Respiratory Flashcards
What are the types of non-small cell lung cancer?
Adenocarcinoma
Squamous cell carcinoma
Large-cell carcinoma
What findings on chest X-ray are suggestive of lung cancer?
Hilar enlargement
“peripheral opacity”
Pleural effusion
Collapse
What are the extra pulmonary manifestations of lung cancer?
Recurrent laryngeal nerve palsy
Phrenic nerve palsy
Superior vena cava obstruction - Pemberton’s sign
Horner’s syndrome - Pancoast’s tumour in the apex pressing on the sympathetic ganglion
SIADH
Cushings
Hypercalcaemia
Limbic encephalitis
Lambert-Eaton myasthenia syndrome
What is Pemberton’s sign?
Raising the hands over the head causes facial congestion and cyanosis - medical emergency
How does superior vena cava obstruction present?
Facial swelling
Difficulty breathing
Distended veins in the neck and upper chest
What is the pathophysiology of Lambert-Eaton Myasthenic Syndrome?
Antibodies produced against small cell lung cancer cells.
These also target and damage voltage-gated calcium channels on presynaptic terminals in motor neurones.
What are the symptoms of Lambert-Eaton Myasthenic Syndrome?
Proximal muscle weakness
Some cranial nerve motor weakness: intraocular (double vision), elevator muscles (ptosis), pharyngeal muscles (slurred speech and dysphagia)
Autonomic dysfunction
What are the signs of Lambert-Eaton myasthenic syndrome?
Reduced tendon reflexes that become temporarily normal for a short period following a period of strong muscle contraction (post-tetanic potentiation)
What is mesothelioma linked to?
Asbestos inhalation, with a big latent period. Poor prognosis
Which type of resp failure is BiPAP used in?
Type 2
What do you see on a high res CT in someone with interstitial lung disease?
Ground glass appearance
What medications can be used to slow the progression of idiopathic pulmonary fibrosis?
Pirfenidone (antifibrotic and anti-inflammatory)
Nintedanib - monoclonal antibody targeting tyrosine kinase
What drugs can induce pulmonary fibrosis?
Amiodarone
Cyclophosphamide
Methotrexate
Nitrofurantoin
What type of hypersensitivity reaction is Hypersensitivity pneumonitis (aka extrinsic allergic alveoli’s)
Type III
How do you test for hypersensitivity pneumonitis?
Bronchoalveolar lavage - shows raised lymphocytes and mast cells
What can cause hypersensitivity pneumonitis?
Bird-fanciers lung
Farmers lung
Mushroom workers lung
Malt workers lung
What is cryptogenic organising pneumonia?
Focal area of inflammation of the lung tissue. Presents very similar to pneumonia both in symptoms and on X-ray. Lung biopsy. Treat with systemic corticosteroids
What is pulmonary hypertension
Increased resistance and pressure of blood in the pulmonary arteries
What are the 5 groups of causes for pulmonary hypertension?
Group 1 - primary pulmonary hypertension or connective tissue disease -e.g. SLE
Group 2 - Left heart failure
Group 3 - Chronic lung disease
Group 4 - Pulmonary vascular disease e.g. PE
Group 5 - Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorders
What are the signs and symptoms of pulmonary hypertension?
Shortness of breath
Syncope
Tachycardia
Raised JVP
Hepatomegaly
Peripheral oedema
What changes do you see on ECG in pulmonary hypertension?
Right ventricular hypertrophy = larger R waves on right sided chest leads (V1-3)
Right axis deviation
RBBB
What changes do you see on chest x ray in pulmonary hypertension?
Dilated pulmonary arteries
Right ventricular hypertrophy
What is an example of a LABA?
Formoterol
Salmetarol
How do muscarinic antagonists work to increase airway dilation?
Block the effects of ACh on muscarinic receptors in smooth. muscle
M3 receptors blocked = reduced Ca2+ intracellular concentrations
What is Ipatropium?
SAMA
What is Tiotropium?
LAMA
What cells produce cysteinyl leukotrienes, causing smooth muscle contractions?
Mast cells
How does Montelukast work?
Blocks binding of leukotrienes toCystLT1 receptors
How does Zileuton work?
Inhibits lipoxygenase, the enzyme that converts arachidonic acid into leukotrienes
What is Theophylline?
A Phosphodiesterase inhibitor
How do phosphodiesterase inhibitors help bronchodilation?
Bind to adenosine A1 receptors and block adenosine mediated bronchoconstriction
Prevent phosphodiesterase inhibitors from breaking down cAMP in smooth muscle cells
How do corticosteroids reduce inflammation?
Suppress activated inflammatory genes at a low dose, or actually code for anti-inflammatory proteins at a high dose
