resp top tier Flashcards
is primary or secondary lung cancer more common
secondary
gender association with lung cancer
m >f
risk factors for lung cancer
Smoking inc passive Urban areas Asbestos Chromium Arsenic Coal Ionising radiation Genetic risk HIV Pre-existing lung disease
types of lung cancer
non- small cell carcinoma (main)
- squamous
- adenocarcinoma
- large cell
- carcinoid tumour
small cell carcinoma
where is lung cancer located
mainly bronchial , sometimes pleura
squamous non-small cell carcinoma
- how does it present
- spread?
- as obstructive lesion –> infection
- local spread common. metastases widespread but relatively late
adenocarcinoma (non-small cell carcinoma) is strongly associated with what
asbestos
small cell carcinoma
- arises from what
- secretes what
- growth/ prognosis
- endocrine cells - kulchitsky cells
- secrete polypeptides and amines which act as hormones or neurotransmitters
- Grow rapidly , with widespread metastases. Highly malignant – frequently inoperable at presentation (poor prognosis)
presentation of lung cancer
Cough Chest pain Haemoptysis (Red flag) Dyspnoea , breathlessness, wheeze Recurrent infection finger clubbing weight loss anaemia nodes headaches
spread of lung cancer and associated symtpoms
- brachial plexus - shoulder/arm pain
- bone - pain and fractures
- sympathetic ganglion - horner’s syndrome (eyes)
- brain - seizures, neurological deficit, headaches
- abdominal pain
- left recurrent laryngeal nerve - hoarse voice
investigations of lung cancer
CXR
- round fluffy / spiking shadow
- hilar enlargement (medial of each lung)
- Consolidation (= filled with fluid rather than air so is no longer compressible. Appears white)
- lung collapse
- pleural effusion
CT/PET - for staging
Bronchoscopy- Biopsy and assess operability
Sputum biopsy
Pleural fluid biopsy
Bloods - FBC low
non small cell carcinoma management
Surgery- can be curative (if no metastatic spread)
Chemo (downstages tumours to render them operable. Advanced disease. or post op
Radiotherapy (good for localised squamous cancers. Advanced disease. Or post op
Stop smoking
Remove carcinogens
small cell carcinoma management
chemo
Limited disease = Chemo-radio combo
Extensive disease = chemo
what sort of symptom relief / palliative care can you think of that would benefit lung cancer
- corticosteroid (dexamethasone) for superior vena cava obstruction
- Analgesia
- Antiemetics
- Bronchodilators
- Antidepressants
- tracheal stenting
- cryotherapy
treatment for PE- short and long term
Immediate - depends on patient condition/signs
- Oxygen if hypoxic
- Morphine + antiemetic for pain/ distress
- IV LMW heparin - anticoagulant
- IV fluid for hypotension
- Call ICU
- Consider thrombolysis if hemodynamically unstable
Long term
- LMW heparin
- Anticoagulants - DOAC or warfarin
PE investigations
Bloods
- FBC
- U/E
- ** D-dimer = +
- Baseline clotting
- ** Troponin levels = raised due to impact on right heart
ABG (decreased PaCO2 and PaO2)
** CT pulmonary angiography (specific, sensitive)
CXR (may be normal. May have dilated pulmonary artery / oligaemia (decreased blood flow through certain segment)
ECG - normal /tachy / RV strain / RBBB
If no other risk factors, consider underlying malignancy
symptoms of PE
Acute breathlessness Pleuritic chest pain Haemoptysis Dizzy Syncope Calf pain
signs of PE
- Pyrexia (Fever)
- Cyanosis
- Tachypnoea
- Tachycardia
- Hypotension
Raised JVP
Pleural rub
Pleural effusion
Tender hard calf
pathophysiology of PE - the two types
inc cause
cause usually = venous thrombi (DVT)
Big
- Embolus obstructs R ventricular outflow (on way to lungs) - but doesn’t block it i don’t think
- Pulmonary vascular resistance increases suddenly
- Causing acute right sided heart failure
Small embolus
- Blocks terminal peripheral pulmonary vessel
- May not notice unless causes pulmonary infarction
- Lung tissue ventilated but not perfused (V/Q mismatch)- impaired gas exchange
risk factors for PE
- DVT
- Previous PE
- Thrombophilia
- Recent surgery - esp abdominal, pelvic, hip replacement, knee replacement
- Malignancy (If not other risk factors, consider underlying malignancy )
- Pregnancy / post partum
- Immobilisation eg leg fracture
- Combined oestrogen pill / hormone replacement therapy
COPD complications
- Respiratory failure
- Recurrent infections
- Pulmonary hypertension → cor pulmonale - enlargement of R heart (heart failure)
- lung carcinoma
COPD management
Smoking cessation - slows deterioration
Avoid infections
Exercise
Bronchodilators = short/long acting beta agonists /muscarinic antagonists:
- 1st line= SABA/SAMA
- 2nd line= LABA/LAMA
- 3rd line= LABA/LAMA + corticosteroid (inhaled/systemic)
- 4th line= LABA + LAMA + corticosteroid (inhaled/systemic)
- 5th line= long term oxygen therapy – Need to be careful not to remove the hypoxic drive in blue bloaters
Ventilation
Surgery - lung transplant
investigations into COPD
- ECG - RV/RA hypertrophy
- ABG - reduced oxygen
Spirometry
= gold standard.
– FEV1/FVC<70%,
– FEV1<80% of predicted
CXR
- > 6 ribs visible
- Hyperinflation
- flattened diaphragm
- -Large central pulmonary arteries
- Decreased peripheral vascular markings
CT
- Bronchial wall thickening
- Scarring
- Air space enlargement (dark areas)
symptoms of COPD
Increased sputum production Chronic cough Shortness of breath, dyspnoea Low moor, tired, lethargic Weight loss