WEEK 4

Question 1

Define the types of carcinoma

Answer 1

1. Adenocarcinoma
   
   • In the lung periphery
   • BRONCHIOLOALVEOLAR epithelial stem cells transform into adenocarcinoma
2. Squamous cell carcinoma
   
   • In the central lung airways
   • BRONCHIAL epithelial stem cells transform into squamous cell carcinoma
3. Small cell carcinoma
4. Large cell carcinoma

Question 2

Describe the pathology of malignant mesothelioma.

Answer 2

Pleural malignancy : Mesothelioma

Rare and aggressive

Occupational

Presentation:

• SOB
• Chest pain
• Weight loss
• Clubbing

Question 3

Define the major groups of antituberculous drugs, their pharmacological profiles and side effects, and their practical application in the management of tuberculosis.

Answer 3

RIPE

MULTIDRUG THERAPY FOR 6 MONTHS!!

First 2 months = 4 drugs (ALL)
Last 4 months = 2 drugs (R/I)

RIFAMPICIN
- orange urine/tears
- Induces liver enzymes
- All hormonal contraceptive methods ineffective
- Hepatitis

ISONIAZID
- Hepatitis
- Peripheral neuropathy

PYRAZINAMIDE
- Hepatitis
- Gout

ETHAMBUTOL
- Optical neuropathy

Question 4

SARCOIDOSIS - definition, aetiology, pathogenesis, investigations and management

Answer 4

A multisystem granulomatous disorder of unknown aetiology
- Young adults, F>M

CLINICAL FEATURES:
- SOB, cough and abnormal CXR

INVESTIGATION:
- Abnormal CXR or CT scan

MANAGEMENT:
- Few symptoms: NO TREATMENT
- Erythema nodosum/arthralgia: NSAIDs
- Skin lesions/anterior uveitis/ cough: TOPICAL STEROIDS
- Cardiac, neurological, eye disease - NOT responding to topical creams: SYSTEMIC STEROIDS

Question 5

HYPERSENSITIVITY PNEUMONITIS - definition, aetiology, pathogenesis, investigations and management

Answer 5

Occupational lung disease
- bird flu!!
SEEN IN SUPERIOR LOBES IN CXR

ACUTE
- Fever, dry cough
- Chills
- Crachles, tachyopnoea, wheeze

CHRONIC
- Insidious
- Malaise, SOB, cough
- Crackles and some wheeze

MANAGEMENT:
Acute:
- Corticosteroids
Chronic:
- Immunosuppressants

Question 6

Define IDIOPATHIC PULMONARY FIBROSIS - definition, aetiology, pathogenesis, investigations and management

Answer 6

(idiopathic = without a known cause)
- Type of interstitial pneumonitis
- Elderly >50 M>F

CLINICAL FEATURES:
- Dyspnoea (SOB), cough
- Basal crackles, cyanosis, clubbing

MANAGEMENT:
- Oral anti-fibrotic
- Pirfenidone
- Nintedanib
- Palliative care
- SURGICAL TRANSPLANT?

Question 7

Recall the causes and effects of endstage lung fibrosis/honeycomb lung.

Answer 7

CAUSES
- Usual interstitial pneumonitis UIP
- Idiopathic pulmonary fibrosis
- Connective tissue diseases
- Granulomatous response
- Sarcoidosis
- Hypersensitivity pneumonitis

Question 8

Describe the staging process used to plan management of lung cancer

Answer 8

TNM staging
CHECK NOTES!!!!!!

Question 9

Describe the causes of a localised opacity (coin lesion) on the chest xray

Answer 9

• Pulmonary mass is an opacity in lung over 3cm with no mediastinal adenopathy or atelectasis
• Pulmonary nodule is an opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis

Question 10

What is the most common strain of bacteria involved in bronchiectasis?

Answer 10

Haemophilus influenzae