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Sarcoidosis (Löfgren's syndrome) — MRCP Part 1 MCQ

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HardRespiratory MedicineSarcoidosis (Löfgren's syndrome)MRCP Part 1UKMLA

A patient with pulmonary sarcoidosis reports two unexplained syncopal episodes. ECG now shows new right bundle-branch block and first-degree AV block. Lung function is stable. What is the most appropriate next step?

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Correct answer: E — Arrange urgent specialist evaluation for possible cardiac sarcoidosis

The best answer is “Arrange urgent specialist evaluation for possible cardiac sarcoidosis”. Syncope and new conduction disease are red flags for cardiac sarcoidosis, a potentially lethal manifestation that can be present despite stable pulmonary disease. BTS recommends baseline ECG and specialist assessment when cardiac involvement is suspected. Evaluation may include ambulatory monitoring and advanced cardiac imaging; routine review or empirical supplementation would be unsafe.

Reference: British Thoracic Society Clinical Statement on pulmonary sarcoidosis: https://www.brit-thoracic.org.uk/document-library/clinical-statements/sarcoidosis/bts-sarcoidosis-clinical-statement/