Sarcoidosis/TB/Pneumothorax Flashcards
What is a Granuloma?
Abnormal lump of inflammatory cells
What is Sarcoidosis?
Inflammatory disease with presence of Non-necrotizing Granulomas in lungs and other organs
In what populations is Sarcoidosis incidence higher than normal?
African Americans
Scandinavian countries
Describe the pathogenesis for Sarcoidosis
- Trigger
–> Dysregulated immune response
=> compact, epitheloid, non-caseating granulomata!
Compact, epithelioid NON-CASEATING Granulomata
Sarcoidosis
What are the symptoms of Sarcoidosis?
Gradual onset of constitutional symptoms
Cough, dyspnea, wheeze, stridor
What are the symptoms of Sarcoidosis?
Gradual onset of constitutional symptoms
Cough, dyspnea, wheeze, stridor
What may be seen on CXR with Sarcoidosis?
Bilateral hilar lymphadenopathy
With Sarcoidosis, levels of ____ correlate with the granuloma burden
ACE levels
Clinical findings + non-caseating granulomas while excluding other similar diseases
Sarcoidosis
What are some labs you could order to exclude other diseases from Sarcoidosis?
Labs (HIV/TB)
CXR, CT, EKG
PFTs
Bronchoscopy with biopsy
If there are no symptoms or no organ damage with Sarcoidosis, what could the treatment be?
Wait and watch
If there are symptoms or organ damage with Sarcoidosis, what is the treatment?
Anti-inflammatory – Corticosteroids, or Immunosuppressants
With Sarcoidosis, the risk for what increases?
Infections and cancers
What causes Tuberculosis?
Airborne infection due to Mycobacterium Tuberculosis complex
What is different about the Granulomas seen with Tuberculosis compared to those with Sarcoidosis?
Tuberculosis Granulomas = contain lipid filled macrophages!
Tuberculosis is the #1 infectious killer. Where is incidence the highest?
Low and middle income countries
What are the strongest risk factors for acquiring Tuberculosis?
- HIV!!
- Diabetes Type 2, Undernourished, Excessive alcohol and smoking
- Close contacts, Healthcare workers
What are the strongest risk factors for acquiring Tuberculosis?
- HIV!!
- Undernourished, DM2, excessive alcohol and smoking
- Close contacts and healthcare workers
Describe how a latent infection occurs with TB
- Inhale M. Tuberculosis
- Bacteria invades interstitium and recruits immune cells which creates
= Granuloma
** latent if it stays here
Describe how an Active infection of TB occurs
- Once granulomas are created, bacteria will continue to replicate inside them
- Active infection = when granuloma cannot contain bacteria!
Latent infections are ____
Asymptomatic
What are the symptoms with an Active TB infection?
Constitutional symptoms
Cough with sputum production/blood
Chest pain
What are the symptoms of an Active TB infection?
Constitutional symptoms
Chest pain
Cough with sputum production/blood
What 2 tests can detect Latent TB (asymptomatic)?
- Tuberculin Skin Test (TST)
2. Interferon Gamma Release Assay (IGRA)
Describe the Tuberculin Skin Test (TST)
- Intradermal injection of antigens (PPD)
(+) = delayed hypersensitivity reaction 48-72 hours later
Describe the Interferon Gamma Release Assay (IGRA)
- In vitro exposure to TB antigens
(+) = increased production of IFN-gamma
Which test for Latent TB is more reliable?
IGRA
The tests for latent TB have a poor predictive value between?
Active and cleared infections
What is the first line diagnostic test for Active TB?
Molecular tests: Nucleic Acid Amplification
What is the gold standard test for Active TB and what can they identify?
Culture based methods
– can identify drug resistance
If someone has an active TB infection, what do you do?
Contact local health deparment
What is the major problem when treating TB?
Drug resistance!
Some countries vaccinate newborns against TB with?
BCG
Why is it important to know if a child was given the BCG vaccination for TB?
They will have a (+) TST!
Air in the pleural space
Pneumothorax
Most causes of Pneumothoraxes are?
Traumatic
- iatrogenic/non-iatrogenic
Primary Spontaneous Pneumothorax occurs?
In the absence of lung disease
Secondary Spontaneous Pneumothorax occurs?
As a complication of underlying lung disease
What usually causes Spontaneous Pneumothoraxes?
Subpleural blebs rupture into pleural cavity
In what patients will you see Primary Spontaneous Pneumothoraxes?
Young, tall, thin, males
Smokers, decreased atmospheric pressure
In what patients will you see Secondary Spontaneous Pneumothoraxes?
COPD, ILD, Malignancy, TB, older males
What miscellaneous things can cause Pneumothoraxes?
Air travel
Scuba diving
Drugs
Symptoms of a pneumothorax?
Acute onset of dyspnea and pleuritic chest pain on the affected side
Acute onset of dyspnea and pleuritic chest pain on the affected side suggests?
Pneumothorax
The exam for a pneumothorax may be normal. What vital signs can predict an impending lung collapse?
Hypotension and tachycardia
– GET HELP
If a patient is hypotensive with tachycardia with a pneumothorax, what may happen?
Impending lung collapse - get help!
Decreased chest excursion, enlarged hemithorax, decreased breath sounds and hyperresonant percussion can indicate?
Pneumothorax
What is the diagnostic test of choice for a Pneumothorax?
Imaging
- CXR, CT, US (if unstable)
Treatment and complication of Pneumothorax?
- Treatment = chest tube thoracostomy or observation
- Complication = Recurrence!
For immunosuppressed individuals, what is a positive result for a TST test?
Induration > 5 mm
For moderate risk individuals what is a positive TST result?
Induration > 10 mm
For healthy individuals, what is a positive TST result?
Induration > 15 mm
What is the treatment for a Latent TB infection?
3-9 months of 2 drugs
What is the treatment for an Active TB infection?
4 drugs for 2 months
2 drugs for 4 months after
When should you use an IGRA?
Those over 5 years old with increased likelihood of infection
With a tension pneumothorax, what is the urgent treatment needed and then what is the treatment after that?
Urgent = needle decompression
– then a chest tube thoracostomy
