Session 7 Flashcards

1
Q

Define latency

A

Bacteria is in a dormant form for many years as the immune system cannot kill it, but can control it

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2
Q

What are the outcomes of a Primary infection?

A

Goes to a Primary complex which can either;
End in resolution
Undergo local progression/distant disease
Undergo tuberculin conversion

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3
Q

Define Tuberculin conversion

A

Patient who has previously had a negative tuberculin skin test develops a positive tuberculin skin test at a later date

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4
Q

How can post Primary tuberculosis occur?

A

Exogenous reinfection

Endogenous reactivation of a latent infection thought to be resolved (Reactivation TB)

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5
Q

What are some of the symptoms of respiratory TB?

A
Malaise & fatigue
Weight loss
Fever - Low grade or hectic
Breathlessness due to pleural effusion
Haemoptysis
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6
Q

What are some of the signs of respiratory TB?

A
Pallor
Fever
Clubbing (In long standing disease only)
Localised wheezing (If bronchioles narrowed)
Cervical nodes palpable
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7
Q

What is Nodosum?

A

A non respiratory sign of TB.

Lumps on the anterior of the leg that are red/blue, elevated and tender

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8
Q

What is the stronger risk factor for TB?

A

Anti TNF alpha treatment (Switches off immune system)

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9
Q

What are some of the types of TB?

A
Pulmonary TB (Classic TB, Abscesses)
Pleural TB (Cavity can get filled with pus, hypersensitivity)
Lymph node TB (In the neck, intrathoracic nodes may collapse into bronchi)
Osteoarticular TB
TB Spondylitis (Starts in sub chondral bone and spreads to vertebral bodies and joint space then spreads to spine)
Miliary TB (Bacilli spread through blood stream)
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10
Q

What are the main investigations for TB?

A

Chest x-ray

Sputum sample

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11
Q

What findings can be on a TB chest x ray?

A
Miliary shadowing
Large effusions
Cardiac enlargement
Cavities
Calcifications
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12
Q

How can you treat TB?

A

Rifampicin

Multi drug treatment to try and reduce resistance and prevent it from developing further

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13
Q

What is Heaf testing?

A

A way of testing for latency of TB

Response is graded I - IV and indicate post or present infection

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14
Q

What is DOT?

A

Directly observed therapy

Recommended for patients who are unlikely to comply eg homeless

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15
Q

What are some of the risk factors for lung cancer?

A
COPD
Asbestos
Radon
Occupational carcinogens
Diet (Deficiency in some vitamins)
Genetic factors
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16
Q

What are some of the symptoms of a Primary lung tumour?

A
Cough
Dyspnoea
Wheezing
Haemoptysis
Chest pain
Weight loss
Malaise
17
Q

What are some of the symptoms of regional metastases of lung cancer?

A

Superior vena cava obstruction
Hoarseness of voice
Dyspnoea
Dysphagia

18
Q

What are some of the symptoms of distant metastases of lung cancer?

A

Bone pain/fractures

CNS symptoms

19
Q

What are some of the common metastases sites of lung cancer?

A
Brain
Bone
Regional lymph nodes
Pericardium
Pleura
Liver
Adrenal glands
20
Q

How do you investigate for lung cancer?

A
Chest xray followed by CT and PET-CT
Bronchoscopy
Biopsys
Serum biochemistry
MRI to clear CNS and brain of metastases
21
Q

What are some of the histiological features of malignancy?

A
Pleomorphic cells
Hyper-Chromatic
Increased size of the nuclei/multiple nuclei
Ulceration/necrosis
Vascular invasion
22
Q

What are the main types of lung carcinoma?

A

Squamous cell carcinoma
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma

23
Q

What are some of the properties of squamous cell carcinomas in the lung?

A
Has CK5/6 in the blood
Central tumours
Eosinophilic cytoplasm
Keratinisation of the cells
Intercellular bridges called prickles
Keratin pearls
24
Q

What are some of the properties of ademocarcinomas in the lung?

A
Peripheral tumours
Mucin as form glands (Acini)
Columnar/cuboidal cells
Has TTF-1 in the blood in most cases
Papillary structures
May line alveoli
25
Q

What are some of the properties of Small cell carcinomas in the lung?

A

Small nuclei
Little cytoplasm
Nuclear moulding
Necrosis

26
Q

What can happen if there is spread of the cancer within the lung?

A
Necrosis
Cavitation
Ulceration
Haemoptysis
Lung collapse and consolidation
27
Q

What can happen if there is spread of the cancer within the thorax? (Due to direct spread or metastases)

A

Pleural/Pericardial effusions
Vocal cord palsy due to issues with the recurrent laryngeal nerve
Diaphragm palsy due to issues with the Phrenic nerve

28
Q

What are some of the properties of a T1 lung tumour?

A

Less than 3cm so operable
Surrounded by lung and visceral pleura
No invasion
Proximal to lobar bronchus

29
Q

What does survival of Lung cancer depend on?

A

Cell type (Small cell is worse than non small cell)
Disease stage
Biochemical markers
Co-morbidities

30
Q

How can you treat lung cancer?

A

Surgery (Mainly for non small cell)
Radiotherapy (Radical for curative intent or palliative)
Targeted treatment after analysis of a sample (Better as less side effects. eg Vascular endothelial growth factor inhibitors)

31
Q

What is a common site of metastases in small cell lung carcinomas?

A

Cerebral. Usually leads to death of the patient

32
Q

How does a PET scan work?

A

Glucose is given to the patient bound to a compound that release positrons so tissues that use lots of energy light up more