Respiratory disorders and their management III Flashcards
Lung cancer prevalence?
Main cause of cancer related death
2nd most common cancer
Lung cancer features?
85% NSCLC 15% SCLC 10% operable at diagnosis Risk of spread from primary tumours to nodes and distal organs (bone,liver, lung pleura cavity) T N M1A/1B predicts survival
Lung cancer - NSCLC subtypes?
Squamous Cell
Adenocarcinoma
Adenocarcinoma in situ (aka bronchoalveolar carcinoma)
Lung cancer symptoms?
Depend on stage of disease Sob - lobar collapse, effusion, lymphangitis Chest pain - rib involvement, chest wall invasion Cough Haemoptysis Weight loss Low appetite Low energy levels
Lung cancer - paraneoplastic syndromes causes and effects?
High Ca (PTH release/bone involvement) - nausea, confusion, abdo pain and constipation
SIADH - confusion, fits
Lambert eaton syndrome - neuromuscular weakness
Effects of lung cancer being a metastatic disease?
SVCO due to mediastinal disease
Brain mets - confusion, nausea, headache
Bone mets - path fracture, pain
Liver mets - abdo pain
Signs of lung cancer?
Finger nail clubbing Cachexia Horner's syndrome Neck nodes Chest signs Palpable liver SVCO
How to diagnose lung cancer?
Chest X-ray:
- Cheap
- Won’t detect mediastinal disease or small nodules
- Not a staging tool, but a screening tool
CT:
- Staging tool
- Detailed info
- Requires IV contrast (not allowed in pts with CKD)
- Cannot detect microscopic disease
PET scan for radical treatable disease;
- Infusion of FD glucose
- Detects cancer, infec, vasculitis
- Expensive
- Very sensitive
- False positive rate
Tissue biopsy:
- Image guided
- Bronchoscopy +/- endobronchial US
- Thoracoscopy for pleural disease
- Surgical
WHO performance status for lung cancer?
0 = carry out normal activity 1 = restricted in strenuous activity 2 = capable of self care but unable to do work activities 3 = symptomatic, in chair or bed for 50% of day 4 = disabled, cannot care for self
What does lung cancer treatment depend on?
Stage and WHO performance status
RT or surgery for WHO 1/2
Chemo for extensive disease
Immunotherapy - inhibition of PDL suppression by tumours on T-ells
Oral EGFR mAB for EGFR positive disease WHO PS 0-3
BSC for pts not fit for active treatment
How to treat SCLC?
Systemic Cisplatin based Chemotherapy - disease extensive at presentation
Treat within 7/7 of diagnosis to due speed of deterioration
If localised disease – f/u RT
Classification of interstitial lung disease?
Idiopathic
Drug reaction
Extrinsic allergic alveolitis/hypersensitivity pneumonitis
Associated with rheumatological disease
Symptoms of lung disease?
Types of it?
Dyspnea Cough Constitutional symptoms (fevers, weightloss, headaches) EAA - post exposure IPF - chronic AIP - rapid onset
Signs of lung disease?
Nail clubbing
Sclerodactyly
Signs of steroid use
Chest - audible crackles, distribution may influence diagnosis, squeaks - suggest small airways disease
Idiopathic pulmonary fibrosis features?
Male Older population Median survival 3yrs Associated with clubbing Restrictive spirometry and reduced transfer factor Diagnosis by CT
How to treat Idiopathic pulmonary fibrosis?
Supportive Pulm rehab Pirfenidone when FVC <80% Nintenadib FVC 50-89% Palliative care
EAA triggers?
Occupation - baker, farmer, moulds
Where is EAA mainly located?
Predominant upper zone predominance
EAA treatment?
Antigen avoidance
Trail of corticosteroid therapy
Calcium and vitamin supplementation
Possible bisphosphonate
What is sleep apnea?
Prevalence?
Excessive daytime sleepiness with disordered nocturnal irregular breathing
0.5-4% population prevalence cf Type 1 DM
How is the severity of sleep apnea measured?
Apnea-hypopnea index
Mild - AHI 5-14/hr
Mod - AHI 15-30/hr
Severe - AHI >30/hr
Name the types of sleep apnea
Obstructive sleep apnea
Central sleep apnea
Mixed apnea
Risk factors for OSA?
Obesity >17 inch collar Men x2-3 likely Age Cranio-facial and upper airway abnormalities e.g. short mandible, wide craniofacial base
What does sleep apnoea cause?
Excessive daytime sleeping Impaired conc Snoring Unrefreshing sleep Choking episodes during sleep Restless sleep Nocturia
Obstructive sleep apnoea?
Upper airway collapses = snoring and apnoeas
