Main resp. diseases

Question 1

Lung cancer is the third most common cancer in the UK behind which other cancers

Answer 1

breast and cancer

Question 2

non small cell lung cancer is around 20%

Answer 2

no 80%

Question 3

which three nsclc are there

Answer 3

adenocarcinoma
squamous cell carcinoma
large-cell carcinoma

Question 4

why is SCLC responsible for multiple paraneoplastic syndromes

Answer 4

contain neurosecretory granules that can release neuro-endocrine hormones

Question 5

4 symptoms of lung cancer

Answer 5

Shortness of breath
Cough
Haemoptysis
Weight loss

Question 6

Signs of lung cancer

Answer 6

finger clubbing
recurrent pneumonia
wight loss
lymphadenopathy (supraclavicular nodes first to be found on examination)

Question 7

5 investigations for lung cancer

Answer 7

CXR
CT
PET-CT
Bronchoscopy
Histological diagnosis

Question 8

What’s first line investigation for lung cancer

Answer 8

CXR

Question 9

What are you looking for in a CXR for lung cancer? (4)

Answer 9

Hilar enlargement
Peripheral opacity
Pleural effusion
Collapse

Question 10

What’s the CT for lung cancer?

Answer 10

contrast enhanced for lymph node involvement and metastasis

Question 11

Lung cancer, why PET-CT

Answer 11

Has radioactive tracer- attaches to glucose molecules, to see how metabolically active tissues are

Question 12

Why bronchoscopy with EBUS (endobronchial ultrasound) in lung cancer

Answer 12

Detailed assessment of tumor and ultrasound guided biopsy

Question 13

Histological diagnosis- why in lung cancer

Answer 13

Of biopsy, from bronchoscopy or percutaneous. Is it small cell or non-small cell?

Question 14

Treatment options for small cell lung cancer

Answer 14

Radiotherapy and chemotherapy

prognosis rubbish

Question 15

Treatment options for nsclc? (3)

Answer 15

First line = surgery such as lobectomy, segmentectomy, wedge resection

If early enough, radiotherapy

Chemo as adjuvant, or palliative for qol

Question 16

Otherwise asymptomatic patients in lung cancer could have evidence if:

Answer 16

paraneoplastic syndromes
extra-pulmonary manifestations

Question 17

4 examples of extra-pulmonary manifestations of lung cancer

Answer 17

1) recurrent laryngeal nerve palsy (due to tumor)
2) phrenic nerve palsy- nerve compression, diaphragm weakness and SOB
3) superior vena cava obstruction = tumor on it, facial swelling, SOB, distended veins in neck
4) horners syndrome from pancoast tumour on sympathetic ganglion

Question 18

Someone has lung cancer. They raise their hands, and there is facial congestion and cyanosis. Why?

Answer 18

emergency. Pressing on svc

Question 19

what is mesathelioma

Answer 19

affects meothelial cells of the pleura

Question 20

mesothelioma is strongly linked to what

Answer 20

asbestos inhalation

Question 21

latent period in mesothelioma can be how long

Answer 21

even up to 45 years

Question 22

why chemo in mesothelioma

Answer 22

to improve survival, but it is essentially palliative

Question 23

What is pneumonia

Answer 23

infection of the lung tissue

Question 24

what does pneumonia cause

Answer 24

inflammation, sputum filling the airways and alveoli

Question 25

Pneumonia can be seen as what on the CXR

Answer 25

consolidation

Question 26

Would haemoptysis ever present in pneumonia?

Answer 26

Yes

Question 27

6 ways pneumonia presents

Answer 27

SoB Cough productive of sputum Fever Haemoptysis Pleuritic chest pain Delirium

Question 28

Complication of pneumonia 5 incl death

Answer 28

sepsis pleural effusion empyema lung abscess death

Question 29

whats delirium

Answer 29

acute confusion associated with infection

Question 30

Pleuritic chest pain is worse on expiration or inspiration

Answer 30

insp

Question 31

when might you see hypotension (shock) in pneumonia

Answer 31

sepsis

Question 32

signs of that may indicate sepsis secondary to pneumonia (3 groups of 2):

Answer 32

tachypnoea tachycardia hypoxia hypotension (shock) fever confusion

Question 33

3 examination chest signs of pneumonia:

Answer 33

1) bronchial breath sounds 2) focal coarse crackles 3) dullness to percussion

Question 34

You might find bronchial breath sounds with pneumonia. What is this caused by?

Answer 34

harsh breath sounds, equally loud on inspiration and expiration. Caused by consolidation of the lung tissue around the airway

Question 35

Focal coarse crackles can be heard in pneumonia. what causes this?

Answer 35

These are air passing through sputum in the airways similar to using a straw to blow in to a drink.

Question 36

Why hear dullness to percussion in pnunomia?

Answer 36

due to lung collapse and/or consolidation

Question 37

what's the CURB-65 used for

Answer 37

predicting mortality

Question 38

Curb-65 stands for

Answer 38

C- confusion (new) U- urea > 7 R- respiratory rate B- blood pressure < 90/60 65- older than 65

Question 39

curb score of 2 or more =

Answer 39

consider hospital treatment

Question 40

curb score of 3 or more

Answer 40

consider intensive care assessment

Question 41

2 common causes of pneumonia

Answer 41

streptococcus pneumoniae haemophilus influenzae

Question 42

would pneumonia ever be associated with cystic fibrosis and if so, what

Answer 42

staphylococcus aureus

Question 43

what don't atypical pneumonias respond to

Answer 43

penicillins

Question 44

definition of atypical pneumonia

Answer 44

cannot be detected using a gram stain, or be normally cultured

Question 45

three ways atypical pneumonia's can be treated

Answer 45

macrolides fluroquinolones tetracyclines

Question 46

Typical exam patient has recently had a cheap hotel holiday and presents with hyponatraemia (low sodium, vomiting, fatigue, headache, confusion) = what lung disease

Answer 46

pneumonia

Question 47

5 causes of atypical pneumonia: remember this mnemonic: legions of psittaci MCQs

Answer 47

M= mycoplasma pneumoniae C= chlamydydophila pneumoniae Qs= Q fever

Question 48

when might fungal pneumonia occur

Answer 48

in patients that are immunocompromised

Question 49

PCP pneumonia occurs in what patients

Answer 49

immunocompromised patients

Question 50

People with low CD4 counts are prescribed what to protect against PCP

Answer 50

prophylactic oral co-trimoxazole

Question 51

minimum investigations of pneumonia in community

Answer 51

CXR FBC for raised white cells U&Es for urea CRP (raised in inflammation and infection)

Question 52

Patients with moderate or severe cases of pneumonia should also have:

Answer 52

sputum cultures blood cultures legionella and pneumococcal urinary antigens

Question 53

inflammatory markers of pneumonia?

Answer 53

white blood cells CRP

Question 54

Patients that are immunocompromised may not show an inflammatory response and therefore

Answer 54

may not have raised inflammatory markers

Question 55

Antibiotics for pneumonia looks like?

Answer 55

Mild CAP: 5 day course of oral antibiotics (amoxicillin or macrolide) Moderate to severe CAP: 7-10 day course of dual antibiotics (amoxicillin and macrolide)

Question 56

pleural effusion

Answer 56

abnormal collection of fluid between pleura

Question 57

empyema

Answer 57

purulent fluid collection in the pleural space so basically an infected pleural effusion

Question 58

lung abscess vs empyema

Answer 58

lung abscess involves the lung parenchyma, whereas an empyema involves the pleural space