What are the symptoms of pneumothorax?
acute onset of unilateral chest pain and dyspnea
unilateral chest expansion, decreased tactile fremitus
hypperresonance, decreased breath sounds
mediastinal shift, cyanosis, hypotension
What are the causes of pneumothorax?
spontaneous: primary and secondary
trauma: increased likelihood of tension PTX
What is a primary spontaneous PTX?
PTX occurs in the absence of an underlying lung disease
typically tall, thin males between 10-30
What is a secondary spontaneous PTx?
complication of preexisting pulmonary disease
What is a tension PTX?
trauma that causes the presure of air in the pleural space to exceed alveolar and venous pressures throughout the resp cycle resulting in compression of lung and reductio in venous return to the hemithorax
Small PTX, less than 15% of hemithorax, typically (resolve or need treatment?)
What are the sx of TB?
What are the risk factors
fatigue, weight loss, fever, night sweats, cough
household exposure, incarceration, drug use, travel
Sputum culture and chest xray with pulm opacities
What occurs in the primary phase of TB?
typically clinically and radiographically silent
lemphatic and hematogenous spread occurs
T cells and macrophages form granulomas
can be dormant for years
Can individuals with latent TB spread infection
No, unless is becomes reactivated
Latent TB can reactivate and often occurs when?
What can trigger reactivation?
within the first 2 years of the primary infection if not on preventative therapy
gastrectomy, silicosis, DM, impaired immune response
What are some risks for drug resistant TB?
immigration from areas with DR TB
close and prlonged contact with individuals with drug-resistant TB
unsuccessful previous therapy
Drug resistent TB is resistant to what?
MDR TB is resistant to what?
Extensively drug resistant TB is resistant to what?
either isoniazid or rifamplin
both isoniazid and rifampin, plus others possibly
Isoniazid, rifampin, fluoroquinolones, and either aminoglyocsides or capreomycin or both
Definitive diagnosis of M. Tubercolosis from cultures requires what?
sputum specimens from three consecutive mornings
if patient has trouble producing enough, can do sputum induction with 3% hypertonic saline solution
What are some typical XR findings for TB?
pleural effusions (30-40% of pts)
Miliary appearance in Miliary TB
What may be seen on XR in elderly and immunocompromised pt's with TB?
lower lobe infiltrates with or without effusions (otherwise effusions are often apical)
If a pt with these underlying conditions has a tuberculin skin test is >5mm induration, then they are positive for TB
1. HIV +
2. recent TB contact
3. fibrotic changes in lungs suggestive of previous TB
4. organ transplant or immunospressed
If a pt with these underlying conditions has a tuberculin skin test of >10mm induration, then they are TB +.
1. recent immigrant from areas with high TB rate
2. HIV neg injection drug users
3. mycobacterial lab personnel
4. resident/employee in congregate settings
5. recent gastrectomy, low BMI, bypass, Dm, silicosis, CKD, blood/other cancers
6. kids <4, infants children and teens exposed to adults
If a tuburculin skin test induration is greater than 15mm, regardless of hx, they are (positive or negative for TB)?
postiive for TB
What are the basic principles of anti-TB treatment?
1. administer multiple meds to which the organism is susceptible
2. provide the safest, most effective therapy in the shortest period of time
3. ensure adherence to therapy
4. add at least two new anti-TB drugs to a regimen when treatment failure is suspected
What is pulmonary sarcoidosis and who is at high risk?
noncaseating granulomas systemically
90% of pt's experience lung-related sx
North American African American Women are at highest risk, 30-40 y/o
What are some general s/s of Sarcoidosis?
What is generally required to diagnose?
malaise, fever, dyspnea
skin, eye, neuro, heart manifestations
Noncaseating granulomas on bioppsy
Stage I Sarcoidosis XR findings:
Stage II Sarcoidosis XR findings:
Stage III Sarcoidosis XR findings:
Stage IV Sarcoidosis XR findings:
bilateral hilar adenopathy
hilar adenopathy, parenchymal changes
Parenchymal changes alone
fibrotic changes in upper lobes
not nec. linear changes, can switch back and forth, though fibrosis is fairly permanent