Respiratory Flashcards
what are the two types of lung cancer?
non small cell (majority) - adenocarcinoma, squamous cell carcinoma, large cell carcinoma, other
small cell - contain neurosecretory granules that can release neuroendocrine hormones..paraneoplastic syndromes
what are the signs and sx of lung cancer?
Shortness of breath
Cough
Haemoptysis (coughing up blood)
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy – often supraclavicular nodes are the first to be found on examination
which investigations are required for lung cancer?
chest x ray - hilar enlargement, peripheral opacity (lesion), pleural effusion (usually unilateral), collapse
staging CT TAP with contrast
PET-CT for metastatic spread
bronchoscopy with endobronchial USS - detailed assessment of the tumour
histological diagnosis - types of cells in cancer
what are the tx options for lung cancer?
MDT
surgery for non small cell such as lobectomy, segmentectomy
radiotherapy for non small cell
chemo - adjuvant or palliative for non small cell
chemo + radio - small cell
endobronchial tx with stents or debulking - small cell
what are the extrapulmonary manifestations of lung cancer?
recurrent laryngeal nerve palsy - hoarse voice, compresses as passes through mediastinum
phrenic nerve palsy - diaphragm weakness - SOB
SVC obstruction - facial swelling, difficult breathing, distended veins..pemberton’s sign (raising the hands over head causes facial congestion and cyanosis)
horner’s syndrome - partial ptosis, anhydrosis, miosis caused by pancoast tumour pressing on sympathetic ganglion
SIADH - by ectopic ADH by small cell, hyponatraemia
Cushing’s - ectopic ACTH from small cell
hypercalcaemia - ectopic PTH from squamous cell
limbic encephalitis - small cell causes immune system to make antibdoies to tissues in brain, esp limbic sx…memory impairment, hallucinations, confusion, seizures…anti-Hu antibodies
Lambert-eaton myasthenic syndrome
define labert-eaton myasthenic syndrome
result of antibodies produced by the immune system against small cell lung cancer cells. These antibodies also target and damage voltage-gated calcium channels sited on the presynaptic terminals in motor neurones - weakness, in the proximal muscles also affect intraocular muscles causing diplopia (double vision), levator muscles in the eyelid causing ptosis and pharyngeal muscles causing slurred speech and dysphagia (difficulty swallowing). also experience dry mouth, blurred vision, impotence and dizziness due to autonomic dysfunction.
The tendon reflexes become temporarily normal for a short period following a period of strong muscle contraction. For example, the patient can maximally contract the quadriceps muscle for a period, then have their reflexes tested immediately afterwards, and display an improvement in the response. This is called post-tetanic potentiation.
In older smokers with symptoms of Lambert-Eaton syndrome consider small cell lung cancer.
define mesothelioma
lung malignancy affecting mesothelial cells of the pleura
linked to asbestos but latent period between exposure and sx (45 yrs)
prognosis poor, chemo can help
define pneumonia
inflammation of the lung tissue and sputum filling the airways and alveoli
how does pneumonia present?
Shortness of breath
Cough productive of sputum
Fever
Haemoptysis (coughing up blood)
Pleuritic chest pain (sharp chest pain worse on inspiration)
Delirium (acute confusion associated with infection)
Sepsis
what are the signs of pneumonia?
Tachypnoea (raised respiratory rate)
Tachycardia (raised heart rate)
Hypoxia (low oxygen)
Hypotension (shock)
Fever
Confusion
possibly septic
bronchial breath sounds - harsh breath sounds equally loud on inspiration and expiration
focal coarse crackles - like a straw blowing into a drink
dullness to percussion due to tissue collapse/consolidation
how is the severity of pneumonia measured?
in hospital - CURB 65
out of - no urea measured
C – Confusion (new disorientation in person, place or time)
U – Urea > 7
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65
Score 0/1: Consider treatment at home
Score ≥ 2: Consider hospital admission
Score ≥ 3: Consider intensive care assessment
what are the common causes of pneumonia?
step pneu
haemoph influe
what are the other causes of pneumonia and their associations?
Moraxella catarrhalis in immunocompromised patients or those with chronic pulmonary disease
Pseudomonas aeruginosa in patients with cystic fibrosis or bronchiectasis
Staphylococcus aureus in patients with cystic fibrosis
define atypical pneumonia and the possible causes
pneumonia caused by an organism that cannot be cultured in the normal way or detected using a gram stain. They don’t respond to penicillins and can be treated with macrolides (e.g. clarithomycin), fluoroquinolones (e.g. levofloxacin) or tetracyclines (e.g. doxycycline).
- legionella pneumophila - infected water supplies/air conditioning units -> hyponatraemia from SIADH
- mycoplasma pneumonia - erythema multiforme rash with pink rings and pale centres, neurological sx in young patients
- chlamydiophila pneumonia - school aged child, chronic pneumonia and wheeze
- coxiella burnetii - Q fever - linked to animals and bodily fluids like farmers
- chalmydia psittaci - infected birds like parrot owners
“Legions of psittaci MCQs”
M – mycoplasma pneumoniae
C – chlamydydophila pneumoniae
Qs – Q fever (coxiella burnetii)
what is fungal pneumonia, the risk factors and treatment?
immunocompromised
poorly controlled or new HIV with low CD4
dry cough, SOB on exertion and night sweats
tx with co-trimoxazole, prophylactic for HIV to protect against PCP
which investigations are required for pneumonia?
Chest xray
FBC (raised white cells)
U&Es (for urea)
CRP (raised in inflammation and infection) - can see abx working but VRP delayed and WCC is faster picture, if immunocompromised may not be raised at all
Patients with moderate or severe cases should also have:
Sputum cultures
Blood cultures
Legionella and pneumococcal urinary antigens (send a urine sample for antigen testing)
which abx are used to treat pneumonia?
Mild CAP: 5 day course of oral antibiotics (amoxicillin or macrolide)
Moderate to severe CAP: 7-10 day course of dual antibiotics (amoxicillin and macrolide)
—per local guidlines and resistance patterns
what are the complications of pneumonia?
Sepsis
Pleural effusion
Empyema
Lung abscess
Death
define FEV1 and how it is affected
forced expiratory volume in 1 second…reduced in obstruction
define FVC and how it is affected
forced vital capacity…reduced in restriction
what is the FEV1:FVC ratio in obstructive disease?
<75%
give 2 examples of obstructive disease and how these can be differentiated
asthma - reversible >12% with bronchodilator
COPD -> irreversible, <12%
what is the FEV1:FVC ratio in restrictive disease?
FEV1 and FVC are equally reduced, >75%
what are the causes of restrictive disease?
ILD
neurological - MND
scoliosis
obesity