Tyler Clinical Medicine 2 - Sarcoidosis, TB, Pneumothorax

Question 1

What is a primary spontaneous pneumothorax?

Answer 1

• no underlying lung disease
• tall thin boys and men ages 10-30
• Rupture of subpleural apical blebs in response to high negative intrapleural pressures

-family hx and smoking hx are important

Question 2

What is secondary spontaneous pneumothorax?

Answer 2

complication of preexisting lung disease

Question 3

What could cause a iatrogenic pneumothorax?

Answer 3

• thoracocentesis
• plural biopsy
• subclavian or internal jugular vein catheter
• lung biopsy
• bronchoscopy
• postitive pressure ventilation

Question 4

What causes a tension pneumothorax?

Answer 4

pressure in the pleural space exceeds alveolar and venous pressures in respiratoy cycle

• this causes compression of lung and decrease in venous return

Question 5

What settings would you see a tension pneumothorax?

Answer 5

• penetrating trauma
• lung infection
• cardiopulmonary resuscitation
• positive pressure mechanical ventilation

Question 6

What are the symptoms of TB?

Answer 6

• Fatigue, weightloss, fever, night sweats, productive chronic cough
• Apical pulmonary opacities on CXR
• Acid fast bacilli on sputum smear

Question 7

What is primary TB?

Answer 7

• Lymphatic and hematogenous dissemination before immune response
• clinically/ CXR silent
• T- cells and macrophages will surround organisms to limit spread
• Infection can be dormant in granulomas for years to decades

Question 8

Can latent TB be transmitted?

Answer 8

No, but the disease can be reactivated if the host loses immune function

Question 9

When does active TB occur?

Answer 9

6% of people with latent TB will develop active TB; half within 2 years of primary infection

Question 10

What increases the risk of TB reactivation?

Answer 10

1. Gastrectomy
2. Silicosis
3. DM
4. Immunocompromised

Question 11

What are risk factors for drug resistant TB?

Answer 11

1. Immigration from countries with high prevalence of drug resistant TB
2. Unsuccessful therapy
3. Nonadhearance compliance

Question 12

What drugs is TB resistant to in Drug-resistant TB?

Answer 12

isoniazid OR rifampin

Question 13

What drug is TB resistance to in MULTI drug resistant TB?

Answer 13

isoniazid AND rifampin + additional agent

Question 14

What is TB resistance in extensively drug resistant TB?

Answer 14

Isoniazid AND rifampin AND fluoroquniolones AND EITH aminoglycosides or capreomycin or both

Question 15

Is dyspnea common in TB?

Answer 15

no

Question 16

How do you diagnose TB?

Answer 16

DNA/ RNA amplification from 3 consecutive morning sputum samples

Question 17

What CXR pattern is seen with primary TB?

Answer 17

1. Small unilateral infiltrates
2. hilar and paratrachial lymph node enlargement
3. segmental atelectasis

pleural effusion on 30-40% of patients (may be only abnormality)

Question 18

What is CXR seen with reactivation of TB?

Answer 18

1. Fibrocavitary apical disease
2. discrete nodules
3. pneumonic infiltrates
4. usually in apical or posterior segments of upper lobes or superior segments of lower lobes

Question 19

What lobe of lungs do you expect to be affected in elderly patients?

Answer 19

lower lobe with or without pleural effusions

Question 20

What do you expect the TB pattern to be in immunocompromised patients?

Answer 20

• Lower lung zone
• diffuse or milliary infiltrates
• pleural effusions
• hilar/mediastinal lymph node involvement

Question 21

What is military TB pattern?

Answer 21

• diffuse “millet seed” pattern

- seen with hematologic/ lymphatic dissemination

Question 22

What would you see in a sarcoidosis patient?

Answer 22

1. Symptoms in: lungs, skin, eyes, peripheral nerves, liver, kidney, heart, and other tissue
2. non caseating granulomas
3. exclusions of other granulomatous disorders
4. onset 30s-40s

Question 23

What does Sarcoidosis diagnosis require?

Answer 23

histologic demonstration of noncaseating granuomas

Question 24

What are symptoms of sarcoidosis?

Answer 24

1. Malaise, fever, dyspnea of insidious onset
2. Skin involvement
3. irititi
4. peripheral neuropathy
   5 arthritis
5. cardiomyopathy