Sarcoid, TB, And Pneumothorax - Dr. Miller

Question 1

Sarcoidosis is what

Answer 1

Granulomatous non-caseating (full of inflammatory cells)

= non-necrotizing

Question 2

Sarcoidosis trigger

Answer 2

In genetically predisposed pts they can get Sarcoidosis from inhaling

1. TB
2. Silica
3. Other irritants

Question 3

Sarcoidosis SX

Answer 3

Gradual onset
= fever, WL, fatigue
= cough, dyspnea, strider, wheezing

Question 4

Sarcoidosis cxr

Answer 4

Bilateral hilar LAD

Question 5

Sarcoidosis tx

Answer 5

50% resolve in 2years (corticosteroids)

Some are chronic and some progressive —> fibrosis (corticosteroids)

Question 6

Sarcoidosis and ACE levels

Answer 6

The higher the ACE the higher amount of granulomas

Question 7

Tuberculosis what happens

Answer 7

Granomomatous caseating
= necrotizing
= Lipid filled M
= pathogen Ag

Question 8

Tuberculosis highest risks

Answer 8

HIV x18
Undernourished x3
DM2
Alcohol, smoking 
Close contact

Question 9

Tuberculosis screening in health professionals

Answer 9

Not needed yearly when baseline is taken and no known exposures

Question 10

Tuberculosis infection

Answer 10

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

Question 11

Tuberculosis SX

Answer 11

1. Cough sputum + blood , CP
2. Fever, WL, weakness
3. Can be asymptomatic (need screening)

Question 12

Testing / screening for Tuberculosis

Answer 12

1. TST : Tuberculin skin test : low risk, cheap, delayed hypersensitivity
2. IGRA : Interferon-gamma release assay : high risk, babies in risk, BCG vaccinated = Quantiferon-TB Gold (more accurate)

Question 13

Latent vs active infection signs

Answer 13

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

Question 14

Tuberculosis DX

Answer 14

CXR (granuloma seen on apex usually)
Acid-fast sputum
CULTURE ** (you can see any drug resistance)

Question 15

Prevention of Tuberculosis

Answer 15

Isolate and PPE

= BCG vaccine

Question 16

Latent TB in pts tx

Answer 16

3-9mo ABS (isoniazid, rifampin)

Question 17

Active Tuberculosis tx

Answer 17

6 months multidrug (4 drugs 2months, 2 drugs 4months)

Question 18

Pneumothorax is what

Answer 18

Gas in the pleural space = unable to expand lung

Question 19

Most common cause of Pneumothorax

Answer 19

Blunt or penetrating thoracic trauma

1. Medical procedures (ventilation, central line, thorocentesis)
2. Chest wall trauma causing air to enter in during inspiration (1 way)

Question 20

Primary Pneumothorax is what and who is risk

Answer 20

TALL THIN, ,ales 10-30yo, smoking, genetics, dropping air O+P
Spontaneous cause

Question 21

Secondary Pneumothorax is what and risks

Answer 21

From diseases (CT, smoking….) MALE over 55yo
COPD, ILD, malignancy, TB

Question 22

How do Pneumothorax happen

Answer 22

Subpleural blebs or bullae (outpouching alveoli) of air burst

Question 23

Pneumothorax sx

Answer 23

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)

Question 24

Pneumothorax DX

Answer 24

CXR
= cant see the vascular markings on one side all the way to periphery of lung
= cant see the diaphragm and clear

Question 25

Simple vs tension Pneumothorax

Answer 25

Simple : Madeline trachea and esophagus are there

Tension : midline structures shifted to other side (tachy, hypotension, sob severe = emergent decompression)

Question 26

Pneumothorax TX unstable, stable + small Pneumothorax, stable + large Pneumothorax

Answer 26

1. Unstable : chest tube thoracostomy (needle decompression if no chest tube)
2. Small and stable : O2 and observe
3. Large and stable : needle or catheter aspiration (not as common) , chest tube, observe

Question 27

Pneumothorax risk

Answer 27

Recurrence 10-30% (primary)

50% in COPD

Question 28

Procedure that can help pts with high recurrence of Pneumothorax

Answer 28

Pleurodesis ( inflammation made in pleural space so it sticks more)