Miller Sarcoidosis, TB, & Pneumothorax

Question 1

Pathophysiology of ssarcoidosis?

Answer 1

• Trigger such as infection or inhaled particle
• Interaction of trigger with other factors in a genetically predisposed person
• Dysregulated immune response
• leads to sarcoidosis hallmark of a non necrotizing granuloma

Question 2

Clinical presentation of pulmonary sarcoidosis?

Answer 2

• gradual onset
• constitutional symptoms
• respiratory symptoms
• incidentally discovered
• course may be self limited and resolve or chronic and stable or chronic and progressive

Question 3

Diagnosis of sarcoidosis?

Answer 3

• clinical findings plus the histology of non caseating granulomas
  
  • exclude other diseases with similar pictures

Question 4

Complications of sarcoidosis?

Answer 4

• anxiety depression sleep disorder
• increased risk of cancers
• increased infection risk
• CHF
• cerebrovascular accident
• VTE
• AI

Question 5

What is world’s #1 infectious killer?

Answer 5

• TB

Question 6

Risks for TB?

Answer 6

• HIV
• Undernourished
• DM2
• Alcohol abuse
• Smoking
• Close contacts

Question 7

pathophysiology of TB

Answer 7

• inhale TB
• if not eliminated by macrophages bacteria invades interstitium
• immune cells recruited to lung parenchyma to form granuloma
  
  • stays latent
  • OR bacteria replicate and can’t be contained

Question 8

Clinical presentation of TB

Answer 8

• asymptomatic found on screening
• cough with sputum and blood and chest pain
• Constitutional sx

Question 9

How do you diagnose a TB infection?

Answer 9

• Tuberculin skin test
• Interferon gamma release assay

Question 10

When is an IGRA recommended over a TST?

Answer 10

When a person is at least five years old and are likely to have TB

Question 11

After an abnormal screening for TB, what do you do next?

Answer 11

• CXR
• acid fast sputum smears
• culture based methods are gold standard
  
  • can ID drug resistance

Question 12

What test does WHO conditionally recommend as the first line diagnostic test?

Answer 12

Molecular tests such as nucleic acid amplification testing

Question 13

How do you manage latent TB?

Answer 13

• screen at risk groups
• 3-9 months of abx

Question 14

How do you manage active tb?

Answer 14

6 month multi drug regimen

Question 15

Prevention of TB?

Answer 15

• appropriate isolation and use of PPE
• BCG vaccine in other parts of world (not US)
  *

Question 16

Spontaneous pneumothorax?

Answer 16

• occurs in absence of external event
  
  • primary-absence of lung disease
  • secondary- underlying disease

Question 17

Traumatic pneumothorax?

Answer 17

• iatrogenic induced by medical procedure
• non iatrogenic- caused by trauma

Question 18

Who does a Primary spontaneous PTX occur in?

Answer 18

• tall thin males btw 10-30 yo
• smokers
• genetic predisposition
• drops in atmospheric pressure

Question 19

Who does a secondary spontaneous PTX occur in?

Answer 19

• COPD, ILD, malignancy in US
• world wide TB
• males older than 55

Question 20

Hx and PE of pneumothorax?

Answer 20

• acute onset of dyspnea and chest pain (pleuritic)
• pain felt on ipsilateral side
• exam may be noraml
  
  • labored breathing accessory mms
  • Abnormal VS such as tachy or hypotension is sign of collapse coming
  • Decreased movement on side, enlarged hemithorax, decrease sounds, absent tactile fremitus

Question 21

Diagnostic test for PTX?

Answer 21

CXR

Question 22

Primary PTX treatment?

Answer 22

chest tube

Question 23

Complications pneumorhorax?

Answer 23

• recurrence

Question 24

Prevention of PTX?

Answer 24

• smoking cessation
• avoid air travel 2 weeks
• permanently avoid scuba diving
• gradually re introduce exercise
• pleurodesis if recurrence risk is high