a characteristic feature of cutaneous granulomas that may help in differential diagnosis?

<p>Epithelioid cells surrounded by lymphocytes ('naked granulomas') (C)</p> Signup and view all the answers

What is a potential role of magnetic resonance imaging in sarcoidosis?

<p>Revealing extrathoracic disease involvement (C)</p> Signup and view all the answers

What is necessary for the diagnosis of sarcoidosis?

<p>Confirmation of granulomatous involvement in at least 2 separate organs (B)</p> Signup and view all the answers

When can isolated skin granulomas be assumed to represent sarcoidosis?

<p>When no alternative diagnoses are apparent (A)</p> Signup and view all the answers

What does confirmation of sarcoidosis require?

<p>Proof of granulomatous involvement in at least 2 separate organs (C)</p> Signup and view all the answers

In which scenario can the diagnosis of sarcoidosis be accepted without a tissue biopsy?

<p>When cutaneous manifestations are typical for the disease (A)</p> Signup and view all the answers

What is the significance of serum angiotensin-converting enzyme (SACE) levels in the diagnosis of sarcoidosis?

<p>Elevated SACE levels are insufficiently specific for the diagnosis of sarcoidosis and are also insufficiently sensitive to exclude the diagnosis. (C)</p> Signup and view all the answers

What is the role of posteroanterior chest radiograph in diagnosing sarcoidosis?

<p>It is abnormal in more than 90% of patients with sarcoidosis. (B)</p> Signup and view all the answers

What is the characteristic feature of gallium-67 scanning in identifying sarcoidosis?

<p>Gallium uptake in thoracic and extrathoracic sites is typically absent in areas of skin involvement in sarcoidosis. (A)</p> Signup and view all the answers

What is the significance of gadolinium enhancement on nuclear magnetic resonance imaging in sarcoidosis?

<p>It plays a major role in detecting neurosarcoidosis and monitoring therapeutic response. (C)</p> Signup and view all the answers

What is the role of fluorodeoxyglucose positron emission tomography scanning in sarcoidosis?

<p>It is more sensitive in revealing granulomatous inflammation than gallium-67 scanning. (B)</p> Signup and view all the answers

What percentage of cases show pulmonary parenchymal infiltrates in sarcoidosis?

<p>25% to 60% (A)</p> Signup and view all the answers

What is noted in 50% to 85% of sarcoidosis cases?

<p>Asymptomatic hilar adenopathy (D)</p> Signup and view all the answers

What stage of sarcoidosis is characterized by pulmonary infiltrates only?

<p>Stage III (A)</p> Signup and view all the answers

Which of the following is associated with a more than 80% rate of spontaneous remission within 4 to 6 weeks?

<p>Erythema nodosum with fever and arthralgia (D)</p> Signup and view all the answers

Which cutaneous manifestation of sarcoidosis indicates chronic disease and is associated with upper respiratory tract involvement, pulmonary fibrosis, and bony cysts?

<p>Lupus pernio (A)</p> Signup and view all the answers

Which of the following is associated with a worse prognosis in sarcoidosis?

<p>Forced vital capacity less than 1.5 L (A)</p> Signup and view all the answers

What is the general prognosis of sarcoidosis?

<p>Favorable prognosis for all types of sarcoidosis (A)</p> Signup and view all the answers

What causes almost all significant impairment from sarcoidosis?

<p>Hyalinization of fibrotic response (C)</p> Signup and view all the answers

What is the likely cause of the propensity for a brisk fibrotic response in sarcoidosis?

<p>Host response (C)</p> Signup and view all the answers

Which part of the body accounts for most of the remaining deaths related to sarcoidosis in the United States?

<p>Central nervous system involvement (A)</p> Signup and view all the answers

What is the characteristic feature of skin lesions from fibrosis in sarcoidosis?

<p>Ulceration or destruction of adjacent bone and cartilage (B)</p> Signup and view all the answers

What is the typical remission period for sarcoidosis after diagnosis?

<p>2-5 years (D)</p> Signup and view all the answers

What is the usual prognosis for liver and peripheral lymph node sarcoidosis?

<p>Favorable (B)</p> Signup and view all the answers

What is the main cause of significant impairment from sarcoidosis?

<p>Development of fibrosis (B)</p> Signup and view all the answers

What may resolve in cutaneous sarcoidosis with or without scarring or pigmentary changes?

<p>Skin lesions (C)</p> Signup and view all the answers

Which topical medication may be effective for cutaneous sarcoidosis without causing skin atrophy and hypopigmentation?

<p>Tacrolimus ointment (A)</p> Signup and view all the answers

What is the recommended initial dose of prednisone equivalent for the treatment of pulmonary sarcoidosis?

<p>20 to 40 mg/day (A)</p> Signup and view all the answers

When should an attempt be made to taper the corticosteroid dose for sarcoidosis treatment?

<p>Within 9 to 12 months of therapy initiation (D)</p> Signup and view all the answers

What is the most reliable immediate initial therapy for sarcoidosis?

<p>Systemic corticosteroids (C)</p> Signup and view all the answers

What is the usual range for tapering the corticosteroid dosage over a few months for sarcoidosis treatment?

<p>0.1 to 0.2 mg/kg (A)</p> Signup and view all the answers

What is the recommended initial dose of prednisone equivalent for the treatment of cutaneous sarcoidosis?

<p>$40$ to $60$ mg/day (B)</p> Signup and view all the answers

Which medication is considered the most studied steroid-sparing agent for the treatment of sarcoidosis?

<p>Methotrexate (C)</p> Signup and view all the answers

Which drug, used for sarcoidosis, has a higher potential of causing retinal damage?

<p>Chloroquine (C)</p> Signup and view all the answers

Which medication has been reported to improve skin sarcoidosis in case series and may take up to 2 years to be effective?

<p>Doxycycline (B)</p> Signup and view all the answers

Which regimen has shown some effectiveness for the treatment of sarcoidosis, with clinical trials currently ongoing to better assess its usefulness?

<p>CLEAR (combined levofloxacin, ethambutol, azithromycin, and rifampin) regimen (B)</p> Signup and view all the answers

Which medication is reserved for severe or potentially life-threatening disease due to its significant side effect profile, including carcinogenic potential?

<p>Cyclophosphamide (A)</p> Signup and view all the answers

Which medication is effective for many forms of sarcoidosis but should be carefully monitored due to liver function tests and blood cell counts?

<p>Cyclophosphamide (C)</p> Signup and view all the answers

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