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HYMS Block 13 > Lung Infections and Cancer > Flashcards

Lung Infections and Cancer Flashcards

1
Q

Name 6 common respiratory signs

A
  1. breathlessness
  2. cough
  3. sputum
  4. haemoptysis
  5. wheeze
  6. chest pain
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2
Q

Name causes of breathlessness

  1. sudden onset
  2. rapid onset
  3. subacute onset
  4. slow onset
A
  1. pulmonary oedema; anaphylaxis, pneumothorax
  2. PE, pneumonia
  3. heart failure, lung cancer, pleural effusion
  4. COPD
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3
Q
  1. what is the cause of purulent sputum?
  2. why is purulent sputum not always indicative of infection?
  3. name 2 conditions in which large volumes of sputum are produced
  4. name a condition whereby sputum tastes putrid
A
  1. myeloperoxidase from neutrophils/eosinophils
  2. eosinophils are also activated in asthma
  3. bronchiectasis and bronchoalveolar carcinoma
  4. lung abscess (anaerobic infection)
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4
Q
  1. Name a condition where haemoptysis is a pink, frothy sputum
  2. name a condition where the sputum is “rusty”
A
  1. pulmonary oedema

2. pneumonia

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5
Q
  1. What is wheeze?

2. What is stridor?

A
  1. musical noise ON EXHALATION, produced by air moving through narrowed airways
  2. noise with inhalation
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6
Q
  1. From which structure does pain from respiratory disease come from?
  2. what can retrosternal pain indicate?
A
  1. pleura

2. mediastinal tumour

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7
Q

Name 3 respiratory causes of clubbing

A
  1. bronchial carcinoma
  2. COPD
  3. pulmonary tuberculosis
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8
Q
  1. What is astrexis?
  2. Name two causes of astrexis?
  3. what is intercostal undraping?
A
  1. tremor of hands
  2. fine tremor with excessive use of beta2 agonists
    flapping tremor with CO2 retention
  3. skin between ribs is drawn inwards to create a larger negative pressure
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9
Q
  1. What pathology causes deviation of the trachea AWAY?
  2. What pathology causes deviation of the trachea TOWARDS?
  3. What is the normal cricosternal distance?
  4. When is the cricosternal distance reduced?
A
  1. pleural effusion or pneumothorax
  2. collapse or fibrosis
  3. 3-4 finger bredths
  4. hyperinflation
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10
Q
  1. What is the percussive sound made with pleural effusion?
  2. What is the sound of the wheeze with small airways obstruction?
  3. What is the sound of the wheeze with large airways obstruction?
A
  1. stony dull
  2. polyphonic, high pitched
  3. monophonic
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11
Q
  1. Name the three most potent carcinogens in cigarette smoke
  2. Name other carcinogens in cigarette smoke
  3. Name some occupational/environmental carcinogens
  4. How may carcinogens act to cause cancer:
    a) directly
    b) indirectly
A
  1. polycyclic aromatic hydrocarbons
    tobacco specific nitrosamines
    polonium 210
  2. carcinogenic metals, acetaldehyde, NO, formaldehyde, hydrogen cyanide
  3. arsenic, asbestos, ethers, nickel, radon

4a) directly mutagenic
4b) induce inflammation, metaplasia, and hyperplasia

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12
Q
  1. When do small cell carcinomas tend to spread?
  2. When do non-small cell carcinomas tend to be diagnosed
  3. What are non-small cell carcinomas further divided into? (3)
A
  1. early (and hence have poor prognosis)
  2. whilst they are localised
  3. adenocarcinoma
    squamous cell carcinoma
    large cell carcinoma
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13
Q
  1. From which cells do adenocarcinomas arise?
  2. What is the histology of adenocarcinomas?
  3. What protein is produced by adenocarcinomas?
  4. What are most of these cancers caused by?
A
  1. mucous secreting glandular cells
  2. abnormal acinar glandular structures
  3. mucin
  4. smoking
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14
Q
  1. from which cells do squamous cell carcinoma arise?
  2. what protein is produced by these cancer cells?
  3. What are the effects of these carcinomas?
  4. When do these cancers tend to spread?
A
  1. squamous cells
  2. keratin
  3. highly invasive; obstructs bronchus; occasionally cavitates with central necrosis
  4. late
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15
Q
  1. From what cells do small cell lung cancers arise?
  2. what is the histology of these cancers?
  3. What do these tumours produce? What is the effect of this?
  4. when do these cancers tend to spread?
A
  1. neuroendocrine cells
  2. crowded small cells with hyperchromatic nuclei and sparse cytoplasm
  3. polypeptide hormones; gives this tumour paraneoplastic syndrome association
  4. early
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16
Q
  1. How is small cell lung cancer usually treated?

2. How is non-small cell cancer usually treated??

A
  1. Chemotherapy (often due to early metastasis)

2. radiotherapy and surgery

17
Q
  1. What is malignant mesothelioma?

2. What are most cases of malignant mesothelioma caused by?

A
  1. malignancy of the pleura

2. asbestos exposure

18
Q
  1. What are serpentine asbestos fibres?
  2. What are amosite asbestos fibres?
  3. Rank the fibres in terms of potency
A
  1. long, curly, white fibres
  2. straight, rigid fibres. Brown (amosite) or Blue (crocidolite)
  3. crocodolite > amosite > chrysotile
19
Q

Name 9 clinical presentations of malignant mesotheliomas

A
  1. SOB
  2. Chest Pain
  3. Cough
  4. Weakness
  5. fatigue
  6. weight loss
  7. fullness in chest
  8. fever
  9. pleurisy
20
Q
  1. What is pleurdesis?
  2. What does it prevent?
  3. What is the prognosis of malignant mesothelioma?
A
  1. instilling a sclerosing agent into the pleural cavity, causing chemical irritation leading to pleuritis, and obliteration of the pleural cavitiy
  2. pleural effusion
  3. poor. 50% 1 year survival. Rarely survuve more than 2 years.
21
Q

Which antibody is present in the airways and involved in the respiratory defence mechanism

A

IgA

22
Q

Name normal commensal organisms present in the:

  1. nasal cavity
  2. pharynx/larynx
  3. lower resp tract
A
  1. S. aureus, coagulase negative staph; Viridian’s strep
  2. S. aureus, coagulase negative staph; Viridian’s strep, Neisseria, strep pneumonia, H. influenzae
  3. minimal bacterial colonisation
23
Q
  1. Which is the commonest cause of pneumonia
  2. which bacteria is a common cause of acute bronchitis and exacerbations of COPD
  3. Name 4 other pathogenic bacteria of the Lower resp tract
A
  1. S. pneumoniae
  2. H. influenzae
  3. S. aureus
    Legionella pneumophilia
    Mycoplasma pneumoniae
    Chlamydophilia pneumoniae
24
Q
  1. Name 2 pathogenic fungi of the respiratory tract

2. name a pathogenic mycobacterium that can affect the respiratory tract

A
  1. aspergillus
    pneumocystis jjrovecii
  2. mycobacterium tuberculosis
25
Q
  1. What is lobar pneumonia?
  2. What organisms cause lobar pneumonia?
  3. What is bronchopneumonia?
A
  1. Pneumonia involving a large/continuous area of the lobe
  2. S. pneumonia or klebsiella
  3. inflammation of the bronchial walls, with multiple foci of consolidation
26
Q
  1. Which organisms cause generalised interstitial changes?

2. Which organisms cause cavitating pneumonia?

A
  1. atypical bacteria, viruses, pneumocystis jjrovecii

2. S aureus, klebsiella, mycobacteria

27
Q
  1. What is the common presentation of community acquired pneumonia in the elderly?
  2. What is the presentation of Legionnaire’s disease?
  3. How is legionnaire’s disease treated?
  4. What is the presentation of mycoplasma pneumoniae infection?
  5. How is it treated?
A
  1. subtle presentation. Altered mental state, abdo pain common
  2. extrapulmonary findings - fever, diarrhoea, headaches etc
  3. macrolide or quinolone - penicillins don’t work
  4. URT symptoms
  5. macrolide or tetracycline
28
Q

Which organisms cause Hospital Acquired Pneumonia?

A

gram negative aerobes - gut bacteria

29
Q

Name 5 populations where tuberculosis is concentrated

A
  1. the urban poor
  2. alcoholics
  3. intravenous drug users
  4. homeless
  5. prison inmates
30
Q
  1. Which immune cells does tuberculosis grow inside?
  2. How does the bacteria evade normal immune responses?
  3. Are M. tuberculosis aerobic or anaerobic?
  4. How is tuberculosis transmitted?
A
  1. alveolar macrophages
  2. mycolic acid cell wall prevents phagosome fusion with lysosome
  3. strict aerobes
  4. inhalation of droplet nuclei
31
Q
  1. What type of hypersensitivity occurs towards tuberculosis infection?
  2. What is the result of this hypersensitivity reaction?
  3. How is this implicated in HIV?
A
  1. Type IV
  2. produce necrosis
  3. CD4+ cells, which mediate this type of hypersensitivity, which is important in the immune response against TB, are depleted.
32
Q
  1. What structures are formed as part of the immune response to TB?
  2. What is the organisation of these structures when antigen load is low?
  3. What happens to these structures when the antigen load is high?
A
  1. granuloma
  2. lymphocytes and macrophages are organised. Langhan’s giant cells, fibroblasts and capilaries result in formation of granuloma
  3. lymphocytes, macrophages and granulocytes are less organised. Caseating necrosis may be present
33
Q
  1. What is the primary focus of TB infection contained by a granuloma called?
  2. Which lymph nodes tend to be implicated in TB?
  3. What is miliary TB?
  4. What is the pattern seen on a CXR in milliary TB?
A
  1. Gohn focus
  2. Hilar and mediastinal
  3. wide disemination of TB into the body via the blood
  4. many tiny spots distributed throughout the lung fields
34
Q

Name symptoms of TB

A
  1. productive, prolonged cough for 3+ weeks
  2. chest pain
  3. Haemoptysis
  4. Systemic symptoms - night sweats, fever, appetite loss, weight loss, fatigue
35
Q
  1. Which test is more specific to TB than the mantoux test?

2. What does this test measure?

A
  1. IFN-gamma test
  2. Measures cell mediated immune response by quantifying the IFN-gamma released by T cells in response to stimulation by M. Tuberculosis antigens
36
Q

What is the MOA of the first line drugs for TB:

  1. Isonazid
  2. Rifampicin
  3. Pyrazinamide
  4. Ethambutol
  5. Which drug has many interractions and why?
A
  1. inhibits cell wall synthesis
  2. inhibits RNA synthesis
  3. disrupts plasma membrane and cellular metabolism
  4. inhibits cell wall synthesis
  5. Rifampicin (induces CP350 enzymes)
37
Q
  1. What is multi-drug resistant TB?

2. Name some second line drugs used to treat TB

A
  1. TB resistant to isonazid and rifampicin

2. -mycins and -floxacins

HYMS Block 13 (4 decks)

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