Respiratory Flashcards
Name the different types of lung cancer
Non-small cell (80%) - Adenocarcinoma - Squamous cell carcinoma - Large cell carcinoma Small cell (20%)
Describe small cell lung cancers
Contain neurosecretory granules that release neuroendocrine hormones - multiple paraneoplastic syndromes
Give the signs and symptoms of lung cancer
SOB Cough - haemoptysis Clubbing Recurrent pneumonia Weight loss Lymphadenopathy - supraclavicular
What are signs of lung cancer on CXR?
Hilar enlargement
Peripheral opacity
Pleural effusion - unilateral
Collapse
What is the first line treatment for non-small cell lung cancer
Surgery - lobectomy or segmentectomy or wedge resection
Chemo or radiotherapy
What is the treatment for small cell lung cancer
Chemo or radiotherapy
Describe recurrent laryngeal nerve palsy
Hoarse voice - caused by the cancer pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum
Describe phrenic nerve palsy
Compression causing diaphragm weakness and presents as SOB
Describe superior vena cava obstruction
Compression of the tumour on the superior vena cava
Presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest
Describe Pembertons sign
SVC obstruction
Raising arms above head causes facial congestion and cyanosis
Describe Horner’s syndrome
Partial ptosis, anhidrosis and miosis
Associated with Pancoast tumour (pulmonary apex)
How does SIADH present?
Euvolemic hyponatraemia
Describe limbic encephalitis
Autoimmune antibodies to the limbic tissues causing inflammation and short term memory impairment, hallucinations, confusion and seizures
Associated with anti-HU antibodies
Describe lambert eaton myasthenic syndrome
Result of antibodies produced by the immune system against SCLC. They target voltage gated Ca channels on the presynaptic terminals in motor neurone leading to weakness of the proximal muscles and causes diplopia, ptosis, slurred speech and dysphagia. They also experience dry mouth, blurred vision, impotence and dizziness due to autonomic dysfunction
Reduced reflexes which become normal after a period of maximal contraction (post tetanic potentiation)
Describe mesothelioma
Lung mesothelial cells of the pleura
Strongly linked to asbestos and development of mesothelioma - 45years
Prognosis is poor and chemotherapy is palliative
Define hospital acquired pneumonia
Develops >48hrs of hospital admission
Describe the presentation of pneumonia
SOB Cough - haemoptysis Pleuritic chest pain Delirium Sepsis Tachycardia Tachypnoea Hypoxia Hypotension Fever Confusion
Bronchial breath sounds - harsh breath sounds on inspiration and expiration
Focal coarse crackles - air passing through sputum
Dullness to percussion - lung tissue collapse and or consolidation
What is the CURB 65 score
Prediction of the severity of pneumonia and helps guide treatment
Confusion Urea >7 RR >30 BP <90/60 Age >65
0 or 1 - home treatment
>2 - hospital admission
>3 - consider ICU
What are the common causes of pneumonia
Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis
Pseudomonas aeruginosa
Staphylococcus aureus
What is an atypical pneumonia?
One that cannot be cultured in the normal way or detected using gram stain
Describe legionella pneumonophila
Caused by infected water supplies or air conditioning units
Causes a hyponatraemia - causing SIADH
Describe mycoplasma pneumoniae
Milder pneumonia
Erythema multiformed rash - target lesions formed by pink rings with pale centres - can also cause neurological symptoms in young patients
Describe coxiella burnetii
Q fever
Farmers - caused by contact with animals and body fluids
Describe chlamydia psittaci
Contracted from contact with infected birds