Resp Flashcards
which type of lung cancer is most common in people who have never smoked?
Adenocarcinoma
Cause of a hoarse voice in a lung cancer patient?
Recurrent laryngeal nerve palsy
- What are the components of Horner’s syndrome?
- What type of cancer is associated with Horner’s syndrome?
- Ptosis, Miosis, Anhidrosis
- Pancoast tumour at apex of lung (usually non-small cell)
what are the three main types of lung cancer?
Adenocarcinoma (40%)
Squamous cell carcinoma (20%)
Small cell lung cancer (20%)
diaphragmatic weakness and shortness of breath in lung cancer is caused by…
Phrenic nerve palsy- due to nerve compression
Lung cancer patient presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest.
1. Diagnosis?
2. name of sign when raising hands over head causes facial congestion and cyanosis?
- Superior vena cava obstruction
- Pemberton’s sign- this is a medical emergency
Hyponatraemia in a patient with lung cancer could be due to…
SIADH, ectopic ADH secretion by a SCLC
Cushing’s syndrome in a patient with lung cancer could be due to…
Ectopic ACTH secretion by a SCLC
Hypercalcaemia in a lung cancer patient could be due to
ectopic PTH secretion from a squamous cell carcinoma
lung cancer patient presents with short term memory impairment, hallucinations, confusion and seizures.
1. Diagnosis?
2. pathology
- Limbic encephalitis
- Small cell lung cancer causes immune system to make antibodies to tissues in the limbic system of the brain. Associated with Anti-Hu antibodies
Patient with lung cancer presents with weakness of the proximal muscles, diplopia, slurred speech/dysphagia
1. Diagnosis?
2. Pathology
- Lambert Eaton Myasthenic syndrome
- Small cell lung cancer causes immune system to produce antibodies which target and damage voltage-gated calcium channels on the pre-synaptic terminals of motor neurones
Lung cancer investigations:
1. First line investigation (and findings?)
2. Investigation for histological diagnosis
3. scan for increased metabolic activity in metastases?
- CXR, findings can include
- hilar enlargement
- ‘peripheral opacity’ - lesion visible in the lung field
- pleural effusion
- collapse - Histological diagnosis is by Bronchoscopy with Endobrachial Ultrasound (ultrasound guided biopsy)
- PET-CT scan
- management- small cell lung cancer
- Prognosis better or worse than non-small cell?
- Chemotherapy and radiotherapy
- worse
- Management of non-small cell lung cancer
- Surgery is offered first line where the lung cancer is isolated to a single area. Lobectomy=first line
- Radiotherapy can be curative if done early enough
- cancer most commonly associated with ‘cannonball metastases’ in the lung?
- Other associated cancers?
- Renal Cell cancer
- breast, colorectal, prostate and bladder
criteria for diagnosis of pneumonia
(1) clinical presentation of lower respiratory tract symptoms
AND
(2) focal chest signs (e.g. crackles) OR unexplained CXR shadowing
most common cause of CAP
strep pneumoniae (80% of cases)
most common cause of pneumonia in patients with COPD
H. Influenzae
most common cause of pneumonia in patients following influenza infection
Staph Aureus
- pneumonia which occurs secondary to infected air conditioning units. 2. Signs?
- Legionella pneumophiliae
- Hyponatraemia and lymphopenia
pneumonia typically seen in Alcoholics
Klebsiella pneumoniae
pneumonia seen in HIV patients.
Presents with dry cough, exercise induced destaturations and absence of chest signs
Pneumocytis Jivorecii
pneumonia seen in those around birds
chlamydia psittaci
management- hospital acquired pneumonia
- non-severe
- Severe
- If MRSA is suspected
- If non-severe, co-amoxiclav. (doxycycline if penicillin allergic)
- If severe, treat with Piperacillin with Tazobactam (alternatives: Meropenem, cefuroxime, ceftriaxone)
- Add Vancomycin
management- community acquired pneumonia
- mild/moderate
- severe
- Amoxicillin PO 5 days
Clarithro/doxy if penicillin allergic
Clarithro if atypical cause - 7-10 days dual abx therapy with (1) a stable beta lactamase (co-amoxiclav, ceftriaxone) AND (2) a macrolide (clarithromycin)
management options for aspiration pneumonia
clindamycin, levofloxacin, pip+taz
scoring system for severity of pneumonia + interpretation of scores in primary care
CURB 65
Confusion
(Urea >7- only used in secondary care)
RR greater than or equal to 30
BP: systolic less than 90 or diastolic less than 60
age 65
0= low risk
1-2= intermediate risk- consider hospital assessment
3-4= high risk (mortality risk 10%), urgent hospital admission
interpretation of CURB65 scores in hospital setting
0 or 1= home based care
2= ward based care
3+ = consider intensive care treatment
cause of pneumonia most commonly associated with a farmer with Q fever
Coxiella burnetti (treat with Doxy)
cause of pneumonia most commonly associated with a chronic wheezy child
Chlamydophilia (treat with Doxy or Azithromycin)