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Respiratory medicine > Lung cancer, sarcoids > Flashcards

Lung cancer, sarcoids Flashcards

1
Q

Most common lung cancer type

A

SCC (35%)

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2
Q

Most common lung cancer type in non-smokers and more common in M/F

A

Adenocarcinoma (25%)

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3
Q

SCC behaviour

A 
Locally invasive 
Metastasise late 
PTHrP --> raised calcium 
Hyperthyroiditis 
HPOA +clubbing
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4
Q

Adenocarcinoma pathology and behaviour

A

Peripherally located
Gynaecomastia
Glandular differentiation
Extrathoracic mets common + elderly

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5
Q

Large cell pathology and behaviour

A

Peripheral/central
Large, poorly differentiated cells
Poor prognosis

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6
Q

Small cell pathology

A

Central location, near bronchi

Small, poorly differentiated cells

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7
Q

Small cell behaviour

A

80% present late
Very chemosensitive but poor prognosis
SIADH (reduced Na)
Ectopic ACTH (Cushing’s syndrome), lamberton-Eaton

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8
Q

Complications of lung cancer

A

Recurrent laryngeal and phrenic nerve palsy
SVC obstruction, AF
Horner’s

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9
Q

Other paraneoplastic features in lung cancer

A

DERN
Derm - acanthosis nigricans, trousseau syndrome
Endo: serotonin - carcinoid (flushing, diarrhoea, wheeze, pulmonary stenosis, telangiectasis)
Rheum - Dermatomyositis/polymyositis
Neuro - Purkinje cells, peripheral neuropathy

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10
Q

Imaging for lung cancer

A

CXR, contract enhanced volumetric CT, PET-CT, radionucleotide bone scan

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11
Q

Biopsy in lung cancer for peripheral lesions and normal lesions

A

Peripheral - percutaneous FNA

Bronchoscopy/endoscopic bronchial ultrasound biopsy

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12
Q

Mx lung cancer

A

MDT
NSCLC - surgical resect, radio, chemo (platinum based)
SCLC - may respond to chemo

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13
Q

Epidemiology of lung cancer

A

19% of all cancers

27% of cancer deaths - commonest

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14
Q

ARDS pathogenesis and CXR image

A

Direct pulmonary insult
2ndry to severe systemic illness
CXR - bilateral perihilar infiltrates

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15
Q

Pulmonary causes of ARDS

A

pneumonia, aspiration, contusion, inhalation injury

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16
Q

Systemic causes of ARDS

A

Shock, sepsis, trauma, haemorrhage

Acute liver failure, pancreatitis, DIC

17
Q

Lung cancer referral if:

A

CXR findings suggestive

Aged >40 with unexplained haemoptysis

18
Q

Lung mets to

A

Breast, kidney, GI tract

19
Q

Age, sex, ethnicity seen in sarcoidosis

A

Age: 20-40
Sex: F>M
Geo - Afro caribbean

20
Q

Acute sarcodosis features

A

Erythema nodosum, fever, BHL (bi-hilar lymphadenopathy), polyarthralgia

21
Q

General sarcoidosis features

A

fever, anorexia + weight loss

fatigue, lymphadenopathy + HSM

22
Q

Resp stages in sarcoidosis

A 
Upper - otitis + sinusitis 
Lower - Dry cough, SOB, chest pain 
1 - BHL
2 - BHL + peripheral infiltrates
3 -  Peripheral infiltrates alone 
4 - Progressive mid-zone fibrosis
23
Q

Derm, arthralgia and abdo features in sarcoidosis

A

Derm - erythema nodosum, lupus pernio
Abdo - hepatomegaly + cholestatic LFTS, spenomegaly
Arthralgia - polyarthralgia, dactylitis

24
Q

Neuro, renal + hormonal, sarcodosis features

A

Neuro - peripheral/cranial polyneuropathy, meningitis, transverse myelitis
Renal - raised Ca–>stones, nephrocalcinosis, DI
Low hormones - pituitary dysfunction

25
Q

Ophthal and myocardial sarcodosis features

A

Ophthal - uveitis, keratoconjunctivitis, sicc

Myocardial - pericardial effusion, restrictive cardiomyopathy

26
Q

BHL differential

A

Sarcoidosis
Infection - TB, mycoplasma
Malignancy - lymphoma, carcinoma
Interstitial disease - EAA, silicosis

27
Q

Blood results

A

Raised - ESR, Ca, serum ACE, Ig, LFTs

Lymphopenia

28
Q

Other Ix in sarcoidosis

A

CXR, CT, MRI
Tuberculin skin test - negative in 2/3
Tissue biopsy

29
Q

Rx sarcoidosis acute and chronic

A

Acute - bed rest and NSAIDs, spontaneous resolution

Chronic - steroids 40mg, immunosuppression

Respiratory medicine (5 decks)

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