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 should receive chest tube placements with what kind of Pneumothoraces?

Answer 8

Secondary Pneumothorax
Large Pneumothorax
Tension Pneumothorax
Pneumothorax with mechanical ventilation

Question 9

What are the sx of Pulmonary Tuberculosis?

How is it diagnosed on CXR?

Answer 9

1) Fatigue
2) Fever
3) Weight Loss
4) Night Sweats
5) Productive Cough

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

Immunocompromised especially late stage HIV TB infected patients will show what?

Answer 17

Lower Lung zone, diffuse, or miliary infiltrates
Pleural effusions
Hilar/Mediastinal LN involvement

Question 18

A positive tuberculin skin test reactions with indurations greater than or equal to 5mm is shown in which groups of patients?

Answer 18

HIV patients
Recent contact with infectious TB pt
Person with fibrotic change on CXR suggestive of prior TB
Organ Transplant patients

Question 19

A positive TB skin test with induration size greater than or equal to 10 mm is seen in which groups of people?

Answer 19

Recent immigrants from high prevalence countries
IV drug abuser
Mycobacterial laboratory personel
Children exposed to adults at high risk

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