Pulmonary Clinical Medicine IV: Pneumothorax, TB, and Sarcoidosis

Question 1

What is pneumothorax defined as?

Answer 1

Acute onset of unilateral chest pain and dyspnea

Question 2

How is a pneumothorax diagnosied?

Answer 2

Presence of pleural air on CXR

Question 3

Which category of pneumothorax occurs in the absence of an underlying lung disease?

It is thought to occur from?

Answer 3

1) Primary spontaneous pneumothorax

2) Rupture of subpleural apical blebs in response to high negative intrapleural pressures

Question 4

Which category of pneumothorax is a complication of preexisting pulmonary disease?

Answer 4

Secondary spontaneous pneumothorax

Question 5

Which category of pneumothorax usually occurs in the setting of penetrating trauma, lung infection, cardiopulmonary resuscitation, or positive-pressure mechanical ventilation?

Answer 5

Tension pneumothorax

Question 6

What should be suspected in the presence of marked tachycardia, hypotension, and mediastinal or tracheal shift?

Answer 6

Tension pneumothorax

Question 7

What can be performed for a spontaneous primary pneumothorax that is large or progressive?

Answer 7

Aspiration drainage of pleural air with a small-bore catheter

Question 8

Patients with secondary pneumothorax, large pneumothorax, tension pneumothorax, or severe symptoms or those who have a pneumothorax on mechanical ventilation should undergo?

Answer 8

Chest tube placement

Question 9

How is pulmonary tuberculosis diagnosed on CXR?

Answer 9

Apical pulmonary opacities

Question 10

Which phase of TB is clinically and radiographically silent?

Answer 10

Primary phase

Question 11

Individuals with what type of tuberculosis infection do not have active disease and cannot transmit the organism to others?

Answer 11

Latent tuberculosis infection

Question 12

What can cause increased risk of reactivation of TB?

Answer 12

1) Gastrectomy
2) Silicosis
3) DM
4) Immunocompromised

Question 13

What are the risk factor for drug resistance strains of TB?

Answer 13

1) Immigration from countries with a high prevalence of drug-resistant tuberculosis
2) Close and prolonged contact with individuals with drug-resistant tuberculosis
3) Unsuccessful previous therapy
4) Nonadherence to treatment

Question 14

Definitive diagnosis of TB depends on?

Answer 14

Sputum culture positive for M tuberculosis

Question 15

What is encountered on imaging for TB in elderly patients?

Answer 15

Lower lobe infiltrates with or without pleural effusion

Question 16

When is a miliary pattern (diffuse small nodular densities) of TB seen on imaging?

Answer 16

With hematologic or lymphatic dissemination of the organism

Question 17

Which patients usually display lower lung zone, diffuse, or miliary infiltrates; pleural effusions; and involvement of hilar and, in particular, mediastinal lymph nodes?

Answer 17

Immunocompromised patients, particularly those with late-stage HIV infection

Question 18

At what induration size is considered a positive TB skin test for HIV patients, those with recent contact with an infectious TB patient, and those with fibrotic changes on CXR suggestive of prior TB?

Answer 18

Greater than or equal to 5 mm

Question 19

At what induration size is considered a positive TB skin test for recent immigrants from countries with high prevalence, HIV-negative IV drug users, and children exposed to adults at high risk?

Answer 19

Greater than or equal to 10 mm

Question 20

What points to diagnosis of pulmonary sarcoidosis in a biopsy specimen?

(Highlighted in his slides)

Answer 20

Noncaseating granuloma

Question 21

What population is most at risk for sarcoidosis?

Answer 21

Black female

Question 22

Often seen in children, primary pulmonary TB usually affects which lobes?

Reactivation TB usually involves what segments of the upper lobes?

Answer 22

1) Middle and lower lobes

2) Apical and posterior segments of the upper lobes