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Pulmonary & Renal > Sarcoid, TB, & Pneumothorax > Flashcards

Sarcoid, TB, & Pneumothorax Flashcards

1
Q

Patient presents with Lofgren syndrome, what were their findings?

A
  • fever
  • erythema nodosum
  • LAD
  • periarthritis of ankle & knee
  • hilar LAD on CXR
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2
Q

what does Lofgren syndrome indicate?

A

acute sarcoid arthritis

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3
Q

What are clinical & imaging findings of sarcoidosis?

A
  • bilateral hilar LAD
  • pulmonary infiltrate
  • skin lesions
  • b/l LAD on CXR
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4
Q

A patient comes in with fever, fatigue, anorexia, weight loss, & arthralgias. If suspecting a pulmonary cause what would be higher on your differential?

A

sarcoidosis

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5
Q

What is heerfordt syndrome?

A
  • uveitis
  • parotid enlargement
  • facial palsy
  • fever
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6
Q

What are diagnostic criteria for sarcoidosis?

A
  • Clinical & radiographic findings
  • noncaseating granulomas
  • rule-out: TB, fungal, malignancy
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7
Q

What are the CXR findings in sarcoidosis staging?

A
  1. Hilar LAD, 60-80%
  2. Hilar LAD & reticulonodular opacity
  3. Reticulonodular opacities
  4. Fibrotic

reticulonodular pattern is like peripheral interstitial effect

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8
Q

What is the differential if a patient has bilateral hilar LAD on CXR?

A
  • Sarcoidosis
  • TB
  • Malignancy

TB would have apex involvment!

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9
Q

What are the % spontaneous remission according to sarcoid stagin?

A
  1. 60-80%
  2. 50-60%
  3. <30%
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10
Q

What is the differential if considering Sarcoid?

A
  • Infection (TB, fungus, tularemia, brucella, toxoplasma)
  • Berylliosis (pulmonary symptoms)
  • Cancer
  • hypersensitivity pneumonitis
  • Granulomatosis with polyangiitis
  • Eosinophilic granulomatosis with polyangiitis
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11
Q

In a lab workup for sarcoid what may be shown?

A
  • WBC < 4k
  • elevated ESR
  • Hypercalcemia or hypercalciuria
  • elevated ACE (active)
  • restrictive PFT…
  • heart block or dysrhythmia on ECG
  • negative eye exam

PFTs may be normal or obstructive

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12
Q

What would be treatment for symptomatic sarcoidosis?

A

oral corticosteroids

to reduce inflammation & prevent fibrosis

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13
Q

Indications for treating pulmonary sarcoidosis are:

A

worsening symptoms, PFTs, & imaging

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14
Q

Indications for treating extrapulmonary sarcoids are:

A

disabling symptoms, hypercalcemia, or eye, neuro, cardiac, or renal involvment

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15
Q

What are risk factors for M. tuberculosis infection?

A
  • household exposure
  • incarceration
  • drug use
  • travel or residence in endemic area
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16
Q

What are risks of reactivation TB?

A
  • infection traveling/immigration within 2 y
  • immune compromised (TNFi, heme-cancer)
  • DM
  • tobacco use
  • malnutrition
  • gastrectomy
  • silicosis
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17
Q

What is latent TB?

A
  • can NOT transmit
  • no symptoms unless reactivated
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18
Q

What is active TB?

A

symptomatic & transmissable

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19
Q

what is cause of progressive primary TB?

A

random ractivation from inadequate immune response in infants, elderly, & immune suppressed

may or may not be reactivated latent infection

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20
Q

What are the clinical findings in 1º TB?

A

asymptomatic & no imaging findings

infants, elderly, IMM-suppressed

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21
Q

what are the findings in LTB?

A
  • + skin test
  • bacillin in granuloma forming T cells & macrophage
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22
Q

what are the findings in active TB?

A

chronic cough, ill & malnourished

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23
Q

What are clinical signs of pulmonary TB?

A
  • dry -> productive cough
  • malaise
  • fever
  • sweat
  • weight loss
  • adverse lung sounds possible

+/- hemoptysis

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24
Q

What are initial steps for diagnosing TB?

A
  • AFB smear x 3 morning specimens
  • NAAT
  • Drug susceptibility testing
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25
Q

how to treat lofgrens?

A

NSAIDS & colcichine

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26
Q

who are at increased risk of sarcoidosis?

A
  • young & middle aged adults
  • higher in AA population
27
Q

lymphatic involvement in sarcoidosis can present as?

A

parotid enlargment, hepatosplenomegaly, & LAD

28
Q

If a patient presents with below, what would their condition be called?

A

Lupus pernio in sarcoidosis

29
Q

what findings would be present in a patient with cardiac sarcoid?

A

heart block (AV), arrythmia, CHF, reduced LVEF <10%

from granuloma invasion of myocardia

30
Q

how would you diagnose cardiac sarcoid?

A

MRI or PET

31
Q

how to treat cardiac sarcoid with arrythmia?

A

implanted defibrillator or immune modulators

32
Q

when would latent TB reactivate?

A

impaired or reduced immune response

33
Q

if a patient comes in with a TST >5mm, how would you define if they are positive?

A

risk factors:
* HIV positive
* recent contact
* fibrosis on CXR
* Organ transplant or immune suppressed

34
Q

where do most individuals at low risk of TB fall for a TST to be positive?

A

greater than 10mm

35
Q

at what age is interferone gamma release assay indicated?

A

older 5yo

36
Q

what is benefit of IGRA over TST?

A

higher specificity

37
Q

what are cons to both TST & IGRA?

A

poor at differentiating progression, latent/active, reinfection, immune compromised

38
Q

what are general principles in treating TB?

A
  • multiple meds
  • ensure adherence
  • add 2 new antiTB if failure suspected
  • report to public health and infectious disease
39
Q

what drugs are used in treatment of TB?

A
  • isoniazid
  • rifampin
  • rifapentine
  • pyrazinamide
  • ethambutol
40
Q

what are the side-effects of isoniazid?

A

peripheral neuropathy, CNS hepatitis, rash

41
Q

what are the side-effects of rifampin?

A

kidney failure, rash, hepatitis, GI upset, flu-like, bleeding

42
Q

what are the side-effects of rifapentine?

A

marrow suppression, hematuria/pyuria, hepatitis, GI upset, flu-like

43
Q

what are the side-effects of pyrazinamide?

A

hyperuricemia, joint aches, rash, hepatotoxic, GI upset

44
Q

what are the side-effects of ethambutol?

A

optic neuritis

45
Q

What lab tests are indicated for addressing s/e of anti-TB drugs?

A
  • AST/ALT
  • CBC
  • Platelets
  • Uric acid (pyrazinamide)
  • Red-green color discrimination (ethambutol)
46
Q

what drug interactions are likely with isoniazid?

A

phnytoin & disulfiram

47
Q

what drug interaction is likely on rifapentine?

A

CYP450 (inducer)

48
Q

what is difference between 1º, 2º, & traumatic pneumothorax?

A

1º - no pulmonary disease
2º - underlying pulm disease
traumatic - iatrogenic or accident

49
Q

Marfans, ehlers danlos, smoking increase risk of what type of pneumothorax?

A

Primary

50
Q

a patient with 1º pneumothorax is typically

A

Young tall thin male

51
Q

a patient with 2º pneumothorax will have what underlying cystic lung conditions?

A
  • lymphangioleimyomatosis
  • tuberous sclerosis
  • langerhans cell histiocytosis
52
Q

2º pneumothorax is poorly tolerated because underlying disease causes

A

decreased respiratory reserver

53
Q

large pneumothorax will have what PE findings?

A

reduced chest wall movement, breath sounds, fremitus, & hyperresonance

54
Q

pressure in pleural space is greater than alveolar/venous pressure leading to what?

A

compression & decreased venous return

this is tension pneumothorax

55
Q

a patient with tachycardia, hypotension, & mediastinal/tracheal shift away from lesion likely has what?

A

tension pneumothorax

56
Q

a patient is tachycardic with a CXR shown below. What would a potential cause be of this patients condition?

A
  • Penetrating trauma
  • lung infection
  • CPR
  • positive pressure ventilation

tension pneumothorax

57
Q

what findings on CXR show a tension pneumo?

A
  • vasculature to chest wall
  • look for “rim” of lung
58
Q

A patient comes in with pneumothorax, what would you look for to determine if they are stable?

A
  • RR <24
  • HR <120 & >60
  • normal BP
  • Room air (RA) >90%
  • speak whole sentences
59
Q

If a patient has RR 26, HR 121, SpO2 85%, and has to stop speaking between sentences. How would you define their condition?

A

Unstable (likely) 2º pneumothorax

60
Q

In a patient deemed unstable with 2º pneumo, what would be the appropriate next steps?

A

Chest tube thoracostomy or needle decompression

61
Q

In a stable patient with 2º pneumo that is asymptomatic and CXR shows a 1cm pneumo. What would be your next steps?

A

Observe, O2, monitor for aspiration

62
Q

In a stable patient with 2º pneumo with significant symptoms & 1cm pneumo on CXR, what would next steps be?

A

catheter or tube thoracostomy + admitted

63
Q

In a stable patient with 2º pneumo measuring 2cm, what would be next steps?

A

immediate drainage tube or catheter throacostomy + admission

64
Q

In a patient with 1º pneumothorax what are treatment steps?

A

* observe (first or small)
* catheter or needle (large/severe)
* chest tube (if large)
* pleurodesis (chemical)

Pulmonary & Renal (5 decks)

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