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12. Respiratory > 7. Tuberculosis and Lung Cancer > Flashcards

7. Tuberculosis and Lung Cancer Flashcards

1
Q

Why is acid-fast staining needed for mycobacteria?

A

They have a lipid-rich cell wall that retains some dyes and even resists decolourisation with acid.

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2
Q

How does tuberculosis spread?

A

Person to person by aerosol route.

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3
Q

What is the first site of infection for tuberculosis?

A

The lungs.

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4
Q

What is the primary complex of tuberculosis?

A

The resolution of most infections with local scarring at the first site of infection.

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5
Q

What is post-primary infection?

A

The development of tuberculosis beyond the first few weeks.

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6
Q

What is miliary spread of tuberculosis?

A

Infection that progresses throughout the body.

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7
Q

What are the possible outcomes of miliary spread of tuberculosis?

A

Spontaneous resolution or developing into localised infection.

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8
Q

What causes the cavitation in the lungs in tuberculosis?

A

Intense immune response causes local tissue destruction.

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9
Q

What causes the fever and weight loss associated with tuberculosis?

A

Intense immune response causes cytokine-mediated systemic effects.

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10
Q

How does mycobacterium tuberculosis invade?

A

It is ingested by macrophages, but escapes from the phagolysosome to multiply in the cytoplasm.

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11
Q

What are the symptoms of pulmonary tuberculosis?

A

Chronic cough, haemoptysis, fever, weight loss.

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12
Q

What is the presentation of TB like if it affects every organ of the body?

A

Like inflammatory and malignant diseases.

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13
Q

How does tuberculosis meningitis present?

A

With fever and slowly deteriorating levels of consciousness.

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14
Q

How does tuberculosis spread to kidneys present?

A

Signs of local infection, fever and weight loss, complicated by ureteric fibrosis and hydronephropathy.

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15
Q

What is a complication of tuberculosis spread to lumbosacral spine?

A

It may cause vertebral collapse and nerve compression.

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16
Q

What is a complication of tuberculosis spread to large joints?

A

Destructive arthritis.

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17
Q

How does the host respond to TB infection?

A

Ingest it by macrophages. Immune reaction stimulates release of IL-12 which drives release of IFN-y and TNF-a from NK and CD4 cells. These activate and recruit more macrophages to the site of infection, and forms granulomas.

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18
Q

What are the primary changes in TB?

A

Few symptoms, lymph nodes may be enlarged in young people.

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19
Q

What is the classical presentation of post-primary TB?

A

Cough (not always productive), fevers towards the end of the day or at night, weight loss and general debility.

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20
Q

What would the features of a chest X ray be in TB?

A

Pulmonary shadowing - in patchy solid lesions, cavitated solid lesions, streaky fibrosis, or flecks of calcification.

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21
Q

What are the signs of TB?

A

Non-specific, pallor, fever, weight loss, clubbing, palpable lymph nodes.

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22
Q

What are the symptoms of TB?

A

Primary is usually asymptomatic. But otherwise: tiredness and malaise, weight loss and anorexia, fever, cough, breathlessness, haemoptysis occasionally.

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23
Q

What are the X rays changes of TB?

A

Shadowing, cavities, consolidation, calcification, cardiomegaly, miliary seeds.

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24
Q

Which gender is pleural tuberculosis more common in?

A

Males.

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25
Q

What are the pulmonary disease present in pleural tuberculosis?

A

Hypersensitivity response in primary infection, tuberculous empyema with ruptured cavity.

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26
Q

Which populations is lymph node tuberculosis most common in?

A

In children, women, and Asiasns.

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27
Q

What are the symptoms of lymph node tuberculosis?

A

Often painless and occurs in the neck.

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28
Q

What is the most common form of osteo-articular TB?

A

Tuberculous spondylitis.

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29
Q

What is the disease progression of tuberculous spondylitis?

A

Starts in sub-chondral bone and spread to vertebral bodies and joint space, then follows the longitudinal ligaments anterior and posterior to the spine.

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30
Q

Which vertebrae is tuberculous spondylitis most common in?

A

Lower thoracic and lumbar spine.

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31
Q

What is the risk of paraplegia and quadriplegia in cases of tuberculous spondylitis?

A

25% of cases.

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32
Q

What is Poncet’s disease?

A

Aseptic polyarthritis in the knees, ankles, and elbows.

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33
Q

What causes miliary tuberculosis?

A

Bacilli spreading through the blood stream in primary infection or in reactivation.

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34
Q

What do headaches suggest in miliary tuberculosis?

A

Meningeal involvement.

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35
Q

What are the symptoms of miliary tuberculosis?

A

Headaches if meningeal involvement, few respiratory symptoms, ascites can be present, retinal involvement in children.

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36
Q

What can diagnose TB?

A

Clinical features, radiological features, microbiology.

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37
Q

What clinical features diagnose TB?

A

Cough, night fever, weight loss.

38
Q

What radiological features diagnose TB?

A

Shadowing, cavities, consolidation, cardiomegaly, miliary seeds.

39
Q

What microbiology findings diagnose TB?

A

Identification of bacillus, direct smear and subsequent culture of appropriate body fluid.

40
Q

Why is it important to take cultures in TB cases?

A

To isolate the organism and determine its susceptibility to drugs.

41
Q

What is the outline of treatment for TB?

A

In the first two months, four drugs are taken. Then the following four month, two drugs are taken.

42
Q

Which drugs are given in the first two months of TB treatment?

A

Rifampicin, isoniazid, pyrazinamide, ethambutol.

43
Q

Which drugs are given in the 3-6th months of TB treatment?

A

Rifampicin, and isoniazid.

44
Q

Why are multiple drugs used in TB treatment?

A

To combat resistance.

45
Q

What is a main problem with TB treatment?

A

It is a long course of multiple drugs, so compliance is a problem.

46
Q

How can poor compliance in TB treatment be tackled?

A

Patients can receive directly observed therapy, where a clinician will watch them take the drugs.

47
Q

What are the side effects of the anti-TB drug, rifampicin?

A

Hepatitis, rash, flu-like symtpoms, shock, ARF, thrombocytopenic purpura.

48
Q

What are the side effects of the anti-TB drug, isoniazid?

A

Rash, peripheral neuropathy, hepatitis.

49
Q

What are the side effects of the anti-TB drug, pyrazinamide?

A

Rash, hepatitis, arthralgia.

50
Q

What is the main side effect of anti-TB drug, ethambutol?

A

Optic neuritis.

51
Q

What is the BCG vaccine?

A

A vaccination against tuberculosis that is prepared from a strain of attenuated live bovine tuberculosis bacillus.

52
Q

What are the issues with the BCG vaccine?

A

It has variable efficacy, depending on the genetic variation of populations and BCG strains. Efficacy only lasts for a maximum of 15 years.

53
Q

Who does the UK give BCG vaccines to currently?

A

High-risk groups.

54
Q

Who is at high-risk of TB in the UK?

A

HIV, silicosis, malnutrition, overcrowding, IV drug abusers, chronic lung disease, ethnicity, diabetes, corticosteroids.

55
Q

How much of a problem is TB in patients with HIV?

A

A big one, it’s the leading cause of morbidity and mortality in those patients and they have 20-37 times great a risk of developing it than others.

56
Q

What is the protocol with TB suspicion?

A

Immediately contact TB radiology, patient goes straight to TB clinic and has samples taken. Treatment begins with 7 days.

57
Q

What is the incidence of lung cancer in males?

A

Commonest male cancer, mortality is 100 per 100000, incidence is falling due to reduction in smoking.

58
Q

What is the incidence of lung cancer in females?

A

Causes more deaths than breast cancer, mortality rate is 40 per 100000, incidence is steadily rising.

59
Q

How does lung cancer incidence vary in socio-economic groups?

A

Rate is three times higher in lowest groups than highest.

60
Q

What causes lung cancer?

A

90% in men and 80% in women cases are due to smoking. Otherwise due to asbestos exposure, radon exposure, genetic factors, dietary factors.

61
Q

What are the symptoms of primary lung cancer?

A

Cough, dyspnoea, wheezing, haemoptysis, chest pain, post-obstructive pneumonia, weight loss, lethargy/ malaise.

62
Q

What are the symptoms of regional metastases lung cancer?

A

Superior vena cava obstruction, hoarseness from left recurrent laryngeal nerve palsy, dyspnoea from phrenic nerve palsy, dysphagia.

63
Q

What are the symptoms of distant metastases lung cancer?

A

Bone pain and fractures, CNS symtpoms - headache, double vision, confusion etc.

64
Q

What is paraneoplastic syndrome?

A

Te presence of a symptom or disease due to presence of cancer in the body, but not due to local presence of cancer cells.

65
Q

What are the endocrine symptoms from paraneoplastic syndrome?

A

Hypercalcaemia, Cushing’s syndrome.

66
Q

What are the neurological symptoms from paraneoplastic syndrome?

A

Encephalopathy, peripheral neuropathy.

67
Q

What are the skeletal symptoms from paraneoplastic syndrome?

A

Finger clubbing.

68
Q

What are the haematological symptoms from paraneoplastic syndrome?

A

Anaemia, thrombocytopenia, disseminated intravascular coagulation.

69
Q

What are the other symptoms from paraneoplastic syndrome?

A

Nephrotic syndrome, anorexia or cachexia.

70
Q

How is lung cancer diagnosed and staged?

A

CT scan, PET scan, isotope bone scan.

71
Q

What are the two staging systems for lung cancer?

A

Number staging and TNM staging.

72
Q

What are the number stages of lung cancer?

A

Stage 1 - small cancer, localised to one area of the lung.
Stage 2 and 3 - larger cancer, may have grown into surrounding tissues, like lymph nodes.
Stage 4 - cancer has metastasised.

73
Q

What are the T stages of lung cancer?

A

T1 - cancer contained within lung, <3cm.
T2 - cancer 3-7cm diameter.
T3 - cancer >7cm diameter.
T4 - cancer invading mediastinum, heart, major blood vessel, trachea, carina, oesophagus, spine, recurrent laryngeal nerve or nodule in more than one lobe of lung.

74
Q

What are the N stages of lung cancer?

A

N0 - no cancer in lymph nodes.
N1 - cancer in lymph nodes nearest affect lung.
N2 - cancer in lymph nodes in mediastinum, on same side.
N3 - cancer in lymph nodes on the opposite side of the mediastinum/ supraclavicular lymph nodes.

75
Q

What are the M stages of lung cancer?

A

M0 - no evidence of distal cancer spread.

M1 - lung cancer cells in distant parts of the body.

76
Q

How is tissue for biopsies of lung cancer obtained?

A

Bronchoscopy, needle biopsy of lung, or surgical biopsy.

77
Q

What is biopsy important for in lung cancer?

A

For confirmation of diagnosis, and distinguish cell type for prognosis and treatment.

78
Q

What are the two groups of lung cancers based on cells?

A

Non-small cell lung cancer, and small cell lung cancer.

79
Q

What is the presentation of non-small cell lung cancer at first?

A

More than 2/3rds have inoperable disease at presentation.

80
Q

What is the presentation of small cell lung cancer at first?

A

3/4 have metastatic disease at presentation.

81
Q

What does the prognosis of lung cancer depend on?

A

Cell type - worse if small cell than non-small cell. Stage of disease, performance status, biochemical markers, and co-morbidities.

82
Q

What are the treatments available for lung cancer?

A

Surgery, radiotherapy, chemotherapy, combination therapy, biological targeted therapies, palliative care.

83
Q

What type of lung cancer is more suited to surgical treatment?

A

Non-small cell, still only 20% of cases are suitable at presentation though.

84
Q

What are the types of radiotherapy available for lung cancer?

A

Radical for curative treatment or palliative for symptom control.

85
Q

How does chemotherapy affect the two types of lung cancer?

A

Small cell can potentially be cured in the minority of cases, non-small cell has a modest survival increase but mostly for symptom control.

86
Q

What is combination therapy of lung cancer?

A

Chemotherapy and radiotherapy.

87
Q

What are some biological markers for lung cancer?

A

EGFR, and VEGF.

88
Q

How is non-small cell lung cancer normally managed?

A

Multiple modality therapy - palliative radiotherapy for local symptoms, chemotherapy with 50-60% response rates, combination therapy for locally advanced disease, targeted agents - EGFR and VEGF.

89
Q

What is the management of small cell lung cancer?

A

Rarely operable, combination therapy can add a year, palliative chemotherapy for the symptoms.

90
Q

What causes death in small cell lung cancer usually?

A

Cerebral metastases.

12. Respiratory (10 decks)

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