Resp - Bronchiectasis, Lung Cancer, Pulmonary Function Tests Flashcards
Bonchiectasis - what is it?
Irreversible and abnormal dilatation of the airways
Secondary to chronic infection or inflammation
Bonchiectasis - what does it result from?
Results from inflammatory destruction of elastic and muscular components of airways
Leads to:
- Abnormally dilated airways
- Persistent sputum production
- Ineffective sputum clearance
- Recurrent chest infections
Bonchiectasis - what condition is it commonly secondary to?
Cystic Fibrosis
Bonchiectasis - what are some causes?
CF
Post infective: TB, measles, pneumonia
Bronchial obstruction: Lung cancer, foreign body
Allergic bronchopulmonary aspergillosis (ABPA) - exaggerated immune response to Aspergillus, occurs in asthamtics, can lead to bronchiectasis
Idiopathic: 40-50% cases
Bonchiectasis - what are the symptoms?
Persistent SPUTUM PRODUTION with a CHRONIC COUGH
Dyspnoea
Haemoptysis
Weight loss
Bonchiectasis - what are the signs?
Crackles
High pitched inspiratory squeaks
Wheeze
Bonchiectasis - what are the diagnostic investigations?
1st line - Chest XRAY
Diagnostic modality of choice - Thin section CT
Bonchiectasis - what other investigations can you do?
Bloods:
- FBC
- Renal function
Cultures:
- Sputum cultures
- Blood cultures
Aspergillus fumigatus:
- Serum total IgE
- Sensitisation assessment, skin prick test
Bonchiectasis - what organism from a sputum culture is highly suggestive of bronchiectasis?
P. aeruginosa
Bonchiectasis - management?
Assess and treat any underlying treatable causes
Physical training
Postural drainage
Antibiotics for exacerbations
Bronchodilators
Surgery
Lung Cancer - what are the two main categories of lung cancer?
Small Cell Lung Cancer (SCLC)
Non-small Cell Lung Cancer (NSCLC)
Lung Cancer - what are the different NSCLC?
Adenocarcinoma (40%)
Squamous cell carcinoma (20%)
Large cell carcinoma (10%)
Other types
Lung Cancer - what are adenocarcinomas?
Cancer of the mucus secreting cells
Tends to occur peripherally
More common in non-smokers
Lung Cancer - features of squamous cell carcinoma
Usually presents as obstructed bronchus leading to infection (pneumonia)
Occurs central part of lungs
Metastases occur late
Lung Cancer - features of large cell carcinoma
Poorly differentiated tumour
Metastasise early
Undifferentiated neoplasms
Lung Cancer - features of SCLC?
Cancer of the APUD cells - neuroendocrine cell found in lungs
Commonly associated with NEOPLASTIC SYNDROMES
Poor prognosis
Secretes polypeptide hormones
Lung Cancer - why are SCLC’s considered separately from NSCLC’s?
Considered separately due to SCLC’s:
- Fast doubling time
- Aggressive nature
- Early metastasis
Lung Cancer - symptoms?
Frequently asymptomatic, but when symptomatic:
Haemoptysis SoB Recurrent chest infections Chronic cough Weight loss
May present with features of superior vena cava obstruction (SVCO) or a paraneoplastic syndrome
Lung Cancer - signs?
Lymphadenopathy Stridor Wheeze Clubbing Signs of pleural effusion
Lung Cancer - what is Superior Vena Cava Obstruction (SVCO)?
Tumour causes compression on SVC
Causes engorgement of vessels in neck and face
Leads to ‘fullness’ of head and SoB
Lung Cancer - what is a pancoast tumour and what are the clinical features?
Tumour of the pulmonary apex
Clinical features:
- Horner’s syndrome
- Shoulder pain that radiates to arm
- Muscular atrophy of upper limb
Lung Cancer - what are paraneoplastic syndromes?
Paraneoplastic syndromes refer to remote effects of tumours, unrelated to mass effect, invasion, metastasis
Lung Cancer - what are the paraneoplastic syndromes that can occur?
Hypercalcaemia
SIADH
Cushing’s
Lambert-Eaton Syndrome
Hypertrophic osteoarthropathy
Lung Cancer - hypercalcaemia
May occur in lung cancers due to bony metastasis or tumour secretion of parathyroid hormone-related protein or calcitriol
Clinical features: - STONES (renal caculi) BONES (bone pain) GROANS (abdo pain) THRONES (polyuria) and PSYCHIATRIC MOANS (altered mental status)
Seen most in SQUAMOUS CELL CARCINOMA
