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Respiratory > Resp - Bronchiectasis, Lung Cancer, Pulmonary Function Tests > Flashcards

Resp - Bronchiectasis, Lung Cancer, Pulmonary Function Tests Flashcards

1
Q

Bonchiectasis - what is it?

A

Irreversible and abnormal dilatation of the airways

Secondary to chronic infection or inflammation

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2
Q

Bonchiectasis - what does it result from?

A

Results from inflammatory destruction of elastic and muscular components of airways

Leads to:

  1. Abnormally dilated airways
  2. Persistent sputum production
  3. Ineffective sputum clearance
  4. Recurrent chest infections
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3
Q

Bonchiectasis - what condition is it commonly secondary to?

A

Cystic Fibrosis

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4
Q

Bonchiectasis - what are some causes?

A

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

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5
Q

Bonchiectasis - what are the symptoms?

A

Persistent SPUTUM PRODUTION with a CHRONIC COUGH

Dyspnoea

Haemoptysis

Weight loss

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6
Q

Bonchiectasis - what are the signs?

A

Crackles

High pitched inspiratory squeaks

Wheeze

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7
Q

Bonchiectasis - what are the diagnostic investigations?

A

1st line - Chest XRAY

Diagnostic modality of choice - Thin section CT

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8
Q

Bonchiectasis - what other investigations can you do?

A

Bloods:

  1. FBC
  2. Renal function

Cultures:

  1. Sputum cultures
  2. Blood cultures

Aspergillus fumigatus:

  1. Serum total IgE
  2. Sensitisation assessment, skin prick test
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9
Q

Bonchiectasis - what organism from a sputum culture is highly suggestive of bronchiectasis and which organism is most commonly isolated?

A

P. aeruginosa

Haemophilus influenzae (most common)

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10
Q

Bonchiectasis - management?

A

Assess and treat any underlying treatable causes

Physical training

Postural drainage

Antibiotics for exacerbations

Bronchodilators

Surgery

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11
Q

Lung Cancer - what are the two main categories of lung cancer?

A

Small Cell Lung Cancer (SCLC)

Non-small Cell Lung Cancer (NSCLC)

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12
Q

Lung Cancer - what are the different NSCLC?

A

Adenocarcinoma (40%)

Squamous cell carcinoma (20%)

Large cell carcinoma (10%)

Other types

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13
Q

Lung Cancer - what are adenocarcinomas?

A

Cancer of the mucus secreting cells

Tends to occur peripherally

More common in non-smokers

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14
Q

Lung Cancer - features of squamous cell carcinoma

A

Usually presents as obstructed bronchus leading to infection (pneumonia)

Occurs central part of lungs

Metastases occur late

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15
Q

Lung Cancer - features of large cell carcinoma

A

Poorly differentiated tumour

Metastasise early

Undifferentiated neoplasms

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16
Q

Lung Cancer - features of SCLC?

A

Cancer of the APUD cells - neuroendocrine cell found in lungs

Commonly associated with NEOPLASTIC SYNDROMES

Poor prognosis

Secretes polypeptide hormones

17
Q

Lung Cancer - why are SCLC’s considered separately from NSCLC’s?

A

Considered separately due to SCLC’s:

  1. Fast doubling time
  2. Aggressive nature
  3. Early metastasis
18
Q

Lung Cancer - symptoms?

A

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

19
Q

Lung Cancer - signs?

A 
Lymphadenopathy
Stridor
Wheeze
Clubbing 
Signs of pleural effusion
20
Q

Lung Cancer - what is Superior Vena Cava Obstruction (SVCO)?

A

Tumour causes compression on SVC

Causes engorgement of vessels in neck and face

Leads to ‘fullness’ of head and SoB

21
Q

Lung Cancer - what is a pancoast tumour and what are the clinical features?

A

Tumour of the pulmonary apex

Clinical features:

  1. Horner’s syndrome
  2. Shoulder pain that radiates to arm
  3. Muscular atrophy of upper limb
22
Q

Lung Cancer - what are paraneoplastic syndromes?

A

Paraneoplastic syndromes refer to remote effects of tumours, unrelated to mass effect, invasion, metastasis

23
Q

Lung Cancer - what are the paraneoplastic syndromes that can occur?

A

Hypercalcaemia

SIADH

Cushing’s

Lambert-Eaton Syndrome

Hypertrophic osteoarthropathy

24
Q

Lung Cancer - hypercalcaemia

A

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

25
Q

Lung Cancer - hypercalcaemia

A

May occur in lung cancers due to:

  1. Bony metastasis
  2. 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

26
Q

Lung Cancer - SIADH

A

Caused by ectopic ADH secretion by a small cell lung cancer and presents with HYPONATRAEMIA

27
Q

Lung Cancer - Cushing’s syndrome

A

Caused by ectopic ACTH secretion by a SCLC

Cushing’s syndrome caused by exposure to high levels of glucocorticoids

28
Q

Lung Cancer - Lambert-eaton syndrome

A

Antibodies from immune system produced against SCLC cells

These antibodies also target and damage voltage-gated Ca2+ channels sited on presynaptic terminals in motor neurones

Leads to proximal and ocular muscle weakness

Other clinical features:

  1. Diplopia
  2. Ptosis
  3. Dysphagia
  4. Slurred speech
  5. Reduced tendon reflexes
29
Q

Lung Cancer - investigations

A

1st line: CXR

Contrast enhanced staging CT scan

PET-CT

Bronchoscopy with endobronchial ultrasound (EBUS) - also allows for US guided biopsy

30
Q

Lung Cancer - what is the staging system?

A

TNM

Tumour: Tx to T4

Node: Nx to N3

Metastasis: M0, no distant metastasis, M1 distant metastasis

31
Q

Lung Cancer - when should you refer and along which pathway?

A

Refer people using a suspected cancer pathway referral (appointment within 2 weeks) if they:

  1. CXR suggest lung cancer
  2. Aged 40 and over with unexplained haemoptysis

Offer urgent CXR (within 2 weeks) to assess for cancer in patients 40+ if they have 2 or more of the following unexplained symptoms, or they have ever smoked and have 1 or more of the following unexplained symptoms:

  • cough
  • fatigue
  • shortness of breath
  • chest pain
  • weight loss
  • appetite loss
32
Q

Lung Cancer - management for NSCLC

A

Surgical:
Stage I and II disease - lobectomy, segmentectomy, wedge resection

Chemo:
May be used in combination with surgery as:
1. Neo-adjuvant: prior to surgery
2. Adjuvant: following surgery
Also offered to patients where surgery isn’t appropriate

Radiotherapy:

  1. Can be curative if given early enough
  2. Can often be palliative treatment - improve symptoms
33
Q

Lung Cancer - management of SCLC?

A

Surgical - only an option in early disease

Chemotherapy - utilises platinum-based combination therapy

Radiotherapy - used for palliative relief

34
Q

Lung Cancer - what is the staging system?

A

TNM

Tumour: Tx to T4

Node: Nx to N3

Metastasis: M0, no distant metastasis, M1 distant metastasis

35
Q

Lung Cancer - when should you refer and along which pathway?

A

Refer people using a suspected cancer pathway referral (appointment within 2 weeks) if they:

  1. CXR suggest lung cancer
  2. Aged 40 and over with unexplained haemoptysis

Offer urgent CXR (within 2 weeks) to assess for cancer in patients 40+ if they have 2 or more of the following unexplained symptoms, or they have ever smoked and have 1 or more of the following unexplained symptoms:

  • cough
  • fatigue
  • shortness of breath
  • chest pain
  • weight loss
  • appetite loss

Respiratory (8 decks)

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