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Its the final countdown > Resp > Flashcards

Resp Flashcards

1
Q

which lung cancer has the strongest association with smoking

A

squamous cell carcinoma ( NSCLC)

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2
Q

what are the potential consequences of desmoid tumours ( fibrous growths) in retroperitoneal space

A

compression of surrounding structures

invasion into surrounding structures

S: suprarenal (adrenal) gland
A: aorta/IVC
D: duodenum (second and third part)
P: pancreas (except tail)
U: ureters
C: colon (ascending and descending)
K: kidneys
E: (o)oesophagus
R: rectum

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3
Q

what are the 5 categories of lung cancer

A

1) small-cell lung cancer (SCLC) - 20%

non-small-cell lung cancer ( 80%
2 Adenocarcinoma (40%)
3 Squamous cell carcinoma (20%)
4 large cell carcinoma (10%)
5 other (10%)

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4
Q

what is the difference in location between squamous cell lung carcinomas and lung adenocarcinomas

A

squamous cell - close to large airways “lung nodule in close proximity to his left main bronchus.”

adenocarcinomas: peripheral lung

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5
Q

which type of lung cancer is a diagnosis of exclusion

A

large cell lung cancer

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6
Q

which type of lung cancer metastisises early, is associates with para-neoplastic syndromes and is found near the larger airways?

A

squamous cell carcinoma

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7
Q

what lung csncer is associated with an electrolyte disturbance

A

squamous cell

paraneoplastic syndrome –>

releases parathyroid hormone-related protein ( PTHrP) –> hypercalcaemia

ADH –> SIADH –> hyponatraemia

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8
Q

which lung cancer is most strongly assocaited with finger clubbing

A

squamous cell cancer

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9
Q

which lung cancer is most associated with cavitating lesions

A

squamous cell carcinoma

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10
Q

which lung cancer is most common in non-smokers

A

adenocarcinomas

(most non-smokers –> adenocarcinoma, but most adenocarcinomas are from smokers)

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11
Q

give 2 types of lung cancers that are located peripherally in the lung

A

adenocarcinoma
large cell lung carcinoma

( SCC is central, near the large airways)

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12
Q

which lung cancer secretes β-hCG

A

large cell lung cancer

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13
Q

what lung cancer has poorly differentiated tummours & poor prognosis

A

large cell lung carcinoma

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14
Q

which lung cancer is strongly linkedt to asbestos

A

mesothelioma ( mesothelial cells of pleura)

latent period - approx 45 yrs
poor prognosis

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15
Q

what are the features of lung cancer

A
  • Shortness of breath
  • Cough
  • Haemoptysis (coughing up blood)
  • Finger clubbing
  • Recurrent pneumonia
  • Weight loss
  • Lymphadenopathy – often supraclavicular nodes are the first to be found on examination
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16
Q

phrenic nerve palsy is an extrapulmonary manifestation of lung cancer, how does it present

A

diaphragm weakness & SOB

caused by compression on the phrenic nerve

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17
Q

pt with history of lung cancer presents with facial swelling and difficulty breathing. the neck is distended, and so ar =e the uper chest veins. what complication has coccured

A

superior vena cava compression

SVC compression = medical emergency

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18
Q

pembertons sign

A

in SVC compression in lung cancer, raising hands over the head causes facial congestion & cyanosis

SVC compression = medical emergency

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19
Q

what is the name of the lung cancer which causes Horner’s syndrome

A

Pancoast tumour ( tumour in pulmonary apex pressive on sympathetic gaglion)

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20
Q

give 3 things that small cell lung cancer secreats

A

parathyroid- like peptide hormone ( causes hypercalcaemia)

ADH ( causes SIADH -hyponatraemia)

ACTH –> cushings syndrome

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21
Q

what neurological paraneoplastic syndrome occurs in lung cancer and how does it present

A

limbic encephalitis

antibodies to brain tissue (limbic system)–> inflammation –> short term memory impairment
- hallucinations
- confusion
- seizures

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22
Q

what antibodies are associated with limbic encephalitis

A

anti-Hu antibodies

(limbic encephalitis = paraneoplastic syndrome of the brain resulting in short-term memory impairment, hallucinations, confusion, seizures

23
Q

what neurological condition ( not limbic encephalitis) may occur in lung cancer

A

lambert-eaton myasthenic syndrome

Abs against small-cell lung cancer cells

also damage voltage-gated Ca 2+ chnnels in presynaptic terminals in motor neurones –> proximal muscle weakness, intraocular muscle weakness ( diplopia), levator muscle weakness (prtosis), pharyngeal muscle weakness (slurred speech/dysphagia), autonomic dysfunction (dry mouth, blurred vision, impotence, dizziness)

24
Q

NICE: offer CXray within 2 wks in pts >40 with (x5 features)

A
  • Clubbing
  • Lymphadenopathy (supraclavicular or persistent abnormal cervical nodes)
  • Recurrent/ persistent chest infections
  • Raised platelet count (thrombocytosis)
  • Chest signs of lung cancer

*finger clubbing,, supraclavicular lymphadenopathy - key to remember

25
Q

1st lune Ix in lung cancer

A

CXRay

may find
- hilar enlargment (mid, central chest) unilateral/assymetrical =? malignancy (bilateral typical of sarcoidosis)
- peripheral opacity (visble lesion)
- pleural effusion (unilateral in cancer)
- collapse

26
Q

1st line Tx in NSCLC (isolated to 1 area)

A

surgery

radio/chemo offered as aduvants

27
Q

Tx in SCLC

A

chemo/radio

(surgery mostly for NSCLC)

28
Q

Pneumonia with lymphopenia, hyponatraemia & deranged LFTs suggests

A

legionella

29
Q

what are the 3 pneumonia classifications

A

CAP - community acquired

HAP >48hrs of being in hospital

VAP - intubated on ICU ( Ventilator-acquired

30
Q

give 3 chest signs of pneumonia on examination

A

Bronchial breath sounds ( harsh insp/expiratory breath sounds

focal coarse crackles

dullness to percussion ( lung tissue filled with sputum/ collapsed0

31
Q

what are is the scorign system used to determin adx in pneumonia

A

CURB 65
confusion
urea >6mmol
RR >/=30
BP <90
>/=65

32
Q

interpreting the CURB-65 score

A
  • Score 0/1: at home
  • Score ≥ 2: hospital admission
  • Score ≥ 3: intensive care
33
Q

what is atypical pneumonia

A

pneumonia caused by organisms which cannot be cultured in the normal way/detected using a gram stain

34
Q

what tx is used in atypical pneumonia

A

(typical - penecillin)

atypical
macrolides, fluoroquinolones (levofloxacin)

tetracyclines (doxycycline)

35
Q

which organism is associated with
cavitating lesion on CXRay in pneumonia presentation?

A

staph. aureus

cavitating lesion: hollow, air-filled space within the lung parenchyma.

Staphylococcus aureus -propensity for causing abscesses and cavitating lesions within the lung tissue

36
Q

what are the 2 most common causes of bacterial pneumonia

A

strep. pneumonia ( most common- 80%)

H. influenza

37
Q

what 2 causes of pneumonia are more likely in immunocompromised pts

A

Morexella catarrhalis
pcp

38
Q

What causative organisms are associated with pneumonia in pts with CF

A

Pseudomonas aeruginosa ( CF & bronchiectasis)

Staph. aureus ( causes cavitating lesions, most common after influenza infection )

39
Q

what organisms are associated with CAP

A

strep pneumonia ( pneumococcus - most common)

H. influenza
Staph. aureus
atypical pneumonias
viruses

40
Q

what organism is most associated with pneumonia in alcoholics

A

Klebsiella pneumoniae

41
Q

what are the characteristic features of pneumococcal pneumonia

A

rapid onset
high fever
pleuritic chest pain
herpes labialis ( cold sores)

42
Q
A
43
Q

give 2 common causes of legionella

A

-inhaling infected water ( e.g. air conditioning units)

44
Q

what endo condition can legionella cause

A

SIADH (low sodium)

typical exam patient has recently had a cheap hotel holiday and presents with pneumonia symptoms and hyponatraemia ( lymphopenia, hyponatraemia & deranged LFTs)

45
Q

what are the features of pneumonoia caused by mycoplasa pneumoniae

A

mild pneumonia

erythema multiform ( varying-sized target lesions (pink rings with pale centres)) which causes neuro Sx in young pts

46
Q

what are the featurees of pneumonia by chlamydophila pneumniae

A

mild-mod chronic pneumonia and wheezing in school-aged children

47
Q

what causes Coxiella burnetii pneumonia ( atypical pneumonia)

A

body fluids of animals

typical example - farmer with flu-like illness

48
Q

what causes Chlamydia psittaci i pneumonia ( atypical pneumonia)

A

contact with infected birds

typical pt: parrot owner

49
Q

give the 5 causes of atypical pneumonia

A

“legions of psittaci MCQs)

  • Legions – Legionella pneumophila (hyponatraemia, air conditioning)
  • Psittaci – Chlamydia psittaci (infected birds eg parrots)
  • M – Mycoplasma pneumoniae (erythema multiform - target lesions)
  • C – Chlamydophila pneumoniae (children, chronic pneumonia & wheeze)
  • Qs – Q fever (coxiella burnetii - bodily fluids of animals)
50
Q

pneumonia with anosmia suggests

A

COVID-19

pts may have silent bhypoxia (low sats w/o SOB

51
Q

tx of COVID-19 pneumonia

A

resp support
dex
monoclonal ab

52
Q

Tx for mild CAP

A

5days oral Abx

( amoxicillin/doxycycline/ clarithromycin)

53
Q

FEV1 and FVC in obstructive vs restrictive lung disease

A

obstructive disease
FEV1:FVC ratio <70% (FEV1 - forced expiratory is slowed in obstruction hence <70% of FVC - the total)

restrictive
FEV1:FVC are equally reduced ( so FEV1:FVC ratio >70% e.g. FEV1 0.62l and FVC 0.64l)

obstructive lung disease - OBSTRUCTION of air OUTFLOW

restrictive lung disease - RESTRICTED expansion of lungs OR chest wall ( so FEV1 & FVC poor)

54
Q

low FVC AND low FEV1:FVC ratio indicates….

A

combined obstructive and restrictive lung disease

Its the final countdown (23 decks)

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