Sarcoid, TB, And Pneumothorax - Dr. Miller Flashcards
Sarcoidosis is what
Granulomatous non-caseating (full of inflammatory cells)
= non-necrotizing
Sarcoidosis trigger
In genetically predisposed pts they can get Sarcoidosis from inhaling
- TB
- Silica
- Other irritants
Sarcoidosis SX
Gradual onset
= fever, WL, fatigue
= cough, dyspnea, strider, wheezing
Sarcoidosis cxr
Bilateral hilar LAD
Sarcoidosis tx
50% resolve in 2years (corticosteroids)
Some are chronic and some progressive —> fibrosis (corticosteroids)
Sarcoidosis and ACE levels
The higher the ACE the higher amount of granulomas
Tuberculosis what happens
Granomomatous caseating
= necrotizing
= Lipid filled M
= pathogen Ag
Tuberculosis highest risks
HIV x18 Undernourished x3 DM2 Alcohol, smoking Close contact
Tuberculosis screening in health professionals
Not needed yearly when baseline is taken and no known exposures
Tuberculosis infection
Inhlaed then go to lungs into parenchyma and engulfed into granuloma
Then can burst and become a systemic infection
Only most are eliminate before granulosum or latent infection
Tuberculosis SX
- Cough sputum + blood , CP
- Fever, WL, weakness
- Can be asymptomatic (need screening)
Testing / screening for Tuberculosis
- TST : Tuberculin skin test : low risk, cheap, delayed hypersensitivity
- IGRA : Interferon-gamma release assay : high risk, babies in risk, BCG vaccinated = Quantiferon-TB Gold (more accurate)
Latent vs active infection signs
LATENT : (granuloma has formed)
+ TST, + IGRA
No culture or sputum or infectious, or sx, not
Preventative TX
ACTIVE : (burst out from granuloma)
+ TST, + IGRA
+ culture, + sputum, is infectious and has sx
= multidrug tx
Tuberculosis DX
CXR (granuloma seen on apex usually)
Acid-fast sputum
CULTURE ** (you can see any drug resistance)
Prevention of Tuberculosis
Isolate and PPE
= BCG vaccine
Latent TB in pts tx
3-9mo ABS (isoniazid, rifampin)
Active Tuberculosis tx
6 months multidrug (4 drugs 2months, 2 drugs 4months)
Pneumothorax is what
Gas in the pleural space = unable to expand lung
Most common cause of Pneumothorax
Blunt or penetrating thoracic trauma
- Medical procedures (ventilation, central line, thorocentesis)
- Chest wall trauma causing air to enter in during inspiration (1 way)
Primary Pneumothorax is what and who is risk
TALL THIN, ,ales 10-30yo, smoking, genetics, dropping air O+P
Spontaneous cause
Secondary Pneumothorax is what and risks
From diseases (CT, smoking….) MALE over 55yo COPD, ILD, malignancy, TB
How do Pneumothorax happen
Subpleural blebs or bullae (outpouching alveoli) of air burst
Pneumothorax sx
CP and SOB worse with cough or breathing
CP on one side , low breath sounds and chest elevation on that side
X tactile fremitus , hyperresonance to percussion, subcutaneous emphysema)
= tachy + hypotension (YOU NEED HELP)
Pneumothorax DX
CXR
= cant see the vascular markings on one side all the way to periphery of lung
= cant see the diaphragm and clear
Simple vs tension Pneumothorax
Simple : Madeline trachea and esophagus are there
Tension : midline structures shifted to other side (tachy, hypotension, sob severe = emergent decompression)
Pneumothorax TX unstable, stable + small Pneumothorax, stable + large Pneumothorax
- Unstable : chest tube thoracostomy (needle decompression if no chest tube)
- Small and stable : O2 and observe
- Large and stable : needle or catheter aspiration (not as common) , chest tube, observe
Pneumothorax risk
Recurrence 10-30% (primary)
50% in COPD
Procedure that can help pts with high recurrence of Pneumothorax
Pleurodesis ( inflammation made in pleural space so it sticks more)
