Pneumothoracies, TB and sarcoidosis Flashcards
what are the three causes of Pneumothoraces
Spontaneous: Primary and secondary
-ruptured bleb
Trauma increases the likelihood of tension pneumothorax
Iatrogenic
clinical presentation of Pneumothoraces
acute onset of unilateral chest pain and dyspnea
Minimal physical findings except unilateral chest expansion decreased tactile fremitus, hype rresonance, diminished breath sounds, mediastinal shift, cyanosis and hypotension pneumothorax
presence of pleural air on chest radiograph
who is mainly affected in Primary spontanous pneumothorax
occurs in the absence of an underlying lung disease
affects mainly tall, thin boys and men between the ages 10 and 30
rupture form a subpleural apical bleb in response to high negative intrapleural pressures
what is the cause of secondary spontaneous pneumothorax
complication of preexisitng pulmonary disease
what causes a traumatic pneumothorax
results from penetrating or blunt trauma
what are the causes of Iatrogenic pneumothorax
follows procedures such as thoracentesis, pleural biopsy, subclavian or internal jugular vein catheter placement, percutaneous lung biopsy, bronchoscopy with transbronchial biopsy
when should tension pneumothorax be suspected?
chest pain ranging from minimal to severe on the affected side with dyspnea presence of marked tachycardia, hypotension, and mediastinal or tracheal shift
pressure of air in the pleural space exceeds alveolar and venous pressures throughout the respiratory cycle resulting in compression of lung and reduction of venous return to the hemithorax.
what is the treatment of tension pneumothorax
drainage of pleural air with catheter can be performed for spontaneous primary pneumothoraxes
placement of a small bore chest tube with one way valve
or a chest tube placement (tube thoracostomy)
- placed under water seal drainage and suction is applied until the lung expands
- the chest tube can be removed after the air leak subsides
Clincical presentation, risk factors, and chest radiogrph of Pulmonary tuberculosis
Fatigue, weight loss, fever, night sweats, and productive cough
Risk factors: household exposure, incarceration ,drug use, travel to an endemic area
Chest radiograph: pulmonary opacities, most often apica;
what stain is used to see M tuberculosis
acid fast bacili on smear or sputum or sputum culture
what is significant about Primary tuberculosis
Primary phase is usually clinically and radiographically silent
development granulomas to surround the organism and prevent spread
infection is contained but not eradicated since viable organisms may lie dormant within granulomas for years to decades
what is happening during latent tuberculosis infections
infection is not active and cannot transmit the organism
however reactivation of disease may occur if the host immunes defense is impaired
what are some risks that increase the chance of reactivation
Gastrectomy
silicosis
DM
impaired immune response
can TB be drug resistent?
yes
drug resistent TB = isoniazid or rifampin
multidrug resistant TB = isoniazid and rifampin and potentially other agents
Extensively drug resistent TB: resistent to isoniazid, rifampin, fluoroquinolones, and either aminoglycosides, or capreomycin
signs and symptoms of TB
slow progressive constitiutional symptoms: malasie, anorexia, weight loss, fever, and night sweats
Chronic cough and can be blood streaked leading to life threatening hemoptysis in advance disease
appears chronically ill and malnourished
what is the definitive diagnosis of tB
DNA or RNA amplification from cultures with a acid fast stain
What is the traditional chest image of TB
small unilateral infiltrates with hilar and paratracheal lymph node enlargement and segmental atelectasis
what does a miliary TB CXR look like
millet seeds with diffuse small nodular densities
Classification of positive TB skin test >5mm
- HIV patient
- recent contact of a person with infectious TB
- person with fibrotic changes on chest radiograph suggestive of TB
- Patient with organ transplant and other immunosuppressed patients
Classification of positive TB test >10mm
- recent immigrant from high prevalence region
- HIV negative injection drug users
- mycobacteriology laboratory personnel
- resident of and employees in high risk settings
- children younger than 4 years of infants, children, and adolescents exposed to risk adults
- person with medical conditions that increase the risk the risk of progression to TB disease (malignancies, gasterectomy, DM, CKD, hematologic disorders
classification of positive TB test >15 mm
Person with no known risk factors of TB
what are the signs and symptoms of sarcoidosis
- Malaise, fever, and dyspnea of insidious onset
- skin involvement: iritis, peripheral neuropathy, arthritis or cardiomyopathy may also cause the patient to seek care
parotid gland enlargement, hepatosplenomegaly, and lymphadenopathy
what are the 4 stages of sarcoidosis on radiograph
stage 1 = variable and include bilateral hilar adenopathy alone
stage 2 = hilar adenopathy and parenchymal involvement
stage 3 = parenchymal involvement alone (diffuse reticular infiltrates, but focal infiltrates, acinar shadows, nodules, and rarely cavitation may be seen
stage 4 = advanced fibrotic changes in the upper lobes
-fluffy white nodular areas
what is required to make a diagnosis of sarcoidosis
Histologic demonstration of noncaseating granulomas in biopsies
