Miller Sarcoidosis, TB, & Pneumothorax Flashcards
Pathophysiology of ssarcoidosis?
- 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
Clinical presentation of pulmonary sarcoidosis?
- gradual onset
- constitutional symptoms
- respiratory symptoms
- incidentally discovered
- course may be self limited and resolve or chronic and stable or chronic and progressive
Diagnosis of sarcoidosis?
- clinical findings plus the histology of non caseating granulomas
- exclude other diseases with similar pictures
Complications of sarcoidosis?
- anxiety depression sleep disorder
- increased risk of cancers
- increased infection risk
- CHF
- cerebrovascular accident
- VTE
- AI
What is world’s #1 infectious killer?
- TB
Risks for TB?
- HIV
- Undernourished
- DM2
- Alcohol abuse
- Smoking
- Close contacts
pathophysiology of TB
- 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
Clinical presentation of TB
- asymptomatic found on screening
- cough with sputum and blood and chest pain
- Constitutional sx
How do you diagnose a TB infection?
- Tuberculin skin test
- Interferon gamma release assay
When is an IGRA recommended over a TST?
When a person is at least five years old and are likely to have TB
After an abnormal screening for TB, what do you do next?
- CXR
- acid fast sputum smears
-
culture based methods are gold standard
- can ID drug resistance
What test does WHO conditionally recommend as the first line diagnostic test?
Molecular tests such as nucleic acid amplification testing
How do you manage latent TB?
- screen at risk groups
- 3-9 months of abx
How do you manage active tb?
6 month multi drug regimen
Prevention of TB?
- appropriate isolation and use of PPE
- BCG vaccine in other parts of world (not US)
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Spontaneous pneumothorax?
- occurs in absence of external event
- primary-absence of lung disease
- secondary- underlying disease
Traumatic pneumothorax?
- iatrogenic induced by medical procedure
- non iatrogenic- caused by trauma
Who does a Primary spontaneous PTX occur in?
- tall thin males btw 10-30 yo
- smokers
- genetic predisposition
- drops in atmospheric pressure
Who does a secondary spontaneous PTX occur in?
- COPD, ILD, malignancy in US
- world wide TB
- males older than 55
Hx and PE of pneumothorax?
- 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
Diagnostic test for PTX?
CXR
Primary PTX treatment?
chest tube
Complications pneumorhorax?
- recurrence
Prevention of PTX?
- smoking cessation
- avoid air travel 2 weeks
- permanently avoid scuba diving
- gradually re introduce exercise
- pleurodesis if recurrence risk is high
