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CP3 Medicine > RESPIRATORY - TB, Lung cancer, Pneumothorax and Pleural effusions > Flashcards

RESPIRATORY - TB, Lung cancer, Pneumothorax and Pleural effusions Flashcards

1
Q

Peak incidence lung cancer

A

65 y/o

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2
Q

M:F lung cancer

A

3:1

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3
Q

RF lung cancer

A

Smoking
Passive smoking
Urban living
Occupational exposure

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4
Q

Which type of lung cancer do occupational exposures mostly lead to

A

Adenocarcinoma

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5
Q

% of lung cancer in regards to location

A

70% centrally (main bronchi/hilum)

30% peripherally

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6
Q

What are the 4 types of lung cancer

A

Squamous cell carcinoma (40-50%)
Adenocarcinoma (20-40%)
Small cell anaplastic carcinoma (20-30%)
Large cell anaplastic carcinoma (10%)

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7
Q

Where does squamous cell lung carcinoma arise form?

A

Sqamous metaplasia of pseudostratified ciliated columnar epithelium

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8
Q

What is SCC usually in response to

A

Cigarette smoke exposure

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9
Q

Where in the lungs do SCC;’s tend to arise

A

Central + close to carina

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10
Q

What substance can SCC’s secrete + what Sx does this lead to

A

PTH

Hypercalcaemia

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11
Q

Diagnosis SCC

A

CXR

Sputum cytology

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12
Q

Prognosis SCC

A

Slow growing

and may be resectable

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13
Q

Where do adenocarcinomas of the lung tend to arise

A

Peripherally 2/3

Areas of previous lung scarring

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14
Q

Why are non-smoking women at risk of developing lung adenocarcinoma

A

Because they have a high incidence of growth factor receptor

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15
Q

Which type of lung adenocarcinoma is associated with a better prognosis?

A

Bronchoalveolar carcinoma

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16
Q

Another name for small cell anaplastic carcinoma

A

Oat cell carcinoma

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17
Q

Where are small cell carcinoma’s usually located

A

Centrally

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18
Q

Spread small cell carcinoma

A

Grow rapidly

+ often mets at diagnosis

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19
Q

Origin small cell carcinoma

A

From bronchial epithelial

Which DDx into neuroendocrine/Kulchitsky cells

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20
Q

What do Kulchitsky cells do

A

Express markers + secrete ADH + ACTH

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21
Q

Small cell carcinoma can lead to which MG-like syndrome?

A

Eaton-Lambert syndrome

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22
Q

Sx Eaton-Lambert syndrome (5)

A 
Scapular/pelvic girdles 
Reduced tendon reflexes 
Dry eyes 
Sexual impotence 
Neuropathy
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23
Q

Prognosis Eaton-Lambert syndrome

A

usually gets better w/ usage

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24
Q

What are large cell anaplastic carcinomas

A

Show SCC/adenocarinomatous origins

But not DDx enough to be classified

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25
Q

Where in lung do large cell anaplastic carcinomas present

A

Centrally

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26
Q

Prognosis large cell anaplastic carcinomas

A

Poor

Widely disseminated @diagnosis

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27
Q

Which grade Non-small cell lung cancers are operable?

A

T1NO - T3N2

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28
Q

Early catching non-small cell lung cancer 5y survival rate

A

55-67%

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29
Q

PS Lung cancer (7)

A 
Persistent cough 
Haemoptysis 
Dyspnoea 
Chest pain 
B Sx 
Chest infections 
W loss
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30
Q

O/E - lung cancer (6)

A 
Clubbing 
Cahexia 
Signs anaemia 
Hypertrophic pulmonary OA
Chest signs - collapse/consolidation/effusion 
Signs of mets
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31
Q

What is hypertrophic pulmonary OA due to?

A

Paraneoplastic syndrome

= Clubbing + painful periostheitis of small joints of hands

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32
Q

Paraneoplastic syndromes which can arise due to lung cancer (5)

A 
Hypertrophic pulmonary OA 
Lambert-Eaton syndrome 
SIADH
2' Cushings 
HyperPTH
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33
Q

Local invasion issues caused by lung cancers (7)

A 
Rec laryngeal nn palsy 
Phrenic nn palsy 
SVC obstruction 
Pancoast syndrome 
Pericarditis 
Pericardium --> effusion/AF
Oesophageal fistulas/dysphagia
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34
Q

When are phrenic nn palsies asymptomatic?

A

If unilateral

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35
Q

S+S of SVC obstruction

A

Raised JVP
Raised arm BP/swelling
Facial swelling
Headache

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36
Q

What is Pancoast syndrome

A

Malignant neoplasm of lung apex –> destructive lesions of thoracic inlet

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37
Q

Sx Pancoast syndrome (4)

A

Horners syndrome
Shoulder pain R along ulnar forearm + hand
Atrophy hand/arm mm
Oedema b/c BV occlusion

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38
Q

mets lung cancer (4)

A

Brain
Bone
Liver
Adrenal gland

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39
Q

What condition can Adrenal mets PS as

A

Addison’s

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40
Q

Skin conditions indicating lung cancer (2)

A

Acanthosis nigricans

Dermatomyositis

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41
Q

DDx lung mass

A

Granuloma

Aspergilloma

42
Q

Ix lung cancer (10)

A 
FBC (anaemia/polycythaemia) 
LFTs - mets 
U+E - hypercalcaemia/hyponatraemia 
CXR
Sputum/pleural fl cytology 
Staging CT 
Biopsy CT via bronchoscopy 
Pulmonary fct tests 
PET scan (mets)
43
Q

Why use pulmonary function tests when investigating lung cancer?

A

For planning surgery

44
Q

If a lung cancer lesion is hidden by the heart, what should you look for on CXR

A

hilar lymphadenopathy

45
Q

How do children present with 1’ TB (2)

A

Enlarged mediastinal LN + cough

46
Q

Natural Hx TB

A

1 - inhal TB
2 TB –> alveoli - taken up by macrophages + local consolidation occurs
3 –> Ghon focus (infective focus) –> nodes –> 1’ complex
4 -Dissemination occurs –> foci at distant site (bronchi/pleura/pericardium)
5 - Further spread limited by CMI - IV HS
6 - Foci heal by fibrosis + calcify
7 - Viable bacteria remain walled off –> latent TB

47
Q

In what ways can 1’ TB come symptomatic (4)

A

Ghon focus can erode through visceral pleura –> TB pleurisy/pleural effusions
Enlarge LN can –> bronchial obstruction + collapse
LN can erode into bronchus + rupture –> TB bronchopneumonia
Enlarging LN can erode into vessels –> military dissemination (lung) or systemic dissemination

48
Q

What is post-primary TB?

A

M. TB reinfection in tuberculin-sensitive individuals

49
Q

How can post-primary TB occur? (2)

A

From exogenous sources

Or reactivation from healed 1’ complex (> common)

50
Q

pathology post-primary TB

A

Lung: classical apical lesion = assmann focus w/ destruction lung parenchyma –> cavitation
Lesion may heal w/ fibrosis or will progressively enlarge

51
Q

Early Sx TB

A 
B Sx 
Hence malaise 
Night sweats 
Anorexia 
W loss
52
Q

Later Sx TB

A

Productive mucoid cough
Repeated small haemoptysis
PLeural pain
Pneumonia/Pleural effusion

53
Q

O/E TB

A

Fever
Apical crepitations
Clubbing in advanced disease

54
Q

What % of the worlds population is infected by M TB

A

1/3

55
Q

What are the greatest RF for being infected w/ TB

A 
Social deprivation 
Non-white ethnicity 
Alcohol dependence 
HIV
Increasing age 
Overcrowding 
Those on immunosuppressive therapies
56
Q

Ix TB (6)

A

Sputum samples x3 incl 1 monring
Microscopy
PCR
Lowenstein Jensen culture (gold standard)
CXR
Bronchoscopy + biopsy if culture negative

57
Q

Mantoux test >5mm

A

= positive in immunosuppressed indiv or those w/ prior TB/recent contacts

58
Q

Mantoux test >10mm

A

+ve in those w/ RF for YB

59
Q

Mantoux test >15mm

A

Positive in any individual

60
Q

What should every TB pt be screened for before starting Tx

A

HIV

Hep B/C

61
Q

Examples of extrapulmonary features of RB

A 
Lymphatic TB
Potts 
Ileocecal TB
Scrofulderma 
Meningism 
UG
Pericardium 
Adrenal glands
62
Q

What is Pott’s disease

A

Spinal involvement of TB –> chronic back pain

63
Q

If TB affects the pericardum, what is it associated with (4)

A

AF
Elevated JVP
Kussmaul’s sign
Pulsus paradoxus

64
Q

What condition does TB mimic if it affects the adrenals

A

Addisons

65
Q

Cutaneous TB e.g.s (2)

A

Erythema nodosum

Lupus vulgaris

66
Q

Def pneumothorac

A

A tear in the lung –> air leaking out into pleural space

67
Q

PS Pneumothorax

A

Asymp in young pt if small
Or PS w/ sudden onset unilat pleuritic pain
+ progressive breathlessness

68
Q

1’ spontaneous pneumothorax - M:F

A

6:1

69
Q

Cause of primary spontaneous pneumothorax

A

Rupture of apical bleb/bulla
B/C congenital defects in CT alveolar walls
Tall + thin pt

70
Q

Main cause of 2’ pneumothorax

A

COPD

71
Q

Rarer causes of 2’ pneumothorax (4)

A

Bronchial asthma
Carcinoma
Lung abscess
Severe fibrosis (CF)

72
Q

What % pt w/ 2’ pneumothorax have recurrence

A

1/3

73
Q

2 types of non-spontaneous pneumothorax

A

Traumatic pneumothorax

Iatrogenic pneumothorax

74
Q

Mechanism of a tension pneumothorax

A

Intrapleural pressure = high
Due to P differences air = sucked into pleural space during inspiration, but not expelled during exp
Hence: lung deflates + vv return to heart decreases –> cardiac compromise

75
Q

Who gets tension pneumothorax

A

Patients on +ve P ventilation

76
Q

Features suggesting tension pneumothorax (7)

A 
Tracheal deviation AWAY from the affected side
Signs haemodynamic compromise 
\+/- distended neck vv
Reduced expansion 
Increased resonance on percussion 
Decr breath sounds 
Decr vocal resonance
77
Q

Ix for pt w/ suspected pneumothorax

A

Expiratory CXR

ABG

78
Q

Mx tension pneumothorax

A

100% O2
Needle decompression - insert large bore cannula into 2nd ICS, MCL
CXR
Insert chest drain + aspirate if >2cm

79
Q

How does needle decompression work for Mx of pneumothorax

A

Large bore cannula into 2nd ICS MCL on side of suspected lesion
Partially filled w saline
Pull back on syringe to allow air to bubble out until a chest drain can be instered

80
Q

Empyema

A

Accumulation of pus, due to infection

81
Q

Chylothorax

A

Accumulation of lymph due to thoracic duct leakage

82
Q

Haemothorax

A

Accumulation of blood due to trauma

83
Q

Why does a transudate effusion occur?

A

Due to increased HSP or decreased oncotic P

84
Q

Why does an exudate effusion occur>

A

Increased capillary permeability

85
Q

Causes of transudate pleural effusion (4)

A

Cardiac failure
Liver failure
Renal failure
Peritoneal dialysis

86
Q

Causes of exudative effusion (8)

A 
Bacterial pneumonia 
TB
Neoplasms - lung 1/2'
Mesothelioma 
PE
RA/SLE
Pancreatitis 
Subphrenic abscess
87
Q

PS pleural effusion (3)

A

Asymp
Dyspnoea
Pleuritic pain

88
Q

O/E Pleural effusion (5)

A 
Decr chest expansion 
Stony dull to percussion 
Decr breath sounds 
Reduced vocal resonance 
Mediatinal deviation if massive
89
Q

What is an empyema caused by?

A

Bacterial invasion of the pleural space, either by spreading an exudate effusion from adjacent pneumonia or by direct innoculation

90
Q

PS empyema

A

Fever + signs pleural effusion

91
Q

Aspirate empyema (5)

A 
Yellow
Turbid 
pH <7.2 
Low glucose 
High LDH
92
Q

Mx empyema (2)

A

IV Abx

CHest drain

93
Q

Def Pleurisy

A

Inflammation of the pleura (usually due to an infection)

94
Q

Ix pleural effusion (5)

A 
CXR
USS 
Aspiration 
Pleural tap 
Pleural biopsy
95
Q

At what volume effusion can a chest xray begin to ID

A

300ml

96
Q

Why is USS recommended in effusion

A

To guide aspiratoin

97
Q

What 4 things happens to the aspirate from an effusion

A

–> microbiology for MCS
Clinical chemistry - protein/LDH/glucose
Cytology
BG machine for pH

98
Q

Featues of an exudate aspirate (2)

A

Protein >30g/L

LDH >200

99
Q

Features of a transudate aspirate (2)

A

LDH <200

Protein <30

100
Q

When aspirate is borderline, how to ddx from transudate and exudate

A

1 positive element of lights criteria - exudate

101
Q

When is a pleural biopsy useful in effusions

A

Abrams needle

When DDxc malignant effusions + TB

102
Q

Mx effusion if fl is purulent/turbid or pH <7.2

A

Chest drain + consider ABx

Mx underlying cause

CP3 Medicine (29 decks)

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