Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Study Leave semester 2 year 1 > Week 4 > Flashcards

Week 4 Flashcards

1
Q

In Europe alone, on person is dying of lung cancer every x minutes

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pulmonary fibrosis is a risk factor for lung cancer

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Is there a safe smoking threshold?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Passive smoking increases risk to what degree?

A

50-100% increased risk
Causes at least 25% of so called non-smoking lung cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

There is genomic damage with smoking

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why does tobacco smoke cause smoking?

A

Host activation of pro-carcinogens
Inherited polymorphisms predispose:
Metabolism of pro-carcinogens
Nicotine addiction

Epithelial effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the two main pathways of carcinogenesis in the lung?

A

Lung periphery
Central lung airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pathway of carcinogenesis in the lung periphery? (= what?)

A

Bronchioloalveolar epithelial stem cells transform
= adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pathway of carcinogenesis in the central lung airways?

A

Bronchial epithelial stem cells transform
Squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When bronchial epithelial stem cells transform, what carcinoma forms?

A

Squamous cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When bronchioloalveolar epithelial stem cells transform, what cancer forms?

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How common are tumours of bronchial glands?

A

Very rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 4 main types of carcinoma of the lung?

A

Squamous cell
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the three types of NSCLCs???

A

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Primary lung cancer presents when

A

Late in natural history
Grows clinically silent for many years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lung cancer does what to the bronchials

A

Causes obstruction due to collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A local effect of lung cancer is bronchiectasis

A

Yah

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A local effect of lung cancer is infection/ abscess

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Local effect of lung cancer on the pleura?

A

It’s inflammatory and malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Local effect of lung cancer on the phrenic nerve?

A

Diaphragmatic paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Local effect of lung cancer on l recurrent laryngeal?

A

Hoarse, bovine cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Local effect of lung cancer on brachial plexus?

A

Pancoast T1 damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Local effect of lung cancer on cervical sympathetic nerves

A

Hornets syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which type of lung cancer has endocrine effects

A

Small cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Has squamous lung cancer got endocrine effects?

A

PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Prognostic markers might be used to select patients for what type of therapy?

A

Adjuvant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Median survival of small cell carcinoma?

A

4%
Median survival = 9 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Bronchioloalveolar epithelial stem cell transforms to what cancer?

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Bronchial epithelial stem cells transform to what type of cancer?

A

Squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Immunotherapy in NSCLC is rarely used

A

False
It’s actually transformed practice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Squamous cell has little or no effective molecular targeted therapy

A

True
Has none

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Is there an immune response to tumours?

A

Some are immunogenic, some are not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How would a tumour evade the immune response?

A

Inhibitory immune checkpoints are one important mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Where would adenocarcinoma be located?

A

Peripherally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Where would squamous cell carcinoma be located?

A

Located centrally (in the bronchi)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Where would large cell carcinoma be located?

A

Peripherally and centrally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Where is small cell carcinoma located?

A

Centrally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

All the lung cancer metastasise early except which one?

A

Squamous cell, which is more common in smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What does squamous cell carcinoma secrete, causing hypercalcaemia?

A

PTHrP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Clinical features of lung cancer include unexplained cough for at least how long?

A

Unexplained cough for at least 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Why bone pain in lung cancer?

A

Due to metastases- commonly the spine, pelvis and long bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Why fatigue in lung cancer?

A

Due to anaemia of chronic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Patients presenting with red flag symptoms must be referred on a x week wait. How long

A

2

Must have CXR within 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

TB is a differential diagnoses of lung cancer, because of an unexplained cough, and weight loss. What are the features differentiating TB from lung cancer? (3)

A

1) drenching night sweats
2) positive sputum culture and microscopy
3) CXR showing hilar lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Sarcoidosis is a lung cancer differential diagnoses due to cough and unexplained weight loss. What’s the differential symptoms? (2)

A

Skin signs eg erythema nodosum and lupus pernio
Tissue biopsy: non caseating Granulomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What might a FBC of lung cancer show?

A

Anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What might happen to serum calcium in squamous cell carcinoma?

A

Elevated
With secretion of PTH-related protein (PTHrP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What’s SIADH associated with? (Syndrome of inappropriate antidiuretic hormone secretion)

A

Small cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What might a CXR of lung cancer show?

A

Single/ multiple opacities
Pleural effusion
Lung collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What’s used to confirm CXR findings?

A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Why use bronchoscopy?

A

It involves the insertion of a small camera into the airways to directly visualise the tumour.

Then you can take a biopsy.

Biopsy is essential in order to make the diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What imaging enables staging of cancer?

A

Positron emission tomography CT
(PET CT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Stage I lung cancer?

A

One small tumour (<4cm) - localised to one lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Stage II lung cancer?

A

Larger tumour (>4cm) - may have spread to nearby lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Stage III lung cancer?

A

Tumour that has spread to contra lateral lymph nodes, or grown into nearby structures (e.g. trachea)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Stage IV lung cancer?

A

Tumour that has spread to lymph nodes outside the chest, or other organs (e.g. liver)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Stage I-III non-small cell lung cancer management? (3) (incl. if too frail)

A

If too frail/ unsuitable for surgery?

1) surgery eg lobectomy/pneumectomy, or wedge resection in patients with reduced lung function

2) pre-operative & post-operative chemotherapy and radiotherapy (or not if stage 1)

Stereotactic ablative radiotherapy (SABR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Stage IV NSCLC management? (Often palliative) (3)

A

1) targeted therapy- drugs to target mutations which drive pathogenesis

2) immunotherapy- these drugs target immune checkpoints

3) chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Body’s purpose of an immune checkpoint?

A

Prevent the patients immune cells from killing tumour cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

The immune checkpoint is targeted by what?

A

Pembrolizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Which type of lung cancer is associated with high risk of brain metastases?

A

SCLC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What treatment for SCLC due too high risk of brain metastases?

A

Prophylactic cranial irradiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What’s hornets syndrome due to?

A

A pancoast tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What’s a pancoast tumour?

A

A tumour in the lung apex infiltrating the brachial plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Horners syndrome features enophthalmos, what is that?

A

Posterior displacement of the eyeball into the orbit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Tumour that obstructs superior vena cava?

A

Prevents venous drainage from the head and neck, leading to facial swelling and distended neck/chest veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

SIADH is what type of syndrome?

A

Paraneoplastic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

3 treatment related complications of radiotherapy?

A

Mucositis, pneumonitis, oesophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What’s staging of the ECOG (eastern cooperative group) performance status measurement 0-5

A

0= asymptomatic; well
1= symptomatic, able to do light work
2= has to rest but for <50% of the day
3= has to rest for >50% of the day
4= bedbound
5= dead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Staging lung cancer using TNM: what does TNM stand for

A

T = tumour size, but also kinda location

N= nodal involvement

M= distant metastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What’s the principle reason for undertaking thoracic surgery?

A

Lung cancsr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

How many people with lung cancer are operable?

A

Only about 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Patients with lung cancer are at risk from what 2 things that might make them inoperable?

A

Ischaemic heart disease and COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Tumour, if attached to what, cannot be resected?

A

Vital structures such as heart or spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

The larger the tumour, the lower the T number

A

Falss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

T1 tumour is less than 3cm, T2 is less than 5cm, T3 is larger than 5cm, and T4 is if it’s attached to vital structures e.g. trachea, superior vena cava, aorta, spine etc so can’t be resected easily….. true or false

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What lymph nodes might be easily involved in lung cancer? (2)

A

Hilar lymph nodes
Mediastinum lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

TNM staging of lung cancer:
Which has a better prognosis, N1 or N3? What does N3 mean?

A

N3 = involved in other side of mediastinum to the primary tumour, or involved in neck in a different anatomical zone

N3 is worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Lymph node involvement in lung cancer is sometimes responsible for what 2 nerve palsy’s

A

Recurrent laryngeal nerve palsy
Phrenic nerve palsy

Invasion of tumour cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Phrenic nerve is on both sides, true or false

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Recurrent laryngeal nerve is on both sides, and is a branch of the phrenic nerve

A

No
Just left
Off vagus nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

The region between the aortic arch and the left pulmonary artery is called what?

A

Aorto-pulmonary window

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

The ligamentum arteriosum connects which two vessels?

A

Aortic arch and left pulmonary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What does the recurrent laryngeal nerve ‘hook’ around?

A

Medial side of the ligamentum arteriosum, then rises up neck to innervate the left vocal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Phrenic nerve enters chest in relationship with which artery?

A

Left subclavian, on the left side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Vagus nerve enters the chest in relation to which artery?

A

Left common carotid artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Is the phrenic nerve anterior or posterior to the Hilum of the lung?

A

Anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Is the vagus nerve anterior or posterior to the Hilum of the lung?

A

Posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Where does the vagus nerve give off its recurrent laryngeal nerve branch?

A

Just underneath the ligamentum arteriosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Lymph nodes develop carcinomas in the gap under the aortic arch?

A

= May cause recurrent laryngeal nerve palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Common sites of metastasis for lung cancer: (3)

A

Bones
Liver
Adrenals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Common symptom of metastasis in the bones or brain?

A

Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Personality change in lung cancer why?

A

Cerebral metastasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What imaging to see nerve palsy?

A

Maybe x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Patients with supraclavicular lymph nodes may indicate the presence of inoperable disease

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Resect tumours that have metastasised?

A

You could… but then would that actually be a permanent cure?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

A malignant pleural effusion might indicate?

A

That surgery wouldn’t get rid of lung cance r

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Pleural effusion

A

Collection of fluid between the thin layers of pleura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

4 things we look for in CXR when staging lung cancer?

A

Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

If phrenic nerve palsy, could lung cancer be operable?

A

No, inoperable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What have we got to do after seeing a collapsed lobe or lung in CXR for lung cancer?

A

Use PET scanning to see how much of the collapsed lung is tumour, and how much is just collapsed normal lung tissue

102
Q

What blood tests for staging of lung cancer and why?

A

Look for features of anaemia for bone marrow involvement

103
Q

Why look for abnormal LFTs when staging lung cancer?

A

To work out if seeing if spread to liver

Look for metastasis and abnormal bone profile

104
Q

Are mediastinal nodes N1 or N2?

A

N2

105
Q

Can we resect the chest wall?

A

Not really

106
Q

Can the diaphragm be resected in lung cancer?

A

Only as long as the central portion only is invaded

Difficult to resect diaphragmatic recesses

107
Q

Why ECHO in staging lung cancer?

A

Will demonstrate presence or absence of significant pericardial effusion

Could be malignant

108
Q

Tumour at main bronchus… we need to do it’s not where?

A

Not at the carina

109
Q

Walk me through what’s involved in a Mediastinoscopy

A

1) telescope is placed to a small incision above the sternum
2) pass down adjacent to the trachea
3) will probably find lymph nodes, so can take biopsies

110
Q

If metastatic spread to the lymph nodes = what

A

No surgeyr

111
Q

We have clinical assessment for fitness for surgery….. why would we want to know about previous CABG or angioplasty? (Coronary artery bypass graft)

A

Because stenosis may have developed

112
Q

Would they consider importance of recent URTI for operating with lung cancer?

A

Yes

113
Q

Would they consider importance of athsma for operating with lung cancer?

A

Yes

114
Q

Why look out for pulmonary hypertension when operating on the lungs?

A

Because if the patient has got the pulmonary arteries (they’re very frail) then they can be easily damaged during surgical dissection

Well known cause of death

115
Q

Where could you pick up presence of pulmonary hypertension on a scan?

A

ECHO

116
Q

Patients with cirrhosis of the liver: suitable for lung cancer surgery?

A

No
What if the liver has a tough time removing poisons from blood stream following post operative infection?

If liver can’t…. Then circulation = vasodilation and increased capillary permeability = circulatory shock (heart works well, but no good blood pressure)

117
Q

We tend to reject patients with cirrhosis and lung cancer

A

Yes

Rather have radiotherapy treatment

118
Q

We do spirometry for our lung cancer patients

A

Yes

119
Q

We do routine lung function testing on our lung cancer patients ?

A

Eg
Spirometry and diffusion studies

Maybe a special radionuclide test to work out how much air is going to each lobe of the lung , to work out post-op lung function with an FEV

120
Q

Post op FEV1 should be what

A

At least 1 litre of more

Remember total lung capacity = 5 litres, which is residual volume + vital capacity

121
Q

Vital capacity

A

Total amount of air exhaled after maximal inhalation

122
Q

Lung cancer patients will get a CT scan. If the coronary arteries are very calcified, then what’s done

A

A coronary angiogram

123
Q

Is resection of parietal structures feasible?

A

Yes

124
Q

You don’t know for certain it’s lung cancer. Can you just go ahead and do a lobectomy, without any worries?

A

Yes, because it’s a lower risk operation

125
Q

Not sure if they’ve got finger clubbing… what question do you ask?

A

Have you noticed recently it has become more difficult to cut their nails?

126
Q

Myocardial infarction is a reason for post operative death (lung cancer)

A

Yes

127
Q

ARDS is a for post operative death following surgery for lung cancer

A

Ues

128
Q

What’s a wedge resection?

A

Using staple guns to chop out the tumour tissue from the lung itself- that’s a wedge resection

129
Q

What’s a common reason for ARDS leading to post operative death?

A

Patient had interstitial lung disease in association with their lung cancer

Stress of operation could activate it

130
Q

Is it common to get chest infections after a surgery

A

Yea

E.g. bronchopneumonia

131
Q

Why are pulmonary embolism or pneumothorax affecting remaining lung so bad? Post-op

A

Cuz after only one lung

132
Q

Would empyema be an example of a non-fatal complication of lung cancer surgery?

A

Yah

But also very serious.

Like

Imagine a whole chest cavity full of pus

133
Q

Would atrial fibrillation be a non fatal complication of surgery for lung cancer?

A

Yes

134
Q

What’s a broncho-pleural fistula?

A

An abnormal connection between bronchi and the pleural cavity

As evidenced by continued leak post-pneumothorax

135
Q

How might a bronchopleural fistula develop?

A

1) patient has had a pneumonectomy so there is a large space
2) large space develops a negative pressure and chest wall collapses
3) space with fluid where lung used to be. Fluid never obliterates
4) negative pressure develops and air can be sucked in through the staple lines and surgical sutures and the bronchus

136
Q

Bronchopleural fistula is difficult to eradicate once established. What’s the main symptom?

A

A chronic chest strain
Repeated chest infections

137
Q

With repeated chest infections with Bronchopleural fistula?

A

Material in the empyema space inevitably leaks into the trachea,

138
Q

Why insufficient ventilation with bronchopleural fistula?

A

When hole between the pleural cavity and the airway is large, tidal volume they breathe in goes into this dead space where the right or left lung should have been

Can be quite breathless

139
Q

True or false: collapse of a lung actually makes tumour size easier to assess

A

No
Obviously not
Make tumour size more difficult to assess

140
Q

Name 3 cels in pleural fluid

A

Macrophages
Lymphocytes
Mesothelial cells

141
Q

How is pleural fluid produced?

A

The process of filtration..
It’s the parietal pleura that’s produces most of the draw coloured fluid

142
Q

Pleural fluid has protein in it

A

Yes

143
Q

Lymphocytes in the pleural fluid comes from where

A

Filtered out from blood

144
Q

Mesothelial cells in the pleural fluid come from where

A

Shed from pleural surface

145
Q

What’s the pressure gradient in the pleural cavity?

A

It’s negative
Most negative at the apex as opposed to the base

146
Q

Why does pleural effusion usually occur? (2)

A

Excessive production
Reduced absorption
Or combo of the two

147
Q

What are the two kinds of pleural effusion?

A

Transudate
Exudate

148
Q

Why does transudate happen?

A

It’s purely a process of filtration

149
Q

Transudate has high or low protein content? Is inflammatory or non-inflammatory?

A

Low protein
Non-inflammatory

150
Q

Exudate has high or low protein

A

High protein
Is inflammatory

151
Q

What’s the general protein cut off/ rule of thumb for exudate vs transudate?

A

Exudate = protein content of 3 grams per decilitre or more

152
Q

What’s the actual criteria to differentiate between transudates or exudates?

A

Lights criteria

153
Q

How much fluid must be present in pleural effusion before it’s detected

A

At least 300ml

154
Q

Signs of pleural effusion (3)

A

Decreased chest wall movement
Dullness to percussion
Diminished breath sounds

Potentially tracheal deviation away from effusion

155
Q

Protein content of normal pleural fluid is what

A

1-2g /dL

156
Q

Exudate are caused by changed to factors that influence what

A

Formation and absorption of pleural fluid

157
Q

Transudates are associated with these conditions:

Malignancy
Infection (eg empyema due to bacterial pneumonia)
Trauma
Pulmonary infarction
Pulmonary embolism

A

No
That’s for exudate

158
Q

Transudates are concerned with these conditions:

A

Congestive heart failure
Liver cirrhosis
Severe hypoalbuminemia
Nephrotic syndrome

159
Q

Transudative = pleural effusions caused by factors that alter what 3 things

A

Hydrostatic pressure
Pleural permeability
Oncotic pressure

160
Q

The fluid is considered an exudate if any of the following are
present:
The ratio of pleural fluid to serum protein is greater than x
The ratio of pleural fluid to serum LDH is greater than y
The pleural fluid LDH value is greater than z of the
upper limit of the normal serum value

A

0.5
0.6
Upper two thirds

161
Q

Purulent fluid indicated what

A

Empyema

162
Q

The presence of food particles in a pleural effusion suggests what

A

Oesophageal rupture

163
Q

LDH for normal pleural effusion is what?

A

Less than 50% plasma concentration

164
Q

Normal pleural fluid glucose levels is similar to that of blood. What would low levels indicate? (2 important ones, 3 maybes)

A

A low pleural fluid glucose level (<3.4mmol/l) may be found in empyema, rheumatoid disease.

TB, malignancy, oesophageal rupture

165
Q

Pleural fluid pH of less than 7.3 is associated with the same pathologies that cause low pleural fluid glucose levels- true or false

A

True
Eg
Rheumatoid disease
Empyema

TB, malignancy, oesophageal rupture

166
Q

Pleural fluid lymphocytosis suggests what

A

TB, sarcoidosis, malignancy

167
Q

Neutrophil dominant effusions are associated with what

A

Empyema and pulmonary embolism

168
Q

Blood in the pleural space may result from pulmonary embolism

A

True

169
Q

Pleural fluid eosinophilia (PFE) is usually caused by the presence of what in the pleural space

A

Air or blood

170
Q

Organ failures eg cardiac, liver and renal account for the majority of transudates or exudates?

A

Transudates

171
Q

Transudates are rarely bilateral effusions

A

False
Often bilateral effusions

172
Q

Pulmonary causes of transudates are common

A

False
They’re rare

173
Q

Pulmonary causes of exudates are common

A

True

174
Q

3 common causes of exudates please

A

Malignancy
Effusions and empyema
TB

So like the most commonly encountered exudates are para pneumonic or effusions associated with pneumonia

175
Q

Rheumatoid arthritis can cause pleural effusions

A

True

176
Q

Investigation of pleural effusion, which three scans and why

A

US: more sensitive than CXR, mark site for aspiration, assess pleura, bedside

CXR: accessible, easy to interpret

CT thorax: complex effusions, visualising the pleura, vascular and mediastinal structures

177
Q

Easiest way to work out what’s causing the effusion?

A

Get a sample of the fluid

178
Q

Pleural fluid analysis? How

A

Aspiration
Inspect: pH (bedside ABG machine), biochemistry, microbiology, cytology

179
Q

If pleural fluid is less than 7.2 what does that indicate?

A

Need for chest drain
Because high likelihood that acidic pleural effusion, will eventually form pus, and therefore infection becomes difficult to control

180
Q

Pus pr blood in pleural fluid = what

A

Need for chest drain

181
Q

Transudate management?

A

Treat the underlying cause, may not need CT imaging

182
Q

Exudate management summed up?

A

Unless cause identified, will need further investigation for e.g. further imaging, and pleural biopsy

183
Q

Why would a spontaneous pneumonthorax occur?

A

Weak surface areas that rupture spontaneously, and then leak air into the pleural cavity

184
Q

Spontaneous pneumothorax: Weak surface areas that rupture spontaneously, and then leak air into the pleural cavity
What happens next?

A

Leak of air accumulates
Compresses the underlying lung

185
Q

What happens to the trachea in a pneumothorax?

A

There is a tracheal shift

186
Q

When is a pneumothorax called a secondary spontaneous pneumothorax?

A

If it occurs in someone with a pre-existing condition

187
Q

Name 4 lung diseases which usually result in pneumothorax?

A

Interstitial lung disease
COPD
Asthma
Cystic Fibrosis

188
Q

Tension pneumothorax is usually less serious

A

No
Life-threatening emergency

189
Q

What’s a tension pneumothorax?

A

When air within the pleural cavity following pneumothorax builds up to the point that it causes pressure and pushes the central structures of the chest and squares opposite lung

190
Q

What happens to blood pressure in a tension pneumothorax?

A

Blood pressure drops

191
Q

Oxygen levels in a tension pneumothorax?

A

Drops due to compression of the opposite lung

192
Q

What’s emergency response to tension pneumothorax?

A

Emergency release of that air under pressure
Eg popping a needle in or putting a chest drain on

193
Q

Normal presentation of spontaneous pneumothorax? (6) (symptoms vs what)

A

Sudden
Chest pain
Sob

Underlying lung disease
Tall thin young men
History of biopsy/ line insertion/ mechanical ventilation

194
Q

Why do patients with pneumothorax dismiss it?

A

Because they thought it was just sob or chest pain following exercise

But then they realised it was quite sudden and quite persistent

195
Q

Breath sounds for pneumothorax?
Percussion sounds like what?

A

None
Hyper resonant

196
Q

Two scans to diagnose a pneumothorax?

A

CXR
US

CT thorax maybe eg when complex, if underlying severe lung disease like COPD, or in CF

197
Q

Easy to miss a pneumothorax on a CXR where?

A

The apice

198
Q

3 management for pneumothorax?

A

Aspiration if patient well and over 2cm (drawing breath)

Chest drain insertion

Surgery (if recurrent events, unresolving)

199
Q

Recurrence rate of pneumothorax

A

25-50%

200
Q

Don’t lift for how long after pneumothorax has healed?

A

And fly
At least a week

201
Q

If pneumothorax occurs a second time on the same side, what’s usually advised?

A

Surgical repair cuz high incidence of recurrence

202
Q

Safe spot for aspiration?

A

Just avoid inadvertent damage to underlying organs like the heart, spleen and liver

203
Q

Benign pleural rumours are quite common!

A

FALSE
Usually pleural malignancy is common , and presents as pleural effusioons

204
Q

Pleural rumours are usually secondary

A

Yes

205
Q

Why do pleural tumours cause/ present as pleural effusions?

A

Block lymphatics. Prevent drainage of pleural fluid, and result in an accumulation of pleural fluid

206
Q

An example of a primary malignant tumour of the pleura language what?

A

Malignant mesothelioma

(Asbestos)

207
Q

Malignant mesothelioma is usually caused by what

A

Asbestos dust and fibres, cause inflammation, provokes tumour formation

208
Q

Mesothelioma of the pleura presents as what

A

Chest pain
SoB
Weight loss of unknown cause

209
Q

CT is good at looking at the pleura why?

A

Looking at pleural surface in greater detail, can tell whether pleural lining is thickened

210
Q

To diagnose mesothelioma of the pleura, what do you need?

A

Tissue (fluid not enough)

Need a biopsy

E.g. to see thickened pleura, pleural nodules or masses, pleural plaques, an effusion, soft tissue infiltration

211
Q

Why would you spray the lining of the king with sterile talcum powder (pleurodesis)?

A

Stop the fluid from re-accumulating

212
Q

Surgery in the treatment of mesothelioma?

A

Decortication (peel off thickened layers of pleura to relieve SoB)
Pleurodesis (spray sterile talcum powder)

213
Q

Regarding lights criteria: if the pleural fluid protein concentration is more than half the serum protein concentration, the effusion is exudative

A

True

Remember:
Pleural fluid protein/serum protein > 0.5
Pleural fluid LDH/serum LDH > 0.6
Pleural fluid LDH > 2/3 the upper limit of the lab reference range for serum LDH

214
Q

Flavoured cigarettes are illegal

A

True

215
Q

Lung cancer can lead to bronchiectasis. How?

A

Small airway obstruction by a lung tumour can cause the abnormal dilatation of airways known as bronchiectasis

216
Q

Rheumatoid arthritis causes an exudative pleural effusion

A

True

217
Q

After PET/CT scan, up to 15% of patients will have the stage of their cancer upgraded, found at later stage than originally thought

A

Yes

218
Q

A person who has to rest less than 50% of their day due to their cancer symptoms and is unable to work has a performance status of 2

A

True

219
Q

Performance status 0 = what?

A

Fully actice

220
Q

Performance status 1?

A

Restricted in physically strenuous activity, but can do light house work, office work etc

221
Q

Performance status 2?

A

Can do self care, but can’t work. Up and about more than 50% of waking hours

222
Q

Performance status of 3?

A

Capable of limited self care, confined to bed or chair more than 50% waking hours

223
Q

4 performance status?

A

completely disabled

224
Q

Performance status 5?

A

Dead

225
Q

What are tyrosine kinase inhibitors (TKIs)

A

They target tumours carrying specific mutations in adenocarcinoma (a non-small cell lung cancer)

226
Q

Lung cancer can be staged from a CXR

A

False
It is “staged” due to its spread, therefore cross sectional whole body imaging is required
E.g ct scan

227
Q

CT scan is often used for staging cancer

A

Yah
But like
The staging has to be related to its spread, therefore cross sectional whole body imaging is required

228
Q

Adenocarcinoma of the lung is more likely to arise centrally

A

False

229
Q

Adenocarcinoma develops how

A

Bronchioalveolar epithelial stem cells transform and undergo atypical adenomatous hyperplasia, developing into adenocarcinoma in situ, and then invasive adenocarcinoma of the lung

This epithelium is normally found in small airways, so this cancer is more likely to arise peripherally

230
Q

Adenocarcinoma is more likely to arise peripherally

A

True dat

231
Q

Generally fluid from an exudative effusion contains 3G/dL of protein or more

A

Yah
Caused by inflammation

232
Q

A pneumothorax which occurs without prior injury in a patient with a pre-existing lung condition is called a primary spontaneous pneumothorax

A

NO BRO
That’s secondary spontaneous pneumothorax

233
Q

Which gland does lung cancer normally metastasise to?

A

Adrenal Glands

234
Q

Lung cancer commonly metastasises to the thyroid gland

A

Flase

235
Q

Doubling time of two different cell cancer types pleeeeeeeze

A

129 days for non small
29 days for small cell

236
Q

Lowest pressure of the pleural fluid where in the lung

A

At the APEX

237
Q

Patients with mesothelioma are entitled to compensation

A

TRUE

238
Q

Regarding CXR’s: a pulmonary mass is classed as an opacity over what

A

3cm

239
Q

Anything smaller than 3cm is classed as what , a mass?

A

NO BRO
It’s a nodule

240
Q

Paraneoplastic syndromes occur due to direct metastatic invasion of endocrine glands by lung cancer

A

False

241
Q

Paraneoplastic syndromes are hormonal or chemical changes- where do the hormones and chemicals come from

A

Primary tumour
Or
Through immune system stimulation.

242
Q

TNM stands for

A

Tumour
Nodes
Metastasis

243
Q

Phrenic nerve damage will cause what

A

Paralysis of the affected hemidiaphragm

244
Q

Giving chemotherapy and radiotherapy concurrently increases the survival compared to radiotherapy by how much?

A

Increase in survival by 5%

245
Q

What’s neoadjuvant treatment?

A

It’s used in other cancer types (not lung currently) and refers to treatment given before planned curative surgery

246
Q

Squamous cell epithelium lines what part of the airway

A

Larger central ones

247
Q

Patients with small cell lung cancer are only given radiotherapy to the brain if there are cranial metastases

A

False

It’s given prophylactically
As it’s known that SCLC frequently spreads to the brain

248
Q

What kind of radiotherapy can be used to remove lung tumours by ablation

A

SABR
Stereotactic ablative radiotherapy

249
Q

Small cell lung cancer tends to have a faster response to treatment

A

Yah

250
Q

Ultrasound is the only imaging modularity that allows a site for drainage of a pleural effusion to be marked

A

Yes

Study Leave semester 2 year 1 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions