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respiratory_week_3_20190518190058 Flashcards

1
Q

what are the symptoms of lung cancer?

A

haemoptysis, recurrent pneumonia, stridor

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2
Q

what does invasion of laryngeal nerve cause

A

horse voice

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3
Q

what causes invasion of brachial plexus

A

pancoast tumour (high up)

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4
Q

what happens when superior vena cava is invaded

A

blood from upper part of body cannot flow back to heart - big veins on neck, big red head

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5
Q

when is the common sites for metastases

A

liver, brain, bone, adrenal gland (located on top of kidneys) and skin

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6
Q

what are symptoms of paraneoplastic tumour (non-metastatic)

A

clubbing, hypertrophic pulmonary osteoarthropathy (expansion of bone lining), weight loss, thrombophlebitis (redness and pain around vein), hypercalcaemia

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7
Q

what is effect of symptom hypercalcaemia

A

stones, bone pain, groans (abdominal pain, constipation), thrones (polyuria) psychiatric (depression, coma), cardiac arrhythmia

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8
Q

what is effect of symptom SIADH (syndrome of inappropriate antidiuretic hormone)

A

low sodium concentration nausea, myoclonus, lethargy/confusion, seizures/coma

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9
Q

tissue is needed to make a full diagnosis of lung cancer: how is this done?

A

bronchoscopy, CT guided biopsy (side of chest), lymph node aspirate, aspiration of pleural fluid, endobronchial ultrasound, thorascopy (inserted between ribs, lung deflated and bio)

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10
Q

what is the first part of clinical presentation (local effects)

A

obstruction of airway (pneumonia), invasion of chest wall (pain), ulceration (haemoptysis)

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11
Q

what is the second part of clinical presentation (metastases)

A

nodes, bones, liver, brain

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12
Q

what is the third part of clinical presentation (systemic effects)

A

weight loss, ectopic hormone production - PTH (squamous) and ATCH (small cell)

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13
Q

what are the four common smoking-associated types of cancer

A

adenocarcinoma, squamous carcinoma, small cell carcinoma, large cell carcinoma

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14
Q

what is the most deadly type

A

small cell - patients almost all dead within a year, chemosensitive but rapidly emerging resistance

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15
Q

what are the molecular genetic abnormalities (potential therapeutic agents) in SCLC

A

oncogenes - myctumour suppressor genes - p53, Rb, 3p

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16
Q

what are the molecular genetic abnormalities (potential therapeutic agents) in NSCLC

A

oncogenes - myc, K-ras, her2(neu) tumour suppressors - p53, 1q, 3p, 9p, 11p, Rb

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17
Q

what is the pattern in peripheral adenocarcinoma?

A

atypical adenomatous hyperplasia, spread of neoplastic cells along alveolar walls and then true invasive adenocarcinoma

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18
Q

what are some other lung neoplasms

A

carcinoids: neuroendocrine neoplasms of low gradebronchial gland neoplasms: often salivary gland

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19
Q

describe tumours of the pleural cavity of lung

A

benign tumours rare, primary malignant neoplasm (mesothelioma)

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20
Q

lining of nasal cavity

A

keratinised stratified squamous epitheliumkeratin then lost

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21
Q

what is layers under respiratory epithelium

A
  1. resp epithelium2. goblet cells3. basal cell (stem cell)4. cilia 5. lamina propia/submucosa
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22
Q

components of lamina propia

A

band of connective tissue containing seromucous glands and a rich venous plexus which can quickly engorge with blood and block nose

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23
Q

components of the larynx

A

walls made up of cartilage, muscle and respiratory epithelium vocal folds - stratified squamous epithelium

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24
Q

components of trachea

A

cartilage spanned by fiibroelastic tissue and smooth muscle wall - resp epithelium backed by basal lamina, lamina proper and submucosa that connects numerous seromucous glands

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25
Q

what is components of the wall of bronchus

A

respiratory epithelium, lamina propria, musculares (ring of smooth muscle) and submocua (w adipose tissue and seromucous glands)

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26
Q

component of bronchioles

A

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

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27
Q

what is the role of terminal bronchioles (last ones)

A

stem cells, detoxification, immune modulation and surfactant production

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28
Q

what is components of type 1 alveoli cell

A

simple squamous epithelium that lines alveoli surfacesprovide barrier that is permeable to gases

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29
Q

what is components of type 1 alveoli cell

A

polygonal in shape - free surface covered by microvilli and cytoplasm displays lamellar bodies (contain surfactant)

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30
Q

what are alveolar macrophages (dust cells)

A

either in septa or migrating over luminal surfaces of alveoli - phagocytose inhaled particles

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31
Q

what is components of visceral pleura?

A

multilayered outer layer - squamous epithelium called mesothelium (cancer - asbestos)between visceral and parietal pleura - cavity containing fluid

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32
Q

anatomy of coughing

A
  1. deep inspiration 2. adduction to close rims glottidis (vagus nerve)3. contraction of abdominal wall - pressure
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33
Q

what sensory receptors stimulated in sneezing

A

CN V or CN IX

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34
Q

what sensory receptors stimulated in coughing

A

CN IX or CN X

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35
Q

what is carotid sheaths

A

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

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36
Q

what is the location and role of pectorals major

A

attaches between sternum/ribs and humerus adducts and rotates humerus if upper limb position fixed, muscle pull ribs upwards/outwards

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37
Q

what is role of pectorals minor

A

can pull ribs 3-5 superiorly towards coracoid process of scapula

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38
Q

what is location of sternocleidomastoid

A

attaches between sternum/clavicle and mastoid process of temporal bonealso attaches between cervical vertebrae and ribs 1 and 2

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39
Q

where is transversus abdonminus

A

(deep to internal oblique) attaches superiorly to deep aspects of lower ribs

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40
Q

what is role of intercostal nerves

A

7th to 11th - thoracoabdominal nerves T12 anterior rami - subcostal nervehalf of L1 = illohypogastric nervehalf of L1 - illoihnguinal nerve

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41
Q

what are pulmonary consequences of chronic cough

A

breach in visceral pleura permits alveolar air to enter build up of air in alveoli lead to rupture of lung and visceral pleura

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42
Q

small pneumothorax vs large pneumothorax

A

small (<2cm gap)large (>2cm gap)

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43
Q

what is found upon examination of pneumothorax

A

reduced ipsilateral chest expansion, reduced breath sounds or hyper-response on percussion absent lung markings peripherally and lung edge visible

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44
Q

what is a tension pneumothorax

A

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

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45
Q

how to manage large pneumothorax

A

needle aspirationchest drain (4th or 5th intercostal space)

46
Q

what is emergency management of a tension pneumothorax

A

large gauge cannula into pleural cavity via 2nd or 3rd intercostal space

47
Q

what is a paraoesophagheal hernia

A

herniated part of stomach passes through oesophageal hiatus to become parallel to oesophagus and in chest

48
Q

what is sliding hiatus hernia

A

herniated part of the stomach slides through oesophageal hiatus into chest with gastro-oesophageal junction

49
Q

describe the inguinal ligaments

A

attach between ASIS and pubic tubercle their medial halves form floors of inguinal canals

50
Q

describe inguinal canals

A

4cm long passageways through anterior abdominal wall in inguinal regionseach canal runs between deep ring (entrance to canal) and superficial ring (exit from canal)

51
Q

what is a inguinal herniae

A

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

52
Q

what is the first step in the descending of the scrotum

A

the process vaginalis (out pouching of parietal peritoneum above scrotum)

53
Q

what is second step in descending of scrotum

A

internal spermatic fascia forms (covering of transversals fascia)

54
Q

what is the third step in the descending of scrotum

A

cremasteric fascia forms (a covering of skeletal muscle fibres from internal oblique)

55
Q

what is fourth step in descending of scrotum

A

V shaped defect forms in medial end of external oblique aponeurosis

56
Q

what is the fifth step in descending of scrotum

A

the external spermatic fascia forms (covering of external oblique aponeurosis)

57
Q

what does the spermatic cord look like

A

3 layers of coverings gained as testes pass through inguinal canal and structures contained within

58
Q

lungs at embryonic stage (26 days to 6 weeks)

A

respiratory diverticulum forms initial branching to give lungs, lobes and segments

59
Q

lungs at pseudo glandular stage (6-16 weeks)

A

14 more generations of branching: terminal bronchioles

60
Q

lungs at canalicular stage (16-28 weeks)

A

terminal bronchioles 3-6 alveolar ducts

61
Q

lungs at saccular stage (28-36 weeks)

A

terminal sacs form: capillaries establish close contact

62
Q

lungs at alveolar stage (36 weeks - early childhood)

A

alveoli mature

63
Q

describe small cell lung cancer (12%)

A

rapid progress, early metastases, rarely suitable for surgery, good initial response to chemo

64
Q

describe non small cell lung cancer

A

curative options are surgery or radial radiotherapy palliative chemotherapy and new targeted treatment

65
Q

what are the stages before lung cancer?

A

bronchoscopy, mediastinoscopy / EBUS (lymph nodes), CT of brain, CT of thorax and PET scan (metastases)

66
Q

what is the surgery for lung cancer

A

pneumonectomy (take out lung) or lobectomy

67
Q

what are stages before chemotherapy

A

bronchoscopy or other cell sampling (know cell type)CT scan (tumour size etc)performance status ECOG score

68
Q

what are the characteristics of cytotoxic chemotherapy

A

better response in SCC, IV infusion every 3-4 weeks, targets rapidly dividing treatment, whole body treatment

69
Q

side effects of chemotherapy

A

nausea, tiredness, bone marrow suppression, hair loss, pulmonary fibrosis

70
Q

what is ionisation radiotherapy

A

external beam

71
Q

what is radical radiotherapy

A

curative intent

72
Q

what is palliative radiotherapy

A

delaying tactic which is useful for metastases

73
Q

what are the snags of radiotherapy

A

maximum cumulative dosecollateral damage - spinal cord, oesophagus and adjacent lung tissue no good for metastases

74
Q

what is stereotactic ablative radiotherapy (SABR)

A

many more beams, less collateral damage, total dose higher so 4d scanning required

75
Q

what is endobronchial therapy

A

stent insertion for stridor, photodynamic therapy, other laser therapy

76
Q

what does palliative care focus on

A

pain, breathlessness, cough, anxiety, poor mobility

77
Q

what is prognosis for lung cancer

A

half be dead in 6 months, 1 in 20 survive for 5 years

78
Q

what is pleural effusion

A

abnormal collection of fluid in pleural space

79
Q

what is appearance of pleural fluid

A

straw colour - cardiac failureblood - trauma, malignancy, infectionmilky - empyema foul smelling - anaerobic empyema bilateral - LVF, PTE, drugs and systemic path

80
Q

characteristics of transudative pleural effusion

A

protein <30g/l, due to heart failure, liver cirrhosis, hypoalbuminaemia, atelectasis, peritoneal dialysis, not always benign

81
Q

characteristics of exudative pleural effusion

A

protein >30g/l, due to malignancy, infection inc TB, pneumonia, pulmonary infarct, asbestos, connective tissue disease

82
Q

when would glucose be low

A

infection, TB, rheumatoid arthritis, malignancy, oesophageal rupture, SLE

83
Q

why would a biopsy be negative

A

involvement of pleural disease is discontinuous the effusion is ancillary to malignancy but not malignant

84
Q

what is mesothelioma

A

uncommon malignant tumour of lining of lung of abdominal cavity

85
Q

what are symptoms of mesothelioma

A

exposure to asbestos breathlessness, chest pain, weight loss, fever, sweating and cough

86
Q

what are the investigations in mesothelioma

A

imaging, pleural fluid aspiration and biopsy

87
Q

how to treat mesothelioma

A

pleurodese effusions, radiotherapy, surgery, chemotherapy, palliative care, report death to fiscal

88
Q

what is the treatment for malignant pleural effusion

A

tac slurry or talc poudrage long term pleural catheters LVF cause - diureticsinfection - drain, antibiotics malignancy - drain, pleurodesis, long term pleural catheter

89
Q

how to predict survival in malignant pleural effusion

A

LENT score:LDHECOG PSNeutrophil to lymphocyte ratio Tumour type

90
Q

what are the complications of talc

A

minor pleuritic pain and fever, pneumonia, rest failure, ARDS, secondary empyema

91
Q

when is pneumothorax more common

A

tall thin men, smokers, cannabis, underlying lung disease

92
Q

what are range of conditions in upper respiratory tract

A

common cold - coryzasore throat - pharyngitissinusitis - epiglottis

93
Q

what are range of conditions in lower respiratory tract

A

acute/chronic bronchitispneumonia influenza fungal infection

94
Q

what tube used for viral throat swab

A

red top

95
Q

symptoms of strep throat

A

exudate, pus, sore throat, dysphagia, dysphonia

96
Q

what is symptoms of tonsillitis

A

swollen tonsils, erythematous, dysphagia, dysphonia

97
Q

what is Quincy

A

complication of tonsillitis - tonsilar abscess

98
Q

describe sinusitis

A

frontal headache, retro-orbital pain, maxillary sinus pain, tooth ache, discharge treatment: nasal decongestions, sometimes antibiotics

99
Q

what is acute bronchitis

A

cold which “goes to chest”productive cough, fever, normal CXR, may have wheezeparacetamol and fluid

100
Q

what is treatment of an acute exacerbation of COPD in primary care

A

antibiotic - doxycycline or amoxicillin bronchodilators

101
Q

what does pneumonia look like on CXR

A

consolidation of tissue filling of alveolar space with inflammatory cells

102
Q

what is the causes of classical flu

A

influenza A and influenza B virus

103
Q

what is the cause of haemophilus influenza

A

bacterium, secondary invader not primary cause of flu

104
Q

how is flu transmitted

A

droplets - infection control precautions also include aerosol protection for aerosol generating procedures

105
Q

what are the complications of flu

A

primary influenzal pneumonia (young adult)secondary (infant, elderly - death)bronchitis, otitis media, severe complications in pregnancy

106
Q

what is the therapy of flu

A

symptomatic - bed rest, fluid, paracetamol antivirals - oseltamivir, zanamivir

107
Q

what is present in killed vaccine

A

virus grown then inactivated and combined with adjuvant, contains 2 influenza A and 1 influenza B

108
Q

what is present in live attenuated virus

A

children 2-17, administered intra-nasally

109
Q

clinical presentation of bronchiolitis

A

infection of bronchioles, 1st of 2nd year of life, fever, coryza, cough, wheezesevere cases - grunting, decreased PaO2

110
Q

what are complications of bronchiolitis

A

respiratory and cardiac failure - prematurity, pre-existing respiratory or cardiac disease

111
Q

what are characteristics of bronchiolitis

A

80% cause due to respiratory syncytial virus lab confirmation by PCR

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