[MCQ] Sarcoidosis- Part 1

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Sarcoidosis- Part 2

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Question 1

The most common mechanism for pulmonary hypertension in sarcoidosis is ?

A	Fibrosis with obliteration of pulmonary vessels
B	Granulomatous infiltration of pulmonary arterioles
C	Hyperviscosity
D	Cardiac dysfunction

Question 1 Explanation:

Fibrosis and the resulting obliteration of the pulmonary vessels is the most common mechanism for pulmonary hypertension in sarcoidosis, although granulomatous infiltration of the pulmonary arterioles can cause pulmonary hypertension in the absence of pulmonary fibrosis.

Question 2

Which of the following is typically unilateral in sarcoidosis ?

A	Hilar lymphadenopathy
B	Parotid enlargement
C	Pleural effusion
D	Erythema nodosum

Question 2 Explanation:

Pleural involvement in sarcoidosis almost always is unilateral pleural effusion. Hilar lymphadenopathy is almost always bilateral. Parotid enlargement is a classic feature of sarcoidosis & bilateral involvement is the rule. Erythema nodosum comprises of bilateral, tender red nodules on anterior surface of legs

Question 3

Which of the following observation helps to differentiate neurosarcoidosis from multiple sclerosis ?

A	Meningeal enhancement
B	Hypothalamic involvement
C	Pulmonary or skin involvement
D	All of the above

Question 3 Explanation:

Optic neuritis occurs in both neurosarcoidosis & multiple sclerosis. Multiple enhancing white matter abnormalities in MRI suggest multiple sclerosis. Presence of meningeal enhancement or hypothalamic involvement and evidence of extraneurologic disease such as pulmonary or skin involvement suggests neurosarcoidosis

Question 4

Which of the following occurs due to cardiac involvement in sarcoidosis ?

A	Congestive heart failure (CHF)
B	Cardiac arrhythmias
C	Heart blocks
D	Any of the above

Question 4 Explanation:

Cardiac disease in sarcoidosis presents as CHF, cardiac arrhythmias or conduction blocks due to infiltration of heart muscle by granulomas.

Question 5

The most common location for sarcoid granulomas and scars in the heart is ?

A	Inter atrial septum
B	Inter ventricular septum
C	Left ventricular free wall
D	Right ventricular free wall

Question 5 Explanation:

The most common location for granulomas and scars is the left ventricular free wall, followed by the intraventricular septum, often with involvement of the conducting system.

Question 6

In sarcoidosis, fatigue is linked to which of the following ?

A	Myelopathy
B	Small peripheral nerve fiber disease
C	Basilar meningitis
D	Anterior hypothalamic disease

Question 6 Explanation:

A link between fatigue & small peripheral nerve fiber disease is noted in sarcoidosis.

Question 7

Which of the following is a complication of sarcoidosis ?

A	Blindness
B	Paraplegia
C	Renal failure
D	All of the above

Question 7 Explanation:

Sarcoidosis complications include blindness, paraplegia, renal failure, respiratory infection & failure.

Question 8

By chest radiographs, Stage 3 sarcoidosis refers to which of the following ?

A	Bilateral hilar lymphadenopathy without infiltration
B	Bilateral hilar lymphadenopathy with infiltration
C	Infiltration alone
D	Fibrotic bands, bullae, hilar retraction, bronchiectasis, and diaphragmatic tenting

Question 8 Explanation:

In sarcoidosis, CxR wise, stage 1 is bilateral hilar lymphadenopathy without infiltration, stage 2 is bilateral hilar lymphadenopathy with infiltration, stage 3 is infiltration alone and stage 4 is fibrotic bands, bullae, hilar retraction, bronchiectasis and diaphragmatic tenting. These stages do not indicate disease chronicity or correlate with changes in pulmonary function.

Question 9

What measure of lymphadenopathy in CT short axis supports the diagnosis of sarcoidosis over other ILDs ?

A	> 0.5 cm
B	> 1.0 cm
C	> 1.5 cm
D	> 2.0 cm

Question 9 Explanation:

Adenopathy >2 cm in CT short axis favours diagnosis of sarcoidosis over other interstitial lung diseases

Question 10

Which of the following is least helpful in defining active sarcoidosis ?

A	Gallium-67 lung scan
B	Bronchoalveolar lavage findings
C	Computed tomography
D	Serum level of ACE

Question 10 Explanation:

Gallium-67 lung scans, BAL & serum ACE level help in defining sarcoidosis disease activity. CT chest is rarely helpful for either diagnosis or prognosis but can identify early fibrosis

Question 11

Serum levels of ACE are elevated in approximately what percentage of patients with acute sarcoidosis ?

A	One-third
B	One-half
C	Two-third
D	Three-fourth

Question 11 Explanation:

Elevated levels of ACE are reported in 60% of patients with acute disease and only 20% of patients with chronic sarcoidosis.

Question 12

Significant elevation of ACE levels is seen in ?

A	Leprosy
B	Gaucher’s disease
C	Hyperthyroidism
D	All of the above

Question 12 Explanation:

Mild elevation of ACE is seen in diabetes. Elevations of >50% of upper limit of normal are seen in sarcoidosis, leprosy, Gaucher’s disease, hyperthyroidism, and disseminated granulomatous infections such as miliary tuberculosis. ACE level is not elevated in malignancy

Question 13

Lower than normal levels of ACE is seen in ?

A	Leprosy
B	Miliary tuberculosis
C	Hyperthyroidism
D	Lymphoma

Question 13 Explanation:

ACE level in lymphoma and patients on ACE inhibitor is lower than normal

Question 14

Biopsy from which of the following can be obtained for the diagnosis of sarcoidosis ?

A	Liver
B	Extrathoracic lymph node
C	Muscle
D	Any of the above

Question 14 Explanation:

Biopsy from lung, skin lesion, liver, extrathoracic lymph node, endomyocardium or muscle can be obtained for the diagnosis of sarcoidosis.

Question 15

Which of the following tests is least relevant in sarcoidosis ?

A	24-hour urinary excretion of calcium
B	24-hour proteinuria
C	Slit-lamp, tonometric, and funduscopic examinations
D	Serum angiotensin-converting enzyme

Question 15 Explanation:

Hypercalcemia, hypercalciuria & renal calculi occur in sarcoidosis. 24-hour urinary excretion of calcium should be measured in all patients with sarcoidosis. Calcium metabolism is disturbed

Question 16

Panda sign and lambda sign relate to ?

A	CxR
B	BAL
C	Gallium scan
D	PET

Question 16 Explanation:

Positive gallium scan can support the diagnosis of sarcoidosis if increased activity is noted in parotids & lacrimal glands (Panda sign) or in right paratracheal & left hilar area (lambda sign)

Question 17

In BAL fluid, CD4 / CD8 ratio more than which of the following is strongly supportive of sarcoidosis ?

A	> 0.5
B	> 1.5
C	> 2.5
D	> 3.5

Question 17 Explanation:

In BAL fluid, CD4/CD8 ratio of > 3.5 is strongly supportive of sarcoidosis

Question 18

In sarcoidosis, bronchoalveolar lavage typically shows an increased proportion of which of the following ?

A	CD4+T lymphocytes
B	Alveolar macrophages
C	Neutrophils
D	Eosinophils

Question 18 Explanation:

BAL typically shows an increased proportion of activated TH1 subset of CD4+T lymphocytes. Remaining cells are mostly alveolar macrophages. In significant fibrosis, a few neutrophils are also found. Eosinophils are rare. In normal individuals, lymphocytes represent <20% of the cell population.

Question 19

In Kveim-Siltzbach skin test, source of intradermal injection sarcoidosis extract is from ?

A	Liver
B	Lung
C	Spleen
D	Lymph node

Question 19 Explanation:

In Kveim-Siltzbach skin test, the intradermal injection of a heat-treated suspension of a sarcoidosis extract is from spleen of a known sarcoidosis patient.

Question 20

In Kveim-Siltzbach test, papule that develops at the site of injection is biopsied how many weeks later ?

A	1 week
B	2 weeks
C	3 weeks
D	4 weeks

Question 20 Explanation:

Kveim-Siltzbach test has been used for the diagnosis of sarcoidosis. It is performed by injecting homogenate of human sarcoid tissue extract intradermally. The papule that develops at the site of injection is biopsied 4 weeks later

Question 21

Chronic sarcoidosis is likely if the acute form does not resolve within ?

A	First 2 - 5 months
B	First 6 - 12 months
C	First 12 - 18 months
D	First 2 - 5 years

Question 21 Explanation:

Chronic sarcoidosis is likely if acute form does not resolve within first 2 - 5 years

Question 22

Risk factor at presentation for chronic sarcoidosis is ?

A	Lupus pernio
B	Bone cysts
C	Renal calculi due to hypercalciuria
D	All of the above

Question 22 Explanation:

Chronic sarcoidosis can be identified by risk factors at presentation like fibrosis on CxR, lupus pernio, bone cysts, cardiac or neurologic disease & presence of renal calculi due to hypercalciuria

Question 23

Dosage of glucocorticoids is higher for ?

A	Pulmonary sarcoidosis
B	Neurosarcoidosis
C	Cutaneous sarcoidosis
D	Cardiac sarcoidosis

Question 23 Explanation:

Dosage of glucocorticoids is higher for neurosarcoidosis & lower for cutaneous disease.

Question 24

For the treatment of hypercalcemia in sarcoidosis, which of the following drugs is effective ?

A	Azathioprine
B	Hydroxychloroquine
C	Thalidomide
D	Methotrexate

Question 24 Explanation:

Hydroxychloroquine is used for hypercalcemia, skin disease & neurologic involvement. Thalidomide & Methotrexate are recommended in Lupus pernio. Azathioprine is recommended in sarcoidosis with intracerebral involvement

Question 25

Bilateral hilar adenopathy is seen in ?

A	Sarcoidosis
B	Lymphoma
C	Brucellosis
D	All of the above

Question 25 Explanation:

Bilateral hilar adenopathy is seen in sarcoidosis, lymphoma, tuberculosis, coccidioidomycosis, brucellosis, and bronchogenic carcinoma

Question 26

Usually, after glucocorticoids, which of the following is the most preferred drug in the treatment of sarcoidosis ?

A	Methotrexate
B	Hydroxychloroquine
C	Azothioprine
D	Cyclophosphamide

Question 26 Explanation:

Therapy of choice for sarcoidosis is glucocorticoids. Methotrexate is the second-line medication. Other drugs in refractory cases include indomethacin, oxyphenbutazone, chloroquine, hydroxychloroquine, thalidomide, infliximab, etanercept, pentoxifylline, tacrolimus, p-aminobenzoate, allopurinol, levamisole, azothioprine, and cyclophosphamide.

Question 27

Sarcoidosis clears spontaneously in about what percentage of patients ?

A	10 %
B	25 %
C	50 %
D	75 %

Question 27 Explanation:

Sarcoidosis clears spontaneously in ~50% of patients. As permanent organ derangements often do not improve with glucocorticoid treatment, decision making on therapy depends on the extent and activity of the inflammatory process in lung, eye, heart, and CNS

Question 28

Prednisone therapy in sarcoidosis is usually slowly tapered over how many months ?

A	1 to 2 months
B	2 to 3 months
C	3 to 4 months
D	4 to 6 months

Question 28 Explanation:

Usual therapy for sarcoidosis is prednisone, 1 mg/kg, for 4 to 6 weeks, followed by a slow taper over 2 to 3 months

Question 29

Glucocorticoids in sarcoidosis are most effective through which of the following routes of administration ?

A	Oral
B	Intravenous
C	Intramuscular
D	Inhaled

Question 29 Explanation:

High-dose bolus intravenous glucocorticoids in sarcoidosis are not as effective as oral therapy. There is no evidence that inhaled glucocorticoids are efficacious

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Sarcoidosis- Part 1|Sarcoidosis- Part 2

1. Besnier-Boeck-Schauman disease refers to ?
A. Hydatid disease of lung
B. Syphilis of lung
C. Sarcoidosis
D. Miliary tuberculosis
2. Condition known to cause granulomas is ?
A. Fungal infections
B. Malignancy
C. Beryllium
D. All of the above
3. Which of the following is false about sarcoidosis ?
A. Inflammatory disease
B. Noncaseating granulomas
C. Multisystem involvement

D. Involvement in >= 3 organs for a specific diagnosis

4. Which of the following has been implicated in the possible etiology of sarcoidosis ?
A. Burkholderia pseudomallei
B. Propionibacter acnes
C. Capnocytophaga canimorsus
D. Pseudomonads

5. Highest prevalence of sarcoidosis is reported in ?
A. Nordic population
B. Hispanic population
C. Aborigines in Australia
D. Red Indian tribes

6. Organ most frequently affected in sarcoidosis is ?
A. Lung
B. Skin
C. Eye
D. Lymph node

7. Which of the following organs is least affected in sarcoidosis ?
A. Heart
B. Liver
C. Ovary
D. Central nervous system

8. Which of the following HLA haplotype is associated with an increased risk for developing sarcoidosis ?
A. DRB1*0402
B. DQB1*0302
C. DRB1*1501
D. DRB1*1101

9. Persistent chronic form of sarcoidosis is associated with the secretion of high levels of ?
A. IL-8
B. GM-CSF

C. MCP-1
D. Eotaxin

10. Löfgren’s syndrome is characterized by ?
A. Arthritis
B. Erythema nodosum
C. Bilateral hilar adenopathy
D. All of the above

11. Which of the following HLA haplotype is highly associated with Löfgren’s syndrome?
A. DRB1*0402
B. DQB1*0302
C. DRB1*1501
D. DQB1*0201

12. Disease that affect the upper lobe is ?
A. Hypersensitivity pneumonitis
B. Silicosis
C. Langerhans cell histiocytosis
D. All of the above

13. The classic cutaneous lesion in sarcoidosis is ?
A. Erythema nodosum
B. Hyper- and hypopigmentation
C. Keloid formation
D. All of the above

14. The location of lesions in “lupus pernio” is on ?
A. Nape of the neck
B. Cheek and nose
C. Heel
D. Elbows

15. Violaceous papules and plaques are seen in ?
A. Lupus pernio
B. Lymphoma cutis

C. Cutaneous lupus
D. All of the above

16. Most common abnormality of liver function in sarcoidosis is ?
A. Elevation of alkaline phosphatase level
B. Elevation of transaminase levels
C. Elevation of bilirubin level
D. None of the above

17. Most common hematologic problem in sarcoidosis is ?
A. Anemia
B. Lymphopenia
C. Leukopenia
D. Thrombocytopenia

18. Mechanism of hypercalcemia and/or hypercalciuria in sarcoidosis is ?
A. Increased production of 1,25-dihydroxyvitamin D by
granuloma
B. Suppressed parathyroid hormone (PTH) level
C. Increased ACE levels
D. All of the above

19. Which out of the following is the most common neurologic presentation in sarcoidosis ?
A. Cranial-nerve palsies
B. Ataxia
C. Cognitive dysfunction
D. Seizures

20. Which cranial nerve is most commonly involved in sarcoidosis ?
A. III
B. V
C. VI
D. VII

21. Which of the following can be a feature of neurosarcoidosis ?
A. Basilar meningitis
B. Myelopathy
C. Anterior hypothalamic disease

D. All of the above

22. Endocrine abnormality most commonly seen in sarcoidosis is ?
A. Diabetes insipidus
B. Complete hypopituitarism
C. Addison’s syndrome
D. Infertility

23. Which of the following is not a feature of Heerfordt Waldenstrom syndrome ?
A. Fever
B. Parotid enlargement
C. Posterior uveitis
D. Facial nerve palsy

24. Which of the following is not a feature of lymphadenopathy in sarcoidosis ?
A. Rubbery texture
B. Painless
C. Ulcerate
D. Nonadherent

25. Which of the following is not involved in Familial juvenile systemic granulomatosis or Blau’s syndrome ?
A. Joints
B. Skin
C. Lungs
D. Eye

26. In Sarcoidosis, which of the following is instrumental in initiating the formation and maintenance of granulomas ?
A. Tumor necrosis factor alpha
B. CD4+ T cells
C. Macrophage inflammatory protein 1 (MIP-1)
D. GM-CSF

27. Which of the following about active sarcoidosis is false ?
A. Large numbers of activated TH1 cells in affected organs
B. T cells in nonaffected organs are quiescent
C. Hyperglobulinemia
D. None of the above
28. Which of the following is an infrequent constituent of sarcoidal granuloma ?
A. Epithelioid cells
B. T cells
C. B cells
D. Macrophage

Sarcoidosis

[MCQ] Sarcoidosis- Part 1

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Sarcoidosis- Part 2

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