Term
| What % of sarcoidosis pts have respiratory s/sx? |
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Definition
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Term
| How is suspected sarcoidosis evaluated? |
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Definition
chest x-ray
pulmonary fxn test
lab tests
biopsy
Kveim test |
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Term
| What is a difficult, rarely used test for dx'ing sarcoidosis? |
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Definition
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Term
| What are 3 lab tests used in sarcoidosis dx? |
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Definition
ACE (75% elevated)
creatinine, calcium, and liver enzyme serum levels
TB test |
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Term
| What is the primary test for dx'ing sarcoidosis? |
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Definition
| ACE will be elevated 75% of the time. Angiotensin Converting Enzyme is secreted by granulomas --> renal difficulties in sarcoidosis |
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Term
| What does high creatinine levels indicate? |
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Definition
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Term
| Are the tests for sarcoidosis specific or general? |
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Definition
| Non specific, must rule out many other conditions and generally take a biopsy of the lung to definitively say it is sarcoidosis |
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Term
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Definition
| Used to dx sarcoidosis; purified tissue from the spleen of a known sarcoidosis pt is injected into the fore arm of the tested pt and the immune response is checked. Very difficult to perform properly |
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Term
| What % of sarcoidosis remains stable? |
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Definition
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Term
| What % of sarcoidosis will progress? |
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Definition
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Term
| What % of sarcoidosis will spontaneously remit? |
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Definition
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Term
| What % of pt's with progressive sarcoidosis will develop severe pulmonary fibrosis? |
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Definition
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Term
| What indicates a better prognosis for sarcoidosis? |
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Definition
| fast, acute onset has better chance of remission than a slow onset |
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Term
| What is the #1 cause of death in sarcoidosis pt's? |
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Definition
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Term
| What ocular SE are often seen in sarcoidosis? |
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Definition
| Uveitis with candle wax dripping formations on the fundus |
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Term
| What is used for severe sarcoidosis tx? |
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Definition
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Term
| What immune modulating meds are used in sarcoidosis tx? |
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Definition
methotrexate
azathioprine
cyclosporine
hydroxychloroquine |
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Term
| What sarcoidosis drug is toxic to the retina? |
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Definition
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Term
| What anti-inflammatory meds are used in sarcoidosis tx? |
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Definition
| oral corticosteroids and steroid inhalers |
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Term
| What is the tx regimen for sarcoidosis anti inflammatory meds? |
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Definition
| 12 months with a taper for oral corticosteroids |
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Term
| What ocular SE are often seen from sarcoidosis drugs? |
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Definition
| decreased dark adaption or greying out of vision |
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Term
| How often should a sarcoidosis pt visit the optometrist? |
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Definition
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Term
| What baseline tests should be done for a sarcoidosis pt? |
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Definition
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Term
| If decreased ocular fxn is seen in sarcoidosis pt with tx, what should be done? |
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Definition
| discontinue hydroxychloroquine meds as the damage will be permanent and non reversible |
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Term
| After 5 years of hydroxychloroquine what tests should be done by an optometrist? |
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Definition
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Term
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Definition
| reduction of lung volume due to increased stiffnes of chest well and deformation of spine |
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Term
| What must the pt do to compensate for kyphoscoliosis? |
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Definition
| increased work of breathing |
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Term
| What is seen in advanced kyphoscoliosis? |
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Definition
| increased pCO2 and eventually lung failure |
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Term
| What is the mechanism of failure for the lungs in kyphoscoliosis? |
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Definition
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Term
| What does obesity do to pulmonary fxn? |
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Definition
| Squeezes out the lungs, decreasing lung volume and decreased ventilation of lung bases and hypoxemia. Supine position magnifies decreased lung volume |
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Term
| In 1900, what was the prevalence of TB? |
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Definition
| 1/5; was the 2nd most common cause of death by pulmonary dysfunction |
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Term
| What is the prevalence of TB in modern times? |
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Definition
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Term
| When did TB rates rebound? |
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Definition
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Term
| What were the mitigating factors in the rebound of TB in the late 80's/early90's? |
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Definition
HIV epidemic
rise of multidrug resistant TB
decline of TB control programs
immigration from 3rd world countries |
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Term
| Wht is the prevalence of TB in the US currently? |
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Definition
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Term
| How does the rate of TB in foreign born US residents compare to those born in the US? |
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Definition
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Term
| What % of US cases of TB are multidrug resistant? |
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Definition
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Term
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Definition
extensively drug resistant TB
increasing in prevalence in the US |
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Term
| What % of the world's population has TB? |
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Definition
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Term
| How many deaths per year are attributed to TB? |
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Definition
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Term
| How many new cases of TB are seen every year? |
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Definition
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Term
| What is the primary method of TB transmission? |
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Definition
| airborne sputum particles from coughing/sneezing |
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Term
| What % of people exposed to TB will develop TB? |
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Definition
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Term
| What is the reactivation rate of TB? |
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Definition
| 5-10% with latent, non-infectious TB will lose control and have TB revert to worse form |
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Term
| What are risk factors for TB transmission? |
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Definition
close contact with TB pt's
recent exposure
immunocompromised (HIV, transplant)
health care workers
residents/employees of long term care facilities
recent immigrants
IV drug users
children under 4yo
pt's with chronic medical conditions |
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Term
| What is the Mantoux test? |
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Definition
| Subcutaneous purified protein derivative is injected. Used to test for TB |
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Term
| What is injected in the PPD test? |
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Definition
| TB purified protein derivatives |
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Term
| In the Mantoux test, what indicate a positive test? |
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Definition
If the induration is >5mm in pt's who are immunosuppressed, show TB lung fibrosis on chest x-ray or recent contact with active TB pt
If the induration is >10mm in any person who doesn't meet any of the criteria for the 5mm induration and is considered a high risk individual
>15mm is positive regardless |
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Term
| What TB test is similar to what sarcoidosis test? |
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Definition
| Kveim test is same principle as PPD TB test |
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Term
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Definition
| interferon gamma release assay; used to test for TB |
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Term
| How is an IGRA test performed? |
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Definition
blood samples are mixed with TB antigen and incubated for 16-24 hrs
WBC will release interferon gamma if TB infection is present |
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Term
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Definition
| thickening of skin. Indicates positive TB test if large. Extends beyond the limits of the inflamed 'bubble' seen in the skin |
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Term
| What are the advantages of IGRA tests? |
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Definition
Only requires pt visit once
faster than PPD test
No feedback with subsequent tests like PPD test can
more definitive than PPD
fewer false positives |
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Term
| What bacterium can confuse a PPD test into a false positive? |
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Definition
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Term
| What are disdvantages of IGRA tests? |
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Definition
inconsistent in children and immune compromised pt's
blood sample must be processed within 12 hours
More expensive, but fewer false positives may make it more cost effective in the long run |
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Term
| What is the Xpert MTB/RIF test? |
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Definition
WHO endorsed TB test that is not FDA approved yet
automated test that searches for TB DNA |
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Term
| What does the MTB/RIF test look for besides pathogens? |
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Definition
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Term
| What IGRA tests are FDA approved? |
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Definition
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Term
| What does QFT-GIT stand for? |
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Definition
QuantiFeron-TB Gold In Tube
test used for TB dx |
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