Pneumothoracies, TB and sarcoidosis

Question 1

what are the three causes of Pneumothoraces

Answer 1

Spontaneous: Primary and secondary
-ruptured bleb

Trauma increases the likelihood of tension pneumothorax

Iatrogenic

Question 2

clinical presentation of Pneumothoraces

Answer 2

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

Question 3

who is mainly affected in Primary spontanous pneumothorax

Answer 3

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

Question 4

what is the cause of secondary spontaneous pneumothorax

Answer 4

complication of preexisitng pulmonary disease

Question 5

what causes a traumatic pneumothorax

Answer 5

results from penetrating or blunt trauma

Question 6

what are the causes of Iatrogenic pneumothorax

Answer 6

follows procedures such as thoracentesis, pleural biopsy, subclavian or internal jugular vein catheter placement, percutaneous lung biopsy, bronchoscopy with transbronchial biopsy

Question 7

when should tension pneumothorax be suspected?

Answer 7

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.

Question 8

what is the treatment of tension pneumothorax

Answer 8

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

Question 9

Clincical presentation, risk factors, and chest radiogrph of Pulmonary tuberculosis

Answer 9

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;

Question 10

what stain is used to see M tuberculosis

Answer 10

acid fast bacili on smear or sputum or sputum culture

Question 11

what is significant about Primary tuberculosis

Answer 11

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

Question 12

what is happening during latent tuberculosis infections

Answer 12

infection is not active and cannot transmit the organism

however reactivation of disease may occur if the host immunes defense is impaired

Question 13

what are some risks that increase the chance of reactivation

Answer 13

Gastrectomy
silicosis
DM
impaired immune response

Question 14

can TB be drug resistent?

Answer 14

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

Question 15

signs and symptoms of TB

Answer 15

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

Question 16

what is the definitive diagnosis of tB

Answer 16

DNA or RNA amplification from cultures with a acid fast stain

Question 17

What is the traditional chest image of TB

Answer 17

small unilateral infiltrates with hilar and paratracheal lymph node enlargement and segmental atelectasis

Question 18

what does a miliary TB CXR look like

Answer 18

millet seeds with diffuse small nodular densities

Question 19

Classification of positive TB skin test >5mm

Answer 19

• 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

Question 20

Classification of positive TB test >10mm

Answer 20

• 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

Question 21

classification of positive TB test >15 mm

Answer 21

Person with no known risk factors of TB

Question 22

what are the signs and symptoms of sarcoidosis

Answer 22

• 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

Question 23

what are the 4 stages of sarcoidosis on radiograph

Answer 23

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

Question 24

what is required to make a diagnosis of sarcoidosis

Answer 24

Histologic demonstration of noncaseating granulomas in biopsies