Respiratory Flashcards
5 categories of lung cancer symptoms?
Local
Constitutional
Metastatic
Paraneoplastic
Ectopic hormones
Local lung cancer symptoms?
Cough
Breathlessness
Haemoptysis
Hoarse voice
Superior vena cava obstruction
Pancoast tumour
Constitutional lung cancer symptoms?
Anorexia
Fevers/sweats
Metastatic lung cancer areas?
lymph
Brain
Bone
Breast
Liver
Ectopic hormones in lung cancer?
What do they cause?
ADH - Hyponatraemia
PTH - hypercalcaemia
What is courtesy stigma?
Stigma experienced by association with the person
Stages of stigma formation?
People identify and label differences
These differences are linked to negative attributes
Individuals are labelled as distinct
Loss and discrimination by labelled individuals
Two forms of stigma?
- Felt stigma: shame associated with stigma and fear of exclusion
- Enacted stigma: actual rejection/discrimination
What is the mechanism of pathogenesis associated with smoking and the p53 gene?
Benzopyrene damages the p53 gene, which is a tumour suppressant gene. This increases the chance of cancer
4 main types of lung tumours?
Squamous cell carcinoma
Adenocarcinoma
Large cell undifferentiated carcinoma
Small cell carcinoma
What structures do squamous cell and adenocarcinoma originate in?
Squamous cell - bronchial epithelia
Adenocarcinoma - Airway surface epithelium
Clinical definition of chronic bronchitis?
Cough productive of sputum for at least three months in two or more consecutive years
Clinical definition of emphysema?
Permanent distension of alveoli with destruction of the alveolar septum
What is bronchiolitis?
Small airway infection mostly in children, affecting bronchioles, mostly caused by RSV, can lead to fibrosis
4 examples of inflammatory lung disease?
Pneumonia
Bronchiectasis
TB infection
Asthma
What is bronchiectasis?
Dilatation of the bronchi associated with suppuration and persistent infection
What are the features and causes of bronchiectasis?
Features:
- chronic productive cough
- exacerbations
- haemoptysis
Causes:
- Tumour
- Enlarged lymph node
- Post-infection
Presentation of pneumonia?
Cough
Fever
Dyspnoea
Fatigue
Headache
Myalgia
SIgns:
- Tachycardia
- Tachypnoea
- Hypertension
- Crepitations
- Bronchial breathing
What causes aspiration pneumonia?
Abnormal gag reflex
Definitions of sepsis, sever sepsis and septic shock?
Sepsis: Two or more SIRS criteria in response to infection
Severe sepsis: sepsis associated with organ dysfunction
Septic shock: sepsis induced hypotension
General process of sepsis?
There is and injury or trigger that causes an inflammatory response, this leads to endothelial inflammation and a systemic overspill of inflammatory components in the cardiovascular system.
Cytokines involved in sepsis/inflammation?
TNF-α, IL-1/6/10
Signs and symptoms of sepsis?
Lowered conscious level
Tachypnoea
Hypoxia
Oliguria/anuria
Tachycardia
Hypotension
Acidosis
Organs that fail in sepsis, whats normally the first?
Respiratory (normally first)
CVS
GI
Renal
Treatment of sepsis?
Broad spectrum antibiotics until blood culture then treat with narrow spectrum
What is a COPD exacerbation?
Acute event characterised by worsening of the patients respiratory symptoms, beyond normal day-to-day variation
COPD exacerbation treatment?
Controlled oxygen therapy
Nebulisers
Steroids
Antibiotics
Chest physiotherapy
What is the FEV1/FVC ratio in COPD?
Below 0.7
Why do smokers get chronic bronchitis?
Mucus gland hypertrophy and hyperplasia
Cilia are damaged, impairing the mucociliary elevator
Why do smokers get emphysema?
Permanent enlargement of the distal alveoli due to septal damage
Elastin damage leading to premature closing of the airways
What systemic effects of smoking lead to cardiovascular disease?
Activation of clotting pathways
Raised cholesterol - increased oxidised LDL
Raised blood pressure - effects of nicotine
What can be done to support smoking cessation?
Nicotine replacement therapy - e.g. gum
Antidepressants
Nicotine receptor partial agonist - champix
Behavioural support
Presentation of TB?
Cough, weight loss, night sweats
Specific treatment for influenza?
Neuroaminidase inhibitors
What’s atypical pneumonia? Causes?
Pneumonia caused by organisms without a cell wall
Legionella, Mycoplasma, chlamydia
Interaction of elastase, A1 antitrypsin and smoking?
Smoking causes the increased release of elastase, due to inflammation (neutrophil accumulation)
Elastase breaks down the elastin in alveoli
A1 antitrypsin usually breaks down elastase, smoking also reduces the amount of A1 antitrypsin
Examples of bronchodilators?
B2 agonists - salbutamol
methyl xanthines - theophylline
Antimuscarinics - ipratropium
What things would show up too black on a CXR?
Pneumothorax
COPD
Air trapping
Cavity containing gas
What things would show up too white on a CXR?
Consolidation
Collapse
Tumour
Fluid (in pleura)
Interstitial lung disease
Examples of restrictive and obstructive lung diseases?
Restrictive:
Fibrosis
Chest wall issues
Obstructive:
COPD
Asthma
Differences in obstructive vs restrictive lung disease?
Obstructive (over inflated lung):
- Reduced FEV1 and so a reduced FEV1 to FVC ratio
Restrictive (under-inflated lung)
- Both FEV1 and FVC are reduced and so no ratio change
