Session 7 Flashcards
Define latency
Bacteria is in a dormant form for many years as the immune system cannot kill it, but can control it
What are the outcomes of a Primary infection?
Goes to a Primary complex which can either;
End in resolution
Undergo local progression/distant disease
Undergo tuberculin conversion
Define Tuberculin conversion
Patient who has previously had a negative tuberculin skin test develops a positive tuberculin skin test at a later date
How can post Primary tuberculosis occur?
Exogenous reinfection
Endogenous reactivation of a latent infection thought to be resolved (Reactivation TB)
What are some of the symptoms of respiratory TB?
Malaise & fatigue Weight loss Fever - Low grade or hectic Breathlessness due to pleural effusion Haemoptysis
What are some of the signs of respiratory TB?
Pallor Fever Clubbing (In long standing disease only) Localised wheezing (If bronchioles narrowed) Cervical nodes palpable
What is Nodosum?
A non respiratory sign of TB.
Lumps on the anterior of the leg that are red/blue, elevated and tender
What is the stronger risk factor for TB?
Anti TNF alpha treatment (Switches off immune system)
What are some of the types of TB?
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)
What are the main investigations for TB?
Chest x-ray
Sputum sample
What findings can be on a TB chest x ray?
Miliary shadowing Large effusions Cardiac enlargement Cavities Calcifications
How can you treat TB?
Rifampicin
Multi drug treatment to try and reduce resistance and prevent it from developing further
What is Heaf testing?
A way of testing for latency of TB
Response is graded I - IV and indicate post or present infection
What is DOT?
Directly observed therapy
Recommended for patients who are unlikely to comply eg homeless
What are some of the risk factors for lung cancer?
COPD Asbestos Radon Occupational carcinogens Diet (Deficiency in some vitamins) Genetic factors
What are some of the symptoms of a Primary lung tumour?
Cough Dyspnoea Wheezing Haemoptysis Chest pain Weight loss Malaise
What are some of the symptoms of regional metastases of lung cancer?
Superior vena cava obstruction
Hoarseness of voice
Dyspnoea
Dysphagia
What are some of the symptoms of distant metastases of lung cancer?
Bone pain/fractures
CNS symptoms
What are some of the common metastases sites of lung cancer?
Brain Bone Regional lymph nodes Pericardium Pleura Liver Adrenal glands
How do you investigate for lung cancer?
Chest xray followed by CT and PET-CT Bronchoscopy Biopsys Serum biochemistry MRI to clear CNS and brain of metastases
What are some of the histiological features of malignancy?
Pleomorphic cells Hyper-Chromatic Increased size of the nuclei/multiple nuclei Ulceration/necrosis Vascular invasion
What are the main types of lung carcinoma?
Squamous cell carcinoma
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma
What are some of the properties of squamous cell carcinomas in the lung?
Has CK5/6 in the blood Central tumours Eosinophilic cytoplasm Keratinisation of the cells Intercellular bridges called prickles Keratin pearls
What are some of the properties of ademocarcinomas in the lung?
Peripheral tumours Mucin as form glands (Acini) Columnar/cuboidal cells Has TTF-1 in the blood in most cases Papillary structures May line alveoli
What are some of the properties of Small cell carcinomas in the lung?
Small nuclei
Little cytoplasm
Nuclear moulding
Necrosis
What can happen if there is spread of the cancer within the lung?
Necrosis Cavitation Ulceration Haemoptysis Lung collapse and consolidation
What can happen if there is spread of the cancer within the thorax? (Due to direct spread or metastases)
Pleural/Pericardial effusions
Vocal cord palsy due to issues with the recurrent laryngeal nerve
Diaphragm palsy due to issues with the Phrenic nerve
What are some of the properties of a T1 lung tumour?
Less than 3cm so operable
Surrounded by lung and visceral pleura
No invasion
Proximal to lobar bronchus
What does survival of Lung cancer depend on?
Cell type (Small cell is worse than non small cell)
Disease stage
Biochemical markers
Co-morbidities
How can you treat lung cancer?
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)
What is a common site of metastases in small cell lung carcinomas?
Cerebral. Usually leads to death of the patient
How does a PET scan work?
Glucose is given to the patient bound to a compound that release positrons so tissues that use lots of energy light up more
