PTX, Sarcoidosis, TB

Question 1

What are the symptoms of pneumothorax?

Answer 1

acute onset of unilateral chest pain and dyspnea

unilateral chest expansion, decreased tactile fremitus

hypperresonance, decreased breath sounds

mediastinal shift, cyanosis, hypotension

Question 2

What are the causes of pneumothorax?

Answer 2

spontaneous: primary and secondary
trauma: increased likelihood of tension PTX

iatrogenic

Question 3

What is a primary spontaneous PTX?

Answer 3

PTX occurs in the absence of an underlying lung disease

typically tall, thin males between 10-30

Question 4

What is a secondary spontaneous PTx?

Answer 4

complication of preexisting pulmonary disease

Question 5

What is a tension PTX?

Answer 5

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

Question 6

Small PTX, less than 15% of hemithorax, typically (resolve or need treatment?)

Answer 6

resolve spontaneously

Question 7

What are the sx of TB?

What are the risk factors

Diagnosis?

Answer 7

fatigue, weight loss, fever, night sweats, cough

household exposure, incarceration, drug use, travel

Sputum culture and chest xray with pulm opacities

Question 8

What occurs in the primary phase of TB?

Answer 8

typically clinically and radiographically silent

lemphatic and hematogenous spread occurs

T cells and macrophages form granulomas

can be dormant for years

Question 9

Can individuals with latent TB spread infection

Answer 9

No, unless is becomes reactivated

Question 10

Latent TB can reactivate and often occurs when?

What can trigger reactivation?

Answer 10

within the first 2 years of the primary infection if not on preventative therapy

gastrectomy, silicosis, DM, impaired immune response

Question 11

What are some risks for drug resistant TB?

Answer 11

immigration from areas with DR TB

close and prlonged contact with individuals with drug-resistant TB

unsuccessful previous therapy

nonadherence

Question 12

Drug resistent TB is resistant to what?

MDR TB is resistant to what?

Extensively drug resistant TB is resistant to what?

Answer 12

either isoniazid or rifamplin

both isoniazid and rifampin, plus others possibly

Isoniazid, rifampin, fluoroquinolones, and either aminoglyocsides or capreomycin or both

Question 13

Definitive diagnosis of M. Tubercolosis from cultures requires what?

Answer 13

sputum specimens from three consecutive mornings

if patient has trouble producing enough, can do sputum induction with 3% hypertonic saline solution

Question 14

What are some typical XR findings for TB?

Answer 14

pleural effusions (30-40% of pts)

cavitary lesions

infiltrate, granuloma

Miliary appearance in Miliary TB

Question 15

What may be seen on XR in elderly and immunocompromised pt’s with TB?

Answer 15

lower lobe infiltrates with or without effusions (otherwise effusions are often apical)

Question 16

If a pt with these underlying conditions has a tuberculin skin test is >5mm induration, then they are positive for TB

Answer 16

1. HIV +
2. recent TB contact
3. fibrotic changes in lungs suggestive of previous TB
4. organ transplant or immunospressed

Question 17

If a pt with these underlying conditions has a tuberculin skin test of >10mm induration, then they are TB +.

Answer 17

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

Question 18

If a tuburculin skin test induration is greater than 15mm, regardless of hx, they are (positive or negative for TB)?

Answer 18

postiive for TB

Question 19

What are the basic principles of anti-TB treatment?

Answer 19

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

Question 20

What is pulmonary sarcoidosis and who is at high risk?

Answer 20

noncaseating granulomas systemically

90% of pt’s experience lung-related sx

North American African American Women are at highest risk, 30-40 y/o

Question 21

What are some general s/s of Sarcoidosis?

What is generally required to diagnose?

Answer 21

malaise, fever, dyspnea

skin, eye, neuro, heart manifestations

Noncaseating granulomas on bioppsy

Question 22

Stage I Sarcoidosis XR findings:

Stage II Sarcoidosis XR findings:

Stage III Sarcoidosis XR findings:

Stage IV Sarcoidosis XR findings:

Answer 22

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