Resp Flashcards
which lung cancer has the strongest association with smoking
squamous cell carcinoma ( NSCLC)
what are the potential consequences of desmoid tumours ( fibrous growths) in retroperitoneal space
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
what are the 5 categories of lung cancer
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%)
what is the difference in location between squamous cell lung carcinomas and lung adenocarcinomas
squamous cell - close to large airways “lung nodule in close proximity to his left main bronchus.”
adenocarcinomas: peripheral lung
which type of lung cancer is a diagnosis of exclusion
large cell lung cancer
which type of lung cancer metastisises early, is associates with para-neoplastic syndromes and is found near the larger airways?
squamous cell carcinoma
what lung csncer is associated with an electrolyte disturbance
squamous cell
paraneoplastic syndrome –>
releases parathyroid hormone-related protein ( PTHrP) –> hypercalcaemia
ADH –> SIADH –> hyponatraemia
which lung cancer is most strongly assocaited with finger clubbing
squamous cell cancer
which lung cancer is most associated with cavitating lesions
squamous cell carcinoma
which lung cancer is most common in non-smokers
adenocarcinomas
(most non-smokers –> adenocarcinoma, but most adenocarcinomas are from smokers)
give 2 types of lung cancers that are located peripherally in the lung
adenocarcinoma
large cell lung carcinoma
( SCC is central, near the large airways)
which lung cancer secretes β-hCG
large cell lung cancer
what lung cancer has poorly differentiated tummours & poor prognosis
large cell lung carcinoma
which lung cancer is strongly linkedt to asbestos
mesothelioma ( mesothelial cells of pleura)
latent period - approx 45 yrs
poor prognosis
what are the features of lung cancer
- 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
phrenic nerve palsy is an extrapulmonary manifestation of lung cancer, how does it present
diaphragm weakness & SOB
caused by compression on the phrenic nerve
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
superior vena cava compression
SVC compression = medical emergency
pembertons sign
in SVC compression in lung cancer, raising hands over the head causes facial congestion & cyanosis
SVC compression = medical emergency
what is the name of the lung cancer which causes Horner’s syndrome
Pancoast tumour ( tumour in pulmonary apex pressive on sympathetic gaglion)
give 3 things that small cell lung cancer secreats
parathyroid- like peptide hormone ( causes hypercalcaemia)
ADH ( causes SIADH -hyponatraemia)
ACTH –> cushings syndrome
what neurological paraneoplastic syndrome occurs in lung cancer and how does it present
limbic encephalitis
antibodies to brain tissue (limbic system)–> inflammation –> short term memory impairment
- hallucinations
- confusion
- seizures
what antibodies are associated with limbic encephalitis
anti-Hu antibodies
(limbic encephalitis = paraneoplastic syndrome of the brain resulting in short-term memory impairment, hallucinations, confusion, seizures
what neurological condition ( not limbic encephalitis) may occur in lung cancer
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)
NICE: offer CXray within 2 wks in pts >40 with (x5 features)
- 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
1st lune Ix in lung cancer
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
1st line Tx in NSCLC (isolated to 1 area)
surgery
radio/chemo offered as aduvants
Tx in SCLC
chemo/radio
(surgery mostly for NSCLC)
Pneumonia with lymphopenia, hyponatraemia & deranged LFTs suggests
legionella
what are the 3 pneumonia classifications
CAP - community acquired
HAP >48hrs of being in hospital
VAP - intubated on ICU ( Ventilator-acquired
give 3 chest signs of pneumonia on examination
Bronchial breath sounds ( harsh insp/expiratory breath sounds
focal coarse crackles
dullness to percussion ( lung tissue filled with sputum/ collapsed0
what are is the scorign system used to determin adx in pneumonia
CURB 65
confusion
urea >6mmol
RR >/=30
BP <90
>/=65
interpreting the CURB-65 score
- Score 0/1: at home
- Score ≥ 2: hospital admission
- Score ≥ 3: intensive care
what is atypical pneumonia
pneumonia caused by organisms which cannot be cultured in the normal way/detected using a gram stain
what tx is used in atypical pneumonia
(typical - penecillin)
atypical
macrolides, fluoroquinolones (levofloxacin)
tetracyclines (doxycycline)
which organism is associated with
cavitating lesion on CXRay in pneumonia presentation?
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
what are the 2 most common causes of bacterial pneumonia
strep. pneumonia ( most common- 80%)
H. influenza
what 2 causes of pneumonia are more likely in immunocompromised pts
Morexella catarrhalis
pcp
What causative organisms are associated with pneumonia in pts with CF
Pseudomonas aeruginosa ( CF & bronchiectasis)
Staph. aureus ( causes cavitating lesions, most common after influenza infection )
what organisms are associated with CAP
strep pneumonia ( pneumococcus - most common)
H. influenza
Staph. aureus
atypical pneumonias
viruses
what organism is most associated with pneumonia in alcoholics
Klebsiella pneumoniae
what are the characteristic features of pneumococcal pneumonia
rapid onset
high fever
pleuritic chest pain
herpes labialis ( cold sores)
give 2 common causes of legionella
-inhaling infected water ( e.g. air conditioning units)
what endo condition can legionella cause
SIADH (low sodium)
typical exam patient has recently had a cheap hotel holiday and presents with pneumonia symptoms and hyponatraemia ( lymphopenia, hyponatraemia & deranged LFTs)
what are the features of pneumonoia caused by mycoplasa pneumoniae
mild pneumonia
erythema multiform ( varying-sized target lesions (pink rings with pale centres)) which causes neuro Sx in young pts
what are the featurees of pneumonia by chlamydophila pneumniae
mild-mod chronic pneumonia and wheezing in school-aged children
what causes Coxiella burnetii pneumonia ( atypical pneumonia)
body fluids of animals
typical example - farmer with flu-like illness
what causes Chlamydia psittaci i pneumonia ( atypical pneumonia)
contact with infected birds
typical pt: parrot owner
give the 5 causes of atypical pneumonia
“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)
pneumonia with anosmia suggests
COVID-19
pts may have silent bhypoxia (low sats w/o SOB
tx of COVID-19 pneumonia
resp support
dex
monoclonal ab
Tx for mild CAP
5days oral Abx
( amoxicillin/doxycycline/ clarithromycin)
FEV1 and FVC in obstructive vs restrictive lung disease
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)
low FVC AND low FEV1:FVC ratio indicates….
combined obstructive and restrictive lung disease
