resp from Kelly's ppt Flashcards
describe the characteristics of a squamous cell Lung Ca
may px as obstructive lesion leading to infection
occasionally cavitates
local spread is common
widespread mets occur LATE
secrete PTH - hypercalcaemia
STRONGLY assoc with finger clubbing
describe the characterisitc features of a large cell lung Ca
met early
often peripheral in lungs
anaplastic (poorly differentiated) tumours with a poor prognosis
may secrete B-HCG
features of a lung adenocarcinoma???
associated with asbestos exposure
most common Lung Ca assoc with asbestos exposure - but most who get it are smokers…
features of small cell lung cancer
how would you manage it?
often metastatic at Dx
causes (almost all) the weird syndromes -
ectopic ADH secretion - SIADH and hyponatraemia
ACTH secretion - Cushings
Lambert-eaton syndrome - antibodies to the voltage gated Ca2+ channels causing a myathenic syndrome (that is sort of the opposit of M.Gravis - ie movements are initially helped by doing them a bit more…)
- PX with proximal muscle weakness / reduced tendon reflexes.
managment of SCLC?
most will be with chemo + radio
some with very early stage disease - considered for surgery;..
what symptoms can a pancoast tumour cause..?
think apical tumour…..
- horner’s syndrome (pre-ganglionic) - TRIAD OF: anhidrosis of face/ meiosis / ptosis of eyelid or apparent enopthalmos)
- local nerve effects - Ipsilateral reflex sympathetic dystrophy in arm (increased sensitivity to touch / skin changes etc..)
- Brachial plexus invasion - (C8-T1) - wasting of the intrinsic hand muscles / parasthesiae on medial side of arm
- unilateral recurrent laryngeal nerve palsy - hoarse voice etc..
rarely:
oedema in arm / SVC obstruction 2y to compression of blood vessels….
palliative trreatment options for symptomatic management of lung cancer…
If airway narrowing symptomatic:
- endoscopic laser therapy
- transbronchial stenting
malignant pleural effusions?
- aspirate to dryness
- give sclerosing agent eg. tetracycline / belomicinm in pleural space
general QOL?
- counselling
- opiates
- benzos for anxiety due to breathlessness? - eg. use lorazepam.
features of a bronchial carcinoid tumour?
neuroendocrine ecreting cells - so the standard carcinoid syndrome stuff
recurrent hamoptysis
can also make ACTH sometimes - Cushing’s syndrome
how do you investigate suspected active tb?
and what would the investigations show?
how would you screen for latent tb?
CXR - might show cavitationin the upper lobes / mediastinial or hilar lymphadenopathy /pleural effusion
3 sputum samples - spontaneously produced deep cough symptoms -
- send for microscopy - acid fast bacilli (sputum smear microscopy is the fast one..)
- NAAT testing (for quick results)
- mycobacteria culture (weeks…)
HIV test all
screening for latent TB:
1. Mantoux test:
tuberculin injected intradermally - inspect for signs of skin reaction after 2-3 days
- Interferon gamma release assay test
RAPID RESULT
more reliable
use in under-served groups etc.
tx with 6 months isoniazid with pyroxidine
what are the side effects of: rifampicin isoniazid pyrazinamide ethambutol
R - liver and secretions (S+L=R)
I - p neuropathy (prevent with pyridoxine) + haemo
P - rheumatoid stuff (gout / arthralgia / rash)
E - eyes - optic neuritis and colour blindness
features of pneumoccal pneumonia in particular?
high fever
rapid onset
herpes labialis (cold sores)
pleuritic chest pain
URINARY ATG TEST FOR PNEUMOCCOCUS
who gets h. influenzae pneumonia
COPD pts
who gets s auerus pneumoniae
post influenza
feATURES of mycoplasma pneumonia
dry cough
atyipcal CXR findings
AIHA as well?
erythema multiforme?
legionella pneumonia features?
hyponatraemia
lymphopenia
URINARY ATG TEST FOR LEGIONELLA
who gets klebsiella pneumonia?
alchoholics?