respiratory_week_3_20190518190058 Flashcards
what are the symptoms of lung cancer?
haemoptysis, recurrent pneumonia, stridor
what does invasion of laryngeal nerve cause
horse voice
what causes invasion of brachial plexus
pancoast tumour (high up)
what happens when superior vena cava is invaded
blood from upper part of body cannot flow back to heart - big veins on neck, big red head
when is the common sites for metastases
liver, brain, bone, adrenal gland (located on top of kidneys) and skin
what are symptoms of paraneoplastic tumour (non-metastatic)
clubbing, hypertrophic pulmonary osteoarthropathy (expansion of bone lining), weight loss, thrombophlebitis (redness and pain around vein), hypercalcaemia
what is effect of symptom hypercalcaemia
stones, bone pain, groans (abdominal pain, constipation), thrones (polyuria) psychiatric (depression, coma), cardiac arrhythmia
what is effect of symptom SIADH (syndrome of inappropriate antidiuretic hormone)
low sodium concentration nausea, myoclonus, lethargy/confusion, seizures/coma
tissue is needed to make a full diagnosis of lung cancer: how is this done?
bronchoscopy, CT guided biopsy (side of chest), lymph node aspirate, aspiration of pleural fluid, endobronchial ultrasound, thorascopy (inserted between ribs, lung deflated and bio)
what is the first part of clinical presentation (local effects)
obstruction of airway (pneumonia), invasion of chest wall (pain), ulceration (haemoptysis)
what is the second part of clinical presentation (metastases)
nodes, bones, liver, brain
what is the third part of clinical presentation (systemic effects)
weight loss, ectopic hormone production - PTH (squamous) and ATCH (small cell)
what are the four common smoking-associated types of cancer
adenocarcinoma, squamous carcinoma, small cell carcinoma, large cell carcinoma
what is the most deadly type
small cell - patients almost all dead within a year, chemosensitive but rapidly emerging resistance
what are the molecular genetic abnormalities (potential therapeutic agents) in SCLC
oncogenes - myctumour suppressor genes - p53, Rb, 3p
what are the molecular genetic abnormalities (potential therapeutic agents) in NSCLC
oncogenes - myc, K-ras, her2(neu) tumour suppressors - p53, 1q, 3p, 9p, 11p, Rb
what is the pattern in peripheral adenocarcinoma?
atypical adenomatous hyperplasia, spread of neoplastic cells along alveolar walls and then true invasive adenocarcinoma
what are some other lung neoplasms
carcinoids: neuroendocrine neoplasms of low gradebronchial gland neoplasms: often salivary gland
describe tumours of the pleural cavity of lung
benign tumours rare, primary malignant neoplasm (mesothelioma)
lining of nasal cavity
keratinised stratified squamous epitheliumkeratin then lost
what is layers under respiratory epithelium
- resp epithelium2. goblet cells3. basal cell (stem cell)4. cilia 5. lamina propia/submucosa
components of lamina propia
band of connective tissue containing seromucous glands and a rich venous plexus which can quickly engorge with blood and block nose
components of the larynx
walls made up of cartilage, muscle and respiratory epithelium vocal folds - stratified squamous epithelium
components of trachea
cartilage spanned by fiibroelastic tissue and smooth muscle wall - resp epithelium backed by basal lamina, lamina proper and submucosa that connects numerous seromucous glands
what is components of the wall of bronchus
respiratory epithelium, lamina propria, musculares (ring of smooth muscle) and submocua (w adipose tissue and seromucous glands)
component of bronchioles
lack cartilage and glands epithelium decrease in height (columnar to cuboidal) as down respiratory treelamina propia composed of smooth muscle (response to parasympathetic stimulation) and elastic fibres
what is the role of terminal bronchioles (last ones)
stem cells, detoxification, immune modulation and surfactant production
what is components of type 1 alveoli cell
simple squamous epithelium that lines alveoli surfacesprovide barrier that is permeable to gases
what is components of type 1 alveoli cell
polygonal in shape - free surface covered by microvilli and cytoplasm displays lamellar bodies (contain surfactant)
what are alveolar macrophages (dust cells)
either in septa or migrating over luminal surfaces of alveoli - phagocytose inhaled particles
what is components of visceral pleura?
multilayered outer layer - squamous epithelium called mesothelium (cancer - asbestos)between visceral and parietal pleura - cavity containing fluid
anatomy of coughing
- deep inspiration 2. adduction to close rims glottidis (vagus nerve)3. contraction of abdominal wall - pressure
what sensory receptors stimulated in sneezing
CN V or CN IX
what sensory receptors stimulated in coughing
CN IX or CN X
what is carotid sheaths
protective tubes of cervical deep fasciaattach superiorly to bones of base of skulland blends inferiorly with fascia of mediastinumcontains: vagus nerve, internal carotid artery, common carotid artery and internal jugular vein
what is the location and role of pectorals major
attaches between sternum/ribs and humerus adducts and rotates humerus if upper limb position fixed, muscle pull ribs upwards/outwards
what is role of pectorals minor
can pull ribs 3-5 superiorly towards coracoid process of scapula
what is location of sternocleidomastoid
attaches between sternum/clavicle and mastoid process of temporal bonealso attaches between cervical vertebrae and ribs 1 and 2
where is transversus abdonminus
(deep to internal oblique) attaches superiorly to deep aspects of lower ribs
what is role of intercostal nerves
7th to 11th - thoracoabdominal nerves T12 anterior rami - subcostal nervehalf of L1 = illohypogastric nervehalf of L1 - illoihnguinal nerve
what are pulmonary consequences of chronic cough
breach in visceral pleura permits alveolar air to enter build up of air in alveoli lead to rupture of lung and visceral pleura
small pneumothorax vs large pneumothorax
small (<2cm gap)large (>2cm gap)
what is found upon examination of pneumothorax
reduced ipsilateral chest expansion, reduced breath sounds or hyper-response on percussion absent lung markings peripherally and lung edge visible
what is a tension pneumothorax
torn pleura creates one way value which prevents air escaping build up applies tension to mediastinal structures - causes shift (tracheal deviation, hypotension) leads to cardiac arrest
how to manage large pneumothorax
needle aspirationchest drain (4th or 5th intercostal space)
what is emergency management of a tension pneumothorax
large gauge cannula into pleural cavity via 2nd or 3rd intercostal space
what is a paraoesophagheal hernia
herniated part of stomach passes through oesophageal hiatus to become parallel to oesophagus and in chest
what is sliding hiatus hernia
herniated part of the stomach slides through oesophageal hiatus into chest with gastro-oesophageal junction
describe the inguinal ligaments
attach between ASIS and pubic tubercle their medial halves form floors of inguinal canals
describe inguinal canals
4cm long passageways through anterior abdominal wall in inguinal regionseach canal runs between deep ring (entrance to canal) and superficial ring (exit from canal)
what is a inguinal herniae
form in medial half of inguinal region 1) weakness - presence of canal in inguinal part of anterolateral abdominal wall2) increased pressure: intra-abdominal due to chronic cough, constipation etc
what is the first step in the descending of the scrotum
the process vaginalis (out pouching of parietal peritoneum above scrotum)
what is second step in descending of scrotum
internal spermatic fascia forms (covering of transversals fascia)
what is the third step in the descending of scrotum
cremasteric fascia forms (a covering of skeletal muscle fibres from internal oblique)
what is fourth step in descending of scrotum
V shaped defect forms in medial end of external oblique aponeurosis
what is the fifth step in descending of scrotum
the external spermatic fascia forms (covering of external oblique aponeurosis)
what does the spermatic cord look like
3 layers of coverings gained as testes pass through inguinal canal and structures contained within
lungs at embryonic stage (26 days to 6 weeks)
respiratory diverticulum forms initial branching to give lungs, lobes and segments
lungs at pseudo glandular stage (6-16 weeks)
14 more generations of branching: terminal bronchioles
lungs at canalicular stage (16-28 weeks)
terminal bronchioles 3-6 alveolar ducts
lungs at saccular stage (28-36 weeks)
terminal sacs form: capillaries establish close contact
lungs at alveolar stage (36 weeks - early childhood)
alveoli mature
describe small cell lung cancer (12%)
rapid progress, early metastases, rarely suitable for surgery, good initial response to chemo
describe non small cell lung cancer
curative options are surgery or radial radiotherapy palliative chemotherapy and new targeted treatment
what are the stages before lung cancer?
bronchoscopy, mediastinoscopy / EBUS (lymph nodes), CT of brain, CT of thorax and PET scan (metastases)
what is the surgery for lung cancer
pneumonectomy (take out lung) or lobectomy
what are stages before chemotherapy
bronchoscopy or other cell sampling (know cell type)CT scan (tumour size etc)performance status ECOG score
what are the characteristics of cytotoxic chemotherapy
better response in SCC, IV infusion every 3-4 weeks, targets rapidly dividing treatment, whole body treatment
side effects of chemotherapy
nausea, tiredness, bone marrow suppression, hair loss, pulmonary fibrosis
what is ionisation radiotherapy
external beam
what is radical radiotherapy
curative intent
what is palliative radiotherapy
delaying tactic which is useful for metastases
what are the snags of radiotherapy
maximum cumulative dosecollateral damage - spinal cord, oesophagus and adjacent lung tissue no good for metastases
what is stereotactic ablative radiotherapy (SABR)
many more beams, less collateral damage, total dose higher so 4d scanning required
what is endobronchial therapy
stent insertion for stridor, photodynamic therapy, other laser therapy
what does palliative care focus on
pain, breathlessness, cough, anxiety, poor mobility
what is prognosis for lung cancer
half be dead in 6 months, 1 in 20 survive for 5 years
what is pleural effusion
abnormal collection of fluid in pleural space
what is appearance of pleural fluid
straw colour - cardiac failureblood - trauma, malignancy, infectionmilky - empyema foul smelling - anaerobic empyema bilateral - LVF, PTE, drugs and systemic path
characteristics of transudative pleural effusion
protein <30g/l, due to heart failure, liver cirrhosis, hypoalbuminaemia, atelectasis, peritoneal dialysis, not always benign
characteristics of exudative pleural effusion
protein >30g/l, due to malignancy, infection inc TB, pneumonia, pulmonary infarct, asbestos, connective tissue disease
when would glucose be low
infection, TB, rheumatoid arthritis, malignancy, oesophageal rupture, SLE
why would a biopsy be negative
involvement of pleural disease is discontinuous the effusion is ancillary to malignancy but not malignant
what is mesothelioma
uncommon malignant tumour of lining of lung of abdominal cavity
what are symptoms of mesothelioma
exposure to asbestos breathlessness, chest pain, weight loss, fever, sweating and cough
what are the investigations in mesothelioma
imaging, pleural fluid aspiration and biopsy
how to treat mesothelioma
pleurodese effusions, radiotherapy, surgery, chemotherapy, palliative care, report death to fiscal
what is the treatment for malignant pleural effusion
tac slurry or talc poudrage long term pleural catheters LVF cause - diureticsinfection - drain, antibiotics malignancy - drain, pleurodesis, long term pleural catheter
how to predict survival in malignant pleural effusion
LENT score:LDHECOG PSNeutrophil to lymphocyte ratio Tumour type
what are the complications of talc
minor pleuritic pain and fever, pneumonia, rest failure, ARDS, secondary empyema
when is pneumothorax more common
tall thin men, smokers, cannabis, underlying lung disease
what are range of conditions in upper respiratory tract
common cold - coryzasore throat - pharyngitissinusitis - epiglottis
what are range of conditions in lower respiratory tract
acute/chronic bronchitispneumonia influenza fungal infection
what tube used for viral throat swab
red top
symptoms of strep throat
exudate, pus, sore throat, dysphagia, dysphonia
what is symptoms of tonsillitis
swollen tonsils, erythematous, dysphagia, dysphonia
what is Quincy
complication of tonsillitis - tonsilar abscess
describe sinusitis
frontal headache, retro-orbital pain, maxillary sinus pain, tooth ache, discharge treatment: nasal decongestions, sometimes antibiotics
what is acute bronchitis
cold which “goes to chest”productive cough, fever, normal CXR, may have wheezeparacetamol and fluid
what is treatment of an acute exacerbation of COPD in primary care
antibiotic - doxycycline or amoxicillin bronchodilators
what does pneumonia look like on CXR
consolidation of tissue filling of alveolar space with inflammatory cells
what is the causes of classical flu
influenza A and influenza B virus
what is the cause of haemophilus influenza
bacterium, secondary invader not primary cause of flu
how is flu transmitted
droplets - infection control precautions also include aerosol protection for aerosol generating procedures
what are the complications of flu
primary influenzal pneumonia (young adult)secondary (infant, elderly - death)bronchitis, otitis media, severe complications in pregnancy
what is the therapy of flu
symptomatic - bed rest, fluid, paracetamol antivirals - oseltamivir, zanamivir
what is present in killed vaccine
virus grown then inactivated and combined with adjuvant, contains 2 influenza A and 1 influenza B
what is present in live attenuated virus
children 2-17, administered intra-nasally
clinical presentation of bronchiolitis
infection of bronchioles, 1st of 2nd year of life, fever, coryza, cough, wheezesevere cases - grunting, decreased PaO2
what are complications of bronchiolitis
respiratory and cardiac failure - prematurity, pre-existing respiratory or cardiac disease
what are characteristics of bronchiolitis
80% cause due to respiratory syncytial virus lab confirmation by PCR
