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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
how to treat lofgrens?
NSAIDS & colcichine
26
who are at increased risk of sarcoidosis?
* young & middle aged adults * higher in AA population
27
lymphatic involvement in sarcoidosis can present as?
parotid enlargment, hepatosplenomegaly, & LAD
28
If a patient presents with below, what would their condition be called?
Lupus pernio in sarcoidosis
29
what findings would be present in a patient with cardiac sarcoid?
heart block (AV), arrythmia, CHF, reduced LVEF <10% | from **granuloma invasion** of myocardia
30
how would you diagnose cardiac sarcoid?
MRI or PET
31
how to treat cardiac sarcoid with arrythmia?
implanted defibrillator or immune modulators
32
when would latent TB reactivate?
impaired or reduced immune response
33
if a patient comes in with a TST >5mm, how would you define if they are positive?
**risk factors**: * HIV positive * recent contact * fibrosis on CXR * Organ transplant or immune suppressed
34
where do most individuals at low risk of TB fall for a TST to be positive?
greater than 10mm
35
at what age is interferone gamma release assay indicated?
**older 5yo**
36
what is benefit of IGRA over TST?
higher specificity
37
what are cons to both TST & IGRA?
poor at differentiating progression, latent/active, reinfection, immune compromised
38
what are general principles in treating TB?
* multiple meds * ensure adherence * add 2 new antiTB if failure suspected * report to public health and infectious disease
39
what drugs are used in treatment of TB?
* isoniazid * rifampin * rifapentine * pyrazinamide * ethambutol
40
what are the side-effects of isoniazid?
peripheral neuropathy, CNS hepatitis, rash
41
what are the side-effects of rifampin?
**kidney failure, rash,** hepatitis, GI upset, flu-like, bleeding
42
what are the side-effects of rifapentine?
**marrow suppression**, hematuria/pyuria, hepatitis, GI upset, flu-like
43
what are the side-effects of pyrazinamide?
**hyperuricemia, joint aches**, rash, hepatotoxic, GI upset
44
what are the side-effects of ethambutol?
**optic neuritis**
45
What lab tests are indicated for addressing s/e of anti-TB drugs?
* AST/ALT * CBC * Platelets * Uric acid (pyrazinamide) * Red-green color discrimination (ethambutol)
46
what drug interactions are likely with isoniazid?
phnytoin & disulfiram
47
what drug interaction is likely on rifapentine?
CYP450 (inducer)
48
what is difference between 1º, 2º, & traumatic pneumothorax?
1º - no pulmonary disease 2º - underlying pulm disease traumatic - iatrogenic or accident
49
Marfans, ehlers danlos, smoking increase risk of what type of pneumothorax?
Primary
50
a patient with 1º pneumothorax is typically
Young tall thin male
51
a patient with 2º pneumothorax will have what underlying cystic lung conditions?
* lymphangioleimyomatosis * tuberous sclerosis * langerhans cell histiocytosis
52
2º pneumothorax is poorly tolerated because underlying disease causes
decreased respiratory reserver
53
large pneumothorax will have what PE findings?
reduced chest wall movement, breath sounds, fremitus, & *hyper*resonance
54
pressure in pleural space is greater than alveolar/venous pressure leading to what?
compression & decreased venous return | this is **tension pneumothorax**
55
a patient with tachycardia, hypotension, & mediastinal/tracheal shift **away** from lesion likely has what?
tension pneumothorax
56
a patient is tachycardic with a CXR shown below. What would a potential cause be of this patients condition?
* Penetrating trauma * lung infection * CPR * positive pressure ventilation | tension pneumothorax
57
what findings on CXR show a tension pneumo?
* vasculature to chest wall * look for "rim" of lung
58
A patient comes in with pneumothorax, what would you look for to determine if they are stable?
* RR <24 * HR <120 & >60 * normal BP * Room air (RA) >90% * speak *whole sentences*
59
If a patient has RR 26, HR 121, SpO2 85%, and has to stop speaking between sentences. How would you define their condition?
Unstable (likely) 2º pneumothorax
60
In a patient deemed unstable with 2º pneumo, what would be the appropriate next steps?
Chest tube thoracostomy or needle decompression
61
In a stable patient with 2º pneumo that is asymptomatic and CXR shows a 1cm pneumo. What would be your next steps?
Observe, O2, monitor for aspiration
62
In a stable patient with 2º pneumo with significant symptoms & 1cm pneumo on CXR, what would next steps be?
catheter or tube thoracostomy + admitted
63
In a stable patient with 2º pneumo measuring 2cm, what would be next steps?
immediate drainage tube or catheter throacostomy + admission
64
In a patient with 1º pneumothorax what are treatment steps?
*** observe** (first or small) * catheter or needle (large/severe) * chest tube (if large) * pleurodesis (chemical)

Pulmonary & Renal (5 decks)

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