PTX, Sarcoidosis, TB Flashcards Preview

CPR II Exam 2 > PTX, Sarcoidosis, TB > Flashcards

Flashcards in PTX, Sarcoidosis, TB Deck (22)
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1

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 

2

What are the causes of pneumothorax?

spontaneous: primary and secondary 

trauma: increased likelihood of tension PTX

iatrogenic 

3

What is a primary spontaneous PTX?

PTX occurs in the absence of an underlying lung disease 

typically tall, thin males between 10-30

4

 

What is a secondary spontaneous PTx?

complication of preexisting pulmonary disease

5

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

6

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

resolve spontaneously 

7

What are the sx of TB?

 

What are the risk factors

 

Diagnosis?

fatigue, weight loss, fever, night sweats, cough

 

household exposure, incarceration, drug use, travel 

 

Sputum culture and chest xray with pulm opacities

8

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

9

Can individuals with latent TB spread infection

No, unless is becomes reactivated 

10

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 

11

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 

nonadherence 

12

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 

13

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 

14

What are some typical XR findings for TB?

pleural effusions (30-40% of pts) 

cavitary lesions 

infiltrate, granuloma 

Miliary appearance in Miliary TB 

15

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) 

16

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 

17

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 

18

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

postiive for TB

19

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 

20

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

21

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 

22

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