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Phase 4 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the classifications of lung cancer?

A

Small cell

Non small cell:

  • Squamous cell carcinoma
  • Adenocarcinoma
  • Bronchial derived adenocarcinoma
  • Bronchioloalveolar carcinoma
  • Large cell carcinoma
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2
Q

What are the symptoms of lung cancer?

A 
Persistent cough
Haemoptysis
Shortness of breath
Chest pain
Hoarseness
Weight loss
Bone pain
Headache
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3
Q

What are the investigations for lung cancer?

A

X-ray
CT
PET-CT
Biopsy

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4
Q

What is stage 1 lung cancer?

A

The cancer is contained wtihin the lung and hasn’t spread to nearby lymph nodes.

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5
Q

What is stage 2 lung cancer?

A

Cancer is up to 7cm
Involved local lymph nodes
Multiple small tumours
Lung has collapsed and tumour is in airway

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6
Q

What is stage 3 lung cancer?

A

Has invaded local structures - mediastinum, pleura, chest wall, oesophagus, trachea

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7
Q

What is stage 4 lung cancer?

A

Involves both lungs
Pleural effusion
Distant metastases

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8
Q

What T1 lung cancer?

A

Cancer is in lung.

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9
Q

What is T2 lung cancer?

A

Cancer is 3-5cm or involves main bronchus/visceral pleura/lung collapse.

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10
Q

What is T3 lung cancer?

A

Cancer is 5-7cm or more than one tumour in same lobe of lung or invading local structures - such as ribs/diaphragm/pericardium/phrenic nerve

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11
Q

What is T4 lung cancer?

A

> 7cm - more than one lobe/mediastinal involvement/spinal bones.

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12
Q

What is N0 in lung cancer?

A

No nodes

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13
Q

What is N1 lung cancer?

A

Cancer in nodes in lung or hilum.

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14
Q

What is N2 lung cancer?

A

Mediastinal nodes on same side.

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15
Q

What is N3 lung cancer?

A

Opposite side of chest or above collar bone.

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16
Q

What is M0 in lung cancer?

A

No metastases.

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17
Q

What is M1 in lung cancer?

A

Cancer has spread.

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18
Q

What is M1a in lung cancer?

A

Cancer has spread to both lungs/pleural effusion

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19
Q

What is M1b in lung cancer?

A

Single area of cancer outside the lung.

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20
Q

What is M1c in lung cancer?

A

More than one area in several organs.

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21
Q

What is the managment of non small cell carcinoma?

A

Aiming for curative treatment:
Surgical resection is first line:
- lobectomy or wedge resection
- mediastinal sampling is done at time of surgery
- pneumonectomy only offered if need to obtain clear margins
- pre-op pFTs to ensure fit
May get post operative chemo
Radiotherapy indicated for some patients.
Chemoradiotherapy for patients who can’t have surgery.

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22
Q

What kind of chemotherapy would be used for non small cell lung cancer?

A

Docetaxel plus cisplatin.

May qualify for immunotherapy e.g. afatinib.

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23
Q

What are the potential complications of lung cancer?

A 
Superior vena cava obstruction. 
Horners syndrome
Pleural effusion
Endobronchial obstruction
Mets including brain and bleeding
Invasion of main vessels
Shortness of breath
Pain
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24
Q

What are the symptoms of a pleural effusion?

A

Dyspnoea
Pleuritic chest pain
Weight loss/haemoptysis or other symptoms of malignancy
Symptoms of infection - cough/fevers/night sweats

25
Q

What are the signs of a pleural effusion?

A

Reduced expansion
Stony dull percusion
Diminished breath sounds
May be bronchial breathing above it if lung is compressed
Tracheal deviation if big
Cachexial/clubbing/lymphadenopathy/oedema

26
Q

How is a pleural effusion diagnosed?

A

Chest x-ray

27
Q

What would be done to investigate a pleural effusion further?

A

Ultrasound to assess consistency of fluid and where it’s located.
Sample fluid
May need thoracoscopy or biopsy

28
Q

What is the management of a pleural effusion?

A

May need to be drained if symptomatic (definitely if infected)
If malignant likely to get a talc pleuredesis

29
Q

What will be found in the pleural effusion sample if it is an exudate?

A

Protein >30g/L
Pleural fluid to serum ratio of total protein >0.5
Pleural fluid lactic dehydrogenase >200 IU/I
Pleural fluid to serum ratio of LDH is >0.6

30
Q

What are the causes of exudate pleural effusions?

A 
Infection
Malignancy
Haemothorax
Chylothorax
Autoimmune
Pancreatitis
31
Q

What will be seen in the pleural fluid if it is a transudate?

A

TPR <0.5
FLDH <200 IU/I
LDHR <0.6

32
Q

What are the causes of transudate pleural effusions?

A 
Heart failure
Hypoalbuminaemia
Hypothyroidism
Decompensated ALD
Nephrotic syndrome
33
Q

What is a pneumothorax?

A

Accumulation of air in the pleural space.

34
Q

How big is a large pneumothorax?

A

> 2cm margin from lung to chest wall.

35
Q

What are the risk factors for a primary pneumothorax?

A 
Young
Tall 
Slim
Males
Smokers
Marfans syndrome
Homocystinuria
Family history of pneumothorax
36
Q

What is the main risk factor for secondary pneumothorax?

A

COPD

37
Q

What is the pathophysiology of a pneumothorax?

A

Normal alveolar pressure is higher than the intrapleural pressure which is less than atmospheric pressure.
Communication between an alveolus and the pleural space, or between the atmosphere and the pleural space and gas causes pressure gradient and flow into the pleural space.
Flow continues until the pressure gradient resolved and abnormal communication has been sealed.
As thoracic cavity pressure is normally below its resting volume, the thoracic cavity enlarges and the lung becomes smaller when a pneumothorax develops.

38
Q

What are the symptoms of a pneumothorax?

A

Sudden onset symptoms.
Dyspnoea
Chest pain
May be distressed with rapid breathing.

39
Q

What are the signs of a pneumothorax?

A 
Tachycardia
Hypoxia and cyanosis
Diaphoresis
Ipsilateral hyperinflation
Decreased breath sounds
Hyper resonance on percussion and vocal fremitus
40
Q

What is the treatment of a primary pneumothorax?

A

Observation if small or asymptomatic and may be discharged with early follow up.
If short of breath, initial treatment is high flow oxygen therapy.
Percutaneous aspiration fo teh air is as effective as wide bore drains.
If failed once - chest drain.

41
Q

What is the treatment of a secondary pneumothorax?

A

Supplemental oxygen
Chest drain.
24 hours observation.

42
Q

What is the pathophysiology of a pulmonary embolism?

A

A dislodged thrombi occludes the pulmonary vessels

43
Q

What are the potential complications of a pulmonary embolism?

A

Right heart failure

Cardiac arrest

44
Q

What are the risk factors for thrombus formation?

A

Venous stasis
Trauma
Hypercoagulability

45
Q

What makes up Virchow’s triad?

A

Vessel endothelial wall damage.
Venous stasis
Hypercoagulability

46
Q

What can cause hypercoagulability?

A 
Cancer
High oestrogen sate (oral contraceptives, hormone replacement, obesity, pregnancy)
Inflammatory bowel disease
Nephrotic syndrome
Sepsis
Blood transfusion
Inherited thrombophilia
47
Q

What are the risk factors for venous stasis?

A 
Age >40
Immobility
General anaesthesia
Paralysis
Spinal cord injury
Myocardial infarction
Prior stroke
Varicose veins
Advanced congestive heart failure
Advanced COPD
Bed rest >5 days.
48
Q

What is the presentation of pulmonary embolism?

A 
Acute onset shortness of breath 
Pleuritic chest pain
Fever 
Cough
Unilateral calf swelling
49
Q

Which score is used to determine the likelihood of a PE?

A

Well’s score.

50
Q

What does PERC stand for?

A

Pulmonary embolism rule out criteria.

51
Q

What are the PERC criteria?

A 
Age <50 years
Initial heart rate <100bpm
Initial oxygen >94% on room air
No unilateral leg swelling
No haemoptysis
No surgery or trauma within the last 4 weeks
No history of venous thromboembolism
No oestrogen use.
52
Q

How should PERC criteria be used?

A

If patients meet all PERC criteria, risk for PE is lower than the risk of testing - no further test is indicated.

53
Q

When is D-dimer indicated?

A

In haemodynamically stable patients with intermediate clinical probability of PE.
Patients whose initial risk stratification is very low risk of PE but who do not meet all PERC criteria.
Patients who are low risk but PERC wasn’t used.

54
Q

What does a negative V/Q scan show when testing for PE.

A

Exclude PE.

55
Q

What is the management of pulmonary embolism?

A

Oxygen to correct hypoxia.
Anticoagulation - DOAC
Thrombolysis only for massive PEs (hypotensive/significant cardiorespiratory compromise)
Echo/troponins to assess right heart strain. .

56
Q

What are the absolute contraindications to thrombolysis?

A

Haemorrhagic stroke
Ischaemic stroke in the preceeding 6 months.
Central nervous sytem damage
Neoplasms
Recent major trauma/surgery/head injury (in the preceding 3 weeks);
GI bleeding within the last month
Known bleeding risk.

57
Q

What is the pathophysiology of asthma?

A

Th-2-mediated immunoglobulin E response.
Triggers inflammatory reaction in airways and small airways occluded with mucus and swollen membranes.
Bronchial hyper-reactivity and bronchospasm
Significant airway obstruction through narrowed lumens.
Vasoactive prostaglandins, leukotrienes, histamine, and other cellular mediators having a role in pathogenesis.

58
Q

What is the treatment for an acute asthma attack.

A

Oxygen if needed.
Salbutamol and ipratropium nebs.
Steroids (PO prednisolone or IV hydrocortisone)
Antibiotics if infective.
Magnesium - if you’re thinking about this get senior help!

Phase 4 (12 decks)

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