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Old curriculum > Resp 7 lung cancer and tb > Flashcards

Resp 7 lung cancer and tb Flashcards

1
Q

What are the main imaging techniques used in lung cancer ?

A

Chest X-ray
CT scan NB staging CT = extends down to kidney region
PET - to check for distant metastases

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2
Q

What imaging techniques are sometimes used in lung cancer ?

A

MRI
Ultra sound scan
Bone scan
ECHO

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3
Q

Where is lung cancer likely to spread to?

A 
Lung, pericardium, pleura, draining lymph nodes
Brain 
Bone 
Liver
Adrenals
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4
Q

What methods are used for tissue sampling of suspected metastases ?

A

Bronchoscopy
Ultrasound scan
CT biopsy
Thorocoscopy

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5
Q

List the types of lung cancer (classified histologically)

A

Small cell carcinoma

Non small cell carcinoma:
Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma

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6
Q

What treatments are indicated for each histological tumour type? Describe the prognosis

A

Non small cell carcinoma

  • surgery - 20-25% operable - best chance of cure
  • otherwise combination chemotherapy - modest survival increase, symptom control

Small cell
- chemotherapy - potentially curative in a minority

Other treatments -
Combination chemoradiotherapy - potentially curative in a minority
Palliative care - NB can have greater survival time than chemo ( rduced infection risk etc) + better quality of life

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7
Q

Typical pattern of symptoms in lung cancer

1. Those caused by primary tumour

A

Commonly no symptoms until late stage

Respiratory :
Cough
Dysponea
Wheezing
Haemoptysis - coughing blood

Chest & shoulder pain
Lethargy / Malaise
Weight loss

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8
Q

Typical pattern of symptoms in lung cancer

  1. Those caused by metastases and metabolic changes
A

Bloated face - SVC obstruction
Hoarseness - left recurrent laryngeal n. palsy
Dysponea - anaemia, pleural or pericardial effusions
Dysphagia - oesophageal compression
Chest pain - parietal pleural involvement
Bone pain / fractures
CNS symptoms (blurred vision, confusion, headaches etc)

Seizures (hyponatreamia)
Thirst & constipation (hyperkaleamia)

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9
Q

Aetiological factors in lung cancer

A 
Smoking!! - 80% of cases 
Asbestos
Radon
Occupational carcinogens - chromium, nickel & arsenic 
Genetic factors
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10
Q

Clinical signs in lung cancer

A

Often no signs

Consolidation
Signs of pleural effusion 
Cervical (neck) lymphadenopathy 
Liver enlargement 
Finger clubbing
Cachexia
Muffled heart sounds 
Pale conjunctiva 
Horner's syndrome
Skin metastases
Neurological long tract signs
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11
Q

What group/s have highest incidence of lung cancer ?

Not simply smokers

A

Least affluent socio economic groups

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12
Q

What is the first line treatment for TB?

A 
Multi drug regimen :
Rifampicin 
Isoniazid
Pyrazinamide
Ethambutol
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13
Q

What are the symptoms of pulmonary TB?

A 
Cough
Night sweats
Fever
Weight loss & anorexia 
Tiredness & malaise

Breathlessness if pleural effusion
Occasionally haemoptysis

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14
Q

What investigations are indicated in suspected TB?

A

NB notifiable disease!

Chest X-ray

Sputum - 3 early am samples, min 5ml
Or induced sputum
Or bronchoscopy - pts w/ dry cough

HIV test

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15
Q

What are the radiological signs of TB?

A

Commonly apex of lung
Patchy consolidation
Caviation (black area with white border)
May see white areas of pleural effusion

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16
Q

What laboratory tests are used in cases of suspected active TB?

A

NB notifiable disease !

Ziehl Neelsen stain - stain pink (blue background)
Auramine stain - stain yellow ( black background - fluorescent stain)
Also nucleic acid amplification test

HIV test

17
Q

Describe the test used for diagnosis of latent TB

A

Mantoux test
Tuberculin injected intradermally
Size of induration measure 2-3 days later

NB false positives (BCG, other mycobacterium)
And false negatives (Immunosuppression)

18
Q

Describe in principle the TMN staging system

A

T - size, location and number of nodes
N- number of lymph nodes affected
M - metastasis - local intra thoracic or disseminated

19
Q

What groups are at highest risk of TB in the UK?

A

Non UK born
Immunocompromised
Young adults

Homeless
Drug users
Prisoners

20
Q

Describe relationship between HIV and TB

A

HIV at risk group as immunocompromised
Also at higher risk of reactivation in latent infection
Also extra pulmonary TB more likely

All confirmed and suspected cases of TB must have HIV test

21
Q

What are the side effects of the multi drug regimen for TB?

A

Rifampicin -
raised transaminases & induces cytochrome p450
orange secretions

Isoniazid -
peripheral neuropathy
Hepatotoxicity

Pyrazinamide -
hepatotoxicity

Ethambutol -
visual disturbances

22
Q

Describe microbiology of TB

A

Mycobacterium tuberculosis :

Non motile & rod shaped

Cell wall contains lots of long chain fatty acids, complex waxes and glycolipids -> can replicate inside macrophages, structural rigidity, acid & alcohol fast, staining characteristics

Relatively slow growing

23
Q

Describe the pathogenosis of TB from primary infection to primary disease or latent TB.

A 
Inhaled aerosol 
-> engulfed by alveolar macrophages 
-> local lymph nodes 
-> forms primary complex 
Which generally resolves via containment of the infection by the immune system (->latent disease) but can lead to primary disease
24
Q

Describe what is seen in latent TB

A

Not much - not a case of TB, not infectious
(Negative CXR, sputum smears & cultures, no symptoms or signs)
But usually positive TST or IFN gamma result

25
Q

Describe the outcomes of latent TB infection

A

Most resolve - self heal

Some (often immunosuppressed - see risk factors flashcard) have reactivation and develop post primary TB (this can also be caused by exogenous reinfection)
Generally > 5 years after exposure but can be less in immunosuppressed pts

26
Q

Describe the risk factors for reactivation of latent TB

A

HIV
Substance abuse
Immunosuppressive therapy - prolonged corticosteroids etc
TNF-alpha antagonists (used for autoimmune conditions)
Organ transplant
Haematological malignancy

Severe kidney disease
Low body weight
Diabetes mellitus
Silicosis ( lung fibrosis due to silica inhalation)

27
Q

Describe the pathology of TB (NB MoD)

A

Caseating granuloma :
Epitheliod cells (modified immobile macrophages)
Giant Langhans cells (peripheral nuclei)

28
Q

List signs of paraneoplastic syndromes in lung cancer

A

Haematological - anaemia, thrombocytosis
Skeletal - finger clubbing
Endocrine - hypercalceamia (squamous cell), Cushing’s (small cell), SIADH
Neurological - peripheral neuropathy, encephalopathy, Eaton-Lamert syndrome (auto-immune muscle weakness)
Skin - dermatomyositis

29
Q

Describe the behaviour of small cell lung cancer

A

Aggressive, rapid growth, early spread to distant sites
Often causes paraneoplastic syndromes
Sensitive to chemo-and radio- therapies

Old curriculum (12 decks)

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