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2 - CPR (pulmonary) > Sarcoidosis/TB/Pneumothorax > Flashcards

Sarcoidosis/TB/Pneumothorax Flashcards

1
Q

What is a Granuloma?

A

Abnormal lump of inflammatory cells

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2
Q

What is Sarcoidosis?

A

Inflammatory disease with presence of Non-necrotizing Granulomas in lungs and other organs

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3
Q

In what populations is Sarcoidosis incidence higher than normal?

A

African Americans

Scandinavian countries

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4
Q

Describe the pathogenesis for Sarcoidosis

A
  • Trigger
    –> Dysregulated immune response
    => compact, epitheloid, non-caseating granulomata!
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5
Q

Compact, epithelioid NON-CASEATING Granulomata

A

Sarcoidosis

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6
Q

What are the symptoms of Sarcoidosis?

A

Gradual onset of constitutional symptoms

Cough, dyspnea, wheeze, stridor

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7
Q

What are the symptoms of Sarcoidosis?

A

Gradual onset of constitutional symptoms

Cough, dyspnea, wheeze, stridor

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8
Q

What may be seen on CXR with Sarcoidosis?

A

Bilateral hilar lymphadenopathy

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9
Q

With Sarcoidosis, levels of ____ correlate with the granuloma burden

A

ACE levels

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10
Q

Clinical findings + non-caseating granulomas while excluding other similar diseases

A

Sarcoidosis

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11
Q

What are some labs you could order to exclude other diseases from Sarcoidosis?

A

Labs (HIV/TB)
CXR, CT, EKG
PFTs
Bronchoscopy with biopsy

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12
Q

If there are no symptoms or no organ damage with Sarcoidosis, what could the treatment be?

A

Wait and watch

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13
Q

If there are symptoms or organ damage with Sarcoidosis, what is the treatment?

A

Anti-inflammatory – Corticosteroids, or Immunosuppressants

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14
Q

With Sarcoidosis, the risk for what increases?

A

Infections and cancers

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15
Q

What causes Tuberculosis?

A

Airborne infection due to Mycobacterium Tuberculosis complex

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16
Q

What is different about the Granulomas seen with Tuberculosis compared to those with Sarcoidosis?

A

Tuberculosis Granulomas = contain lipid filled macrophages!

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17
Q

Tuberculosis is the #1 infectious killer. Where is incidence the highest?

A

Low and middle income countries

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18
Q

What are the strongest risk factors for acquiring Tuberculosis?

A
  1. HIV!!
  2. Diabetes Type 2, Undernourished, Excessive alcohol and smoking
  3. Close contacts, Healthcare workers
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19
Q

What are the strongest risk factors for acquiring Tuberculosis?

A
  1. HIV!!
  2. Undernourished, DM2, excessive alcohol and smoking
  3. Close contacts and healthcare workers
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20
Q

Describe how a latent infection occurs with TB

A
  • Inhale M. Tuberculosis
  • Bacteria invades interstitium and recruits immune cells which creates
    = Granuloma
    ** latent if it stays here
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21
Q

Describe how an Active infection of TB occurs

A
  • Once granulomas are created, bacteria will continue to replicate inside them
  • Active infection = when granuloma cannot contain bacteria!
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22
Q

Latent infections are ____

A

Asymptomatic

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23
Q

What are the symptoms with an Active TB infection?

A

Constitutional symptoms
Cough with sputum production/blood
Chest pain

24
Q

What are the symptoms of an Active TB infection?

A

Constitutional symptoms
Chest pain
Cough with sputum production/blood

25
Q

What 2 tests can detect Latent TB (asymptomatic)?

A
  1. Tuberculin Skin Test (TST)

2. Interferon Gamma Release Assay (IGRA)

26
Q

Describe the Tuberculin Skin Test (TST)

A
  • Intradermal injection of antigens (PPD)

(+) = delayed hypersensitivity reaction 48-72 hours later

27
Q

Describe the Interferon Gamma Release Assay (IGRA)

A
  • In vitro exposure to TB antigens

(+) = increased production of IFN-gamma

28
Q

Which test for Latent TB is more reliable?

A

IGRA

29
Q

The tests for latent TB have a poor predictive value between?

A

Active and cleared infections

30
Q

What is the first line diagnostic test for Active TB?

A

Molecular tests: Nucleic Acid Amplification

31
Q

What is the gold standard test for Active TB and what can they identify?

A

Culture based methods

– can identify drug resistance

32
Q

If someone has an active TB infection, what do you do?

A

Contact local health deparment

33
Q

What is the major problem when treating TB?

A

Drug resistance!

34
Q

Some countries vaccinate newborns against TB with?

A

BCG

35
Q

Why is it important to know if a child was given the BCG vaccination for TB?

A

They will have a (+) TST!

36
Q

Air in the pleural space

A

Pneumothorax

37
Q

Most causes of Pneumothoraxes are?

A

Traumatic

- iatrogenic/non-iatrogenic

38
Q

Primary Spontaneous Pneumothorax occurs?

A

In the absence of lung disease

39
Q

Secondary Spontaneous Pneumothorax occurs?

A

As a complication of underlying lung disease

40
Q

What usually causes Spontaneous Pneumothoraxes?

A

Subpleural blebs rupture into pleural cavity

41
Q

In what patients will you see Primary Spontaneous Pneumothoraxes?

A

Young, tall, thin, males

Smokers, decreased atmospheric pressure

42
Q

In what patients will you see Secondary Spontaneous Pneumothoraxes?

A

COPD, ILD, Malignancy, TB, older males

43
Q

What miscellaneous things can cause Pneumothoraxes?

A

Air travel
Scuba diving
Drugs

44
Q

Symptoms of a pneumothorax?

A

Acute onset of dyspnea and pleuritic chest pain on the affected side

45
Q

Acute onset of dyspnea and pleuritic chest pain on the affected side suggests?

A

Pneumothorax

46
Q

The exam for a pneumothorax may be normal. What vital signs can predict an impending lung collapse?

A

Hypotension and tachycardia

– GET HELP

47
Q

If a patient is hypotensive with tachycardia with a pneumothorax, what may happen?

A

Impending lung collapse - get help!

48
Q

Decreased chest excursion, enlarged hemithorax, decreased breath sounds and hyperresonant percussion can indicate?

A

Pneumothorax

49
Q

What is the diagnostic test of choice for a Pneumothorax?

A

Imaging

- CXR, CT, US (if unstable)

50
Q

Treatment and complication of Pneumothorax?

A
  • Treatment = chest tube thoracostomy or observation

- Complication = Recurrence!

51
Q

For immunosuppressed individuals, what is a positive result for a TST test?

A

Induration > 5 mm

52
Q

For moderate risk individuals what is a positive TST result?

A

Induration > 10 mm

53
Q

For healthy individuals, what is a positive TST result?

A

Induration > 15 mm

54
Q

What is the treatment for a Latent TB infection?

A

3-9 months of 2 drugs

55
Q

What is the treatment for an Active TB infection?

A

4 drugs for 2 months

2 drugs for 4 months after

56
Q

When should you use an IGRA?

A

Those over 5 years old with increased likelihood of infection

57
Q

With a tension pneumothorax, what is the urgent treatment needed and then what is the treatment after that?

A

Urgent = needle decompression

– then a chest tube thoracostomy

2 - CPR (pulmonary) (26 decks)

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