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RESP > lung cancer ARDS resp failure > Flashcards

lung cancer ARDS resp failure Flashcards

1
Q

what are the types of lung cancer?

A

SCC
adenocarcinoma
large-cell
small-cell

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2
Q

what is the epidemiology of small cell lung cancer?

A

20%

smoking

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3
Q

what is the pathology of small cell lung cancer (location + histology)?

A

central location
near bronchi

histology- small, poorly differentiated cells

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4
Q

how does a small cell lung cancer develop?

A

80% present with advanced disease
very chemosensitive but very poor prognosis
ectopic hormone secretion

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5
Q

what is the epidemiology of large cell lung cancer?

A

10%

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6
Q

what is the pathology of large cell lung cancer (location + histology)?

A

peripheral or central

histology- large, poorly differentiated cells

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7
Q

how does a large cell lung cancer develop?

A

poor prognosis

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8
Q

what is the epidemiology of adenocarcinoma?

A

25%
females
non-smokers
far east

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9
Q

what is the pathology of adenocarcinomas (location + histology)?

A

peripherally located

histology: glandular differentiation
gland formation, mucin production

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10
Q

how does an adenocarcinoma behave?

A

extrathoracic mets common + early

80% present with mets

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11
Q

what is the epidemiology of SCC?

A

35%
M>F
smoking
radon gas

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12
Q

what is the pathology of SCC (location + histology)?

A

centrally located

histology- evidence of squamous differentiation- keratinsation

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13
Q

how does an SCC behave

A

locally invasive
metastasise late via LN
PTHrP -> high Ca2+

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14
Q

what are the other types of rare lung cancers?

A

adenoma- 90% carcinoid tumours
hamartoma
mesothelioma

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15
Q

what is the epidemiology of lung cancer?

A

19% of all cancers

27% of cancer deaths- most common

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16
Q

what are the symptoms of lung cancer?

A 
cough + haemoptysis 
dyspnoea
chest pain 
recurrent or slow resolving pneumonia
anorexia + weight loss
hoarseness
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17
Q

what are the general + chest signs of lung cancer?

A

1) general:
cachexia, anaemia
clubbing + HPOA (painful wrist swelling)
supraclavicular +/- axillary LNs

2) chest:
consolidation
collapse
pleural effusion

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18
Q

what are the signs of metastatic lung cancer?

A

bone tenderness
hepatomegaly
confusion, fits, focal neuro
addisons

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19
Q

what are the local complications of lung cancer?

A 
reccurent laryngeal nerve palsy
phrenic nerve palsy
SVC obstruction 
horner's - pancoast tumour
AF
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20
Q

what are the paraneoplastic complications CATEGORIES of lung cancer?

A

endo
rheum
neuro
derm

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21
Q

what are the paraneoplastic complications of lung cancer? endo

A

1) ADH-> SIADH (euvolaemic decrease Na+)
2) ACTH-> cushing’s syndrome
3) serotonin-> carcinoid (flushing, diarrhoea)
4) PTHrP-> 1* HPT (raised Ca2+, bone pain)- SCC

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22
Q

what are the paraneoplastic complications of lung cancer? rheum

A

dermatomyositis/polymyositis

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23
Q

what are the paraneoplastic complications of lung cancer? neuro

A

1) purkinje cells (CDR2) -> cerebellar degeneration

2) peripheral neuropathy

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24
Q

what are the paraneoplastic complications of lung cancer? derm

A

1) acanthosis nigricans (hyperpigmented body folds)

2) trousseau syndrome- thrombophlebitis migrans

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25
Q

what are the complications of metastic lung cancer?

A

pathological fracture
hepatic failure
confusion, fits, focal neuro
addisons

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26
Q

what are the investigations for lung cancer?

A

1) bloods- FBC UE Ca2+ LFTs
2) cytology- sputum, pleural fluid
3) imaging- CXR, contrast-enhanced volumetric CT, PET-CT, radionucleotide bone scan
4) biopsy
5) lung function tests- assess treatment fitness

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27
Q

what can CXR show for lung cancer?

A 
coin lesion
hilar enlargement
consolidation, collapse
effusion
bony secondaries
28
Q

what is contrast ehanced volumetric CT scan used for in lung cancer?

A

staging- lower neck, chest, upper abdomen

consider CT brain

29
Q

what is PET-CT used for in lung cancer?

A

to exclude distant mets

30
Q

how are biopsies done in lung cancer?

A

1) percutaneous FNA- peripheral lesiosn + LNs
2) bronchoscopy- biopsy + assess operability
3) endoscopic bronchial US biopsy- mediastinal LNs
4) mediastinoscopy

31
Q

what are the ddx for CXR coin lesion?

A 
FANGS
foreign body 
abscess- staph, TB, klebsiella, mycetoma
neoplasia- 1* or 2*
granuloma- RA, wegener's, TB, sarcoid 
structural - AVM
32
Q

what staging is used for non-small cell lung cancers?

A

TNM staging

look at p44 AS notes

33
Q

what is the general management for all lung cancers?

A

MDT- pulmonologist, oncologist, radiologist, histopathologist, cardiothoracic surgeon, specailist nurses, palliative care, GP

assess risk of operative mortality eg thoracoscore (cardioresp fx, co-morbs)

smoking cessation advice

34
Q

what treatments can be offered for non-small cell lung cancers?

A

1) surgical resection for stage I/II
(wedge resection, lobectomy or pneumonectomy +/- adjuvant chemo)

2) curative radiothearpy
3) chemo +/- radiothearpy for more advanced disease

35
Q

what is the management of small cell lung cancer?

A

typically disseminated at presentation

may respond to chemotherapy but invariably relapse

36
Q

what can be done for palliation of lung cancer treatment?

A

1) radiotherapy - bronchial obstruction, haemoptysis, bone or CNS mets
2) SVC obstruction - stenting + radiotherapy + dexamethasone
3) endobronchial therapy- stenting, brachytherapy
4) pleural drainage/pleurodesis
5) analgesia

37
Q

what is the prognosis of non small cell lung cancers?

A

50% 5 years without spread

10% with spread

38
Q

what is the prognosis of small cell lung cancer?

A

1-1.5 years median survival if treated

3 months if untreated

39
Q

what is the pathogenesis of ARDS?

A

may result form direct pulmonary insult or be 2* to severe systemic illness

inflammatory mediatores leads to increased capillary permeability + non-cardiogenic pulmonary oedema

40
Q

what are the clinical features of ARDS?

A

tachypnoea
cyanosis
bilateral fine creps
SIRS/sepsis

41
Q

what investigations would you do for ARDS?

A

bloods- FBC, UE, LFT, clotting, amylase, CRP, cultures, ABG

CXR

42
Q

what does CXR show in ARDS?

A

bilateral perihilar infiltrates

43
Q

what features leads to diagnosis of ARDS?

A

acute onset
CXR - bilateral infiltrates
no evidence of CCF
PaO2:FiO2 <200

44
Q

what is the management of ARDS?

A

admit to ITU for organ support

treat underlying cause

45
Q

what are the indications for ventilation in ARDS?

A

paO2<8kpa despite 60% FiO2

paCO2>6kpa

46
Q

what are the side effects of ventilation in ARDS?

A

VILI
VAP
weaning difficulty

47
Q

how do you monitor circulation in ARDS (ITU?)

A

invasive BP monitoring
maintain CO + CO2 with inotropes eg norad or dobutamine

RF may require haemofiltration

48
Q

what are the management categories for ARDS?

A

ventilation
circulation
sepsis- abx
nutritional support- enteral is best, TPN

49
Q

what is the prognosis of ARDS?

A

50-75% mortality

50
Q

what are the pulmonary causes of ARDS?

A

pneumonia
aspiration
inhalation injury
confusion

51
Q

what are teh systemic causes of ARDS?

A 
shock
sepsis
trauma
haemorrhage + multiple transfusions
pancreatitis
acute liver failure
DIC
obs- eclampsia, amniotic embolism
drugs- aspirin, heroin
52
Q

what are the ddx of EXUDATE pulmonary oedema?

A

ARDS

53
Q

what are the ddx of TRANSUDATE pulmonary oedema if increase in capillary hydrostatic pressure?

A

CCF
iatrogenic fluid overload
renal failure
relative increase in negative pressure pulmonary oedema

54
Q

what are the ddx of TRANSUDATE pulmonary oedema if decrease in capillary oncotic pressure?

A

liver failure
nephrotic syndrome
malnutrition, malabsorption, protein-losing enteropathy

55
Q

what are the ddx of TRANSUDATE pulmonary oedema if increase in interstitial pressure?

A

decrease lymphatic drainage eg cancer

56
Q

what is type 1 resp failure?

A

PaO2 <8KPa and PaCO2 <6KPa

V/Q mismatch and diffusion failure

57
Q

what is type 2 resp failure?

A

PaO2 <8KPa and PaCO2 >6KPa

Alveolar hypoventilation ± V/Q mismatch

58
Q

what are the causes CATEGORES for resp failure?

A

V/Q mismatch (increase in A-a gradient)

alveolar hypoventilation- obstructive + restrictive

diffusion failure - fluid + fibrosis (increase in A-a gradient) which both lead to V/Q mismatch + alv hypovent due to decreased compliance

59
Q

what are the causes of V/Q mismatch?

A

1) vascular- PE, PHT, pulmonary shunt R->L
2) asthma (early)
3) pneumothorax
4) atelectasis

60
Q

what are the causes of OBSTRUCTIVE alveolar hypoventilation?

A 
COPD
asthma
bronchiectasis
bronchiolitis
intra + extrathoracic - cancer, LN, epiglottitis
61
Q

what are the causes of RESTRICTIVE alveolar hypoventilation?

A

1) decreased drive- CNS sedation, trauma, tumour
2) NM disease- cervical cord lesion, polio, GBS, MG
3) chest- flail, kyphoscoliosis, obesity
4) fluid + fibrosis

62
Q

what are the causes of diffusion failure (fluid)?

A

pulmonary oedema
pneumonia
infarction
blood

63
Q

what are the clincal features of resp failure?

A 
1) acute hypoxia
dyspnoea, agitaiton, confusion, cyanosis
2) chronic hypoxia
polycythaemia, PHT, cor pulmonale
3) hypercapnoea
headache, flushing + peripheral vasodilatation, bounding pulse, flap, confusion leading to coma
64
Q

what is the management of type 1 resp failure

A

treat underlying cause

02 aim 94-98
assisted ventilation if paO2<8kpa despite 60% O2

65
Q

what is the management of type 2 resp failure

A

treat underlying cause
controlled O2 therapy at 24% O2 aiming for 88-92 and paO2 of >8kpa

check ABG after 20 mins

  • if paCO2 steady or lower can increase FIO2 if needded
  • if paCO2 higher than >1.5kpa + pt still hypoxic, consider NIV or respiratory stimulant eg doxapram
66
Q

what are the principles of o2 therapy if patient is at risk of hypercapnic resp failure?

A

start O2 therapy at 24% + do ABG
use blue venturi at 2-4L/min
clinically- reduced RR with O2 may be useful sign
if PCO26kpa- increase target SPO2 to 94-98
if PCO2>6kpa maintain target SPO2

67
Q

what mechanisms of O2 therapy are there?

A

nasal prongs 1-4L/min= 24-40% O2

simple face mask

non-rebreath mask 60-90% at 10-15L

venturi mask 
yellow 5%
white 8%
blue 24%
red 40%
green 60%

RESP (4 decks)

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