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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
What 2 tests can detect Latent TB (asymptomatic)?
1. Tuberculin Skin Test (TST) | 2. Interferon Gamma Release Assay (IGRA)
26
Describe the Tuberculin Skin Test (TST)
- Intradermal injection of antigens (PPD) | (+) = delayed hypersensitivity reaction 48-72 hours later
27
Describe the Interferon Gamma Release Assay (IGRA)
- In vitro exposure to TB antigens | (+) = increased production of IFN-gamma
28
Which test for Latent TB is more reliable?
IGRA
29
The tests for latent TB have a poor predictive value between?
Active and cleared infections
30
What is the first line diagnostic test for Active TB?
Molecular tests: Nucleic Acid Amplification
31
What is the gold standard test for Active TB and what can they identify?
Culture based methods | -- can identify drug resistance
32
If someone has an active TB infection, what do you do?
Contact local health deparment
33
What is the major problem when treating TB?
Drug resistance!
34
Some countries vaccinate newborns against TB with?
BCG
35
Why is it important to know if a child was given the BCG vaccination for TB?
They will have a (+) TST!
36
Air in the pleural space
Pneumothorax
37
Most causes of Pneumothoraxes are?
Traumatic | - iatrogenic/non-iatrogenic
38
Primary Spontaneous Pneumothorax occurs?
In the absence of lung disease
39
Secondary Spontaneous Pneumothorax occurs?
As a complication of underlying lung disease
40
What usually causes Spontaneous Pneumothoraxes?
Subpleural blebs rupture into pleural cavity
41
In what patients will you see Primary Spontaneous Pneumothoraxes?
Young, tall, thin, males | Smokers, decreased atmospheric pressure
42
In what patients will you see Secondary Spontaneous Pneumothoraxes?
COPD, ILD, Malignancy, TB, older males
43
What miscellaneous things can cause Pneumothoraxes?
Air travel Scuba diving Drugs
44
Symptoms of a pneumothorax?
Acute onset of dyspnea and pleuritic chest pain on the affected side
45
Acute onset of dyspnea and pleuritic chest pain on the affected side suggests?
Pneumothorax
46
The exam for a pneumothorax may be normal. What vital signs can predict an impending lung collapse?
Hypotension and tachycardia | -- GET HELP
47
If a patient is hypotensive with tachycardia with a pneumothorax, what may happen?
Impending lung collapse - get help!
48
Decreased chest excursion, enlarged hemithorax, decreased breath sounds and hyperresonant percussion can indicate?
Pneumothorax
49
What is the diagnostic test of choice for a Pneumothorax?
Imaging | - CXR, CT, US (if unstable)
50
Treatment and complication of Pneumothorax?
- Treatment = chest tube thoracostomy or observation | - Complication = Recurrence!
51
For immunosuppressed individuals, what is a positive result for a TST test?
Induration > 5 mm
52
For moderate risk individuals what is a positive TST result?
Induration > 10 mm
53
For healthy individuals, what is a positive TST result?
Induration > 15 mm
54
What is the treatment for a Latent TB infection?
3-9 months of 2 drugs
55
What is the treatment for an Active TB infection?
4 drugs for 2 months | 2 drugs for 4 months after
56
When should you use an IGRA?
Those over 5 years old with increased likelihood of infection
57
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

2 - CPR (pulmonary) (26 decks)

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