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YEAR 3 TCD > WEEK 6 - haemoptysis > Flashcards

WEEK 6 - haemoptysis Flashcards

1
Q

cirrhosis of the liver is a pre malignant condition to what?

A

hepatocellular carcinoma

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2
Q

what is the term given for vomiting blood?

A

Haematemesis

If it is haematemesis then patients can have melaena (black stools) indicating altered blood has passed through the GI tract

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3
Q

what is the name for nose bleeds?

A

epistaxis

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4
Q

what is pulmonary vasculitis?

A

caused by autoimmune conditions like Systemic Lupus Erythematosus (SLE), Wegener’s Granulomatosis

can cause haemoptysis

most commonly affects the age group 50-60

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5
Q

what are 2 must not be missed diagnoses in a haemoptysis presentation?

A

PE and lung cancer

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6
Q

what 2 sections is lung cancer broadly divided into? subsections?

A

broadly divided into small cell (15-20%) and non-small-cell (80-85%). Within non-small cell the main subtypes are adenocarcinoma, squamous cell and large cell.

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7
Q

describe lung adenocarcinoma

A

Adenocarcinoma originates in the glandular cells which secrete mucus and tend to develop in small airways, hence are more peripheral on imaging and can resemble pneumonia.

It is associated with smoking but is also the most common subtype seen in non smokers and females.

They can have a pre-invasive stage with a progression towards invasive disease, often termed adenocarcinoma spectrum lesions however this is often a slow progression and, in some cases, can take years to develop from pre-invasive to invasive disease.

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8
Q

describe squamous cell lung cancer

A
  • Squamous cell cancer originates from the transformation of the squamous cells lining the airways and therefore tend to be more central.
  • They can often form a cavity and are smoking related.
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9
Q

describe large cell lung cancer

A
  • Large cell can appear anywhere within the lung and often grow and spread quicker.
  • A subtype called large cell neuroendocrine tumour behaves similar to small cell lung cancer.
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10
Q

describe small cell lung cancer

A
  • Small cell lung cancer tends to grow and spread faster than non-small cell.
  • They unfortunately commonly present with stage 4 disease at the outset.
  • They tend to be more chemotherapy responsive but generally carry a poorer prognosis.
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11
Q

what are the indications for a suspected lung cancer referral?

A
  • CXR findings that suggest lung cancer
    or
  • aged 40 and over with unexplained haemoptysis
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12
Q

what are 4 paraneoplastic manifestations of lung cancer?

A
  • Lambert-Eaton syndrome
  • SIADH
  • hypertrophic osteoarthropathy
  • cushing’s syndrome
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13
Q

what is Lambert-Eaton syndrome?

A

autoantibodies block ACh from being released — causes muscle weakness

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14
Q

how does Lambert-Eaton syndrome differ from myasthenia gravis?

A

Lambert Eaton syndrome and myasthenia gravis happen due to autoantibodies but behave differently in the muscle synapses. The former prevents Acetyl choline being released while the latter blocks ACh acting.

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15
Q

Myasthenia is closely linked to the ________ and a tumour is seen in 15% of patients with the condition but half of patients with a _________ have myasthenia.

A
  • thymus
  • thymoma
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16
Q

what is SIADH?

A

syndrome of inappropriate ADH release

  • has a long list of causes but one classic one is small cell cancer — this should be excluded with a scan if sodium is very low
  • SIADH is confirmed with a raised urinary sodium >30
17
Q

what is hypertrophic osteoarthropathy?

A
  • new bone forms in periosteum in the forearms and lower legs
  • causes pain and marked clubbing
  • treatment of the primary cancer (or any other cause for severe clubbing) will result in resolution of the disease unlike metastases
18
Q

cushing syndrome and lung cancer?

A
  • ectopic secretion of ACTH by small cell tumour
  • causes hypertension, weight gain
19
Q

look on onemed at TNM staging of lung cancer table

A

ok

20
Q

describe the Grade ECOG Performance Status Scale

A
21
Q

describe PET scans (lay)

A

Mrs Jones attends for a PET scan. She was warned not to do strenuous exercise for 24 hours or eat within 6 hours. The technician explained, ‘The scan shows up anything that’s using glucose and that includes your vocal cords and even brown fat on a cold January day. Brown fat is a special type of fat we all have when we are cold and it produces heat to help maintain our temperature in cold weather’.

Most PET scans work by injecting a radiotracer called fluorodeoxyglucose (FDG) which is similar to naturally occurring glucose so the body treats it in a similar fashion. The scan then analyses where the radiotracer does and does not build up in the body. The general concept is that most cancers use glucose at a faster rate than normal cells and will therefore light up on the images. Most PET scans are combined with CT scans. FDG tracer will often show uptake within brown fat especially in the scenario of cold outdoor temperatures.

22
Q

What proportion of smokers will die early due to a smoking related illness?

A

1 in 2

23
Q

Nicotine replacement therapy (NRT) delivers nicotine into the blood stream without the toxic component of cigarette smoking. NRT alleviates cravings for tobacco and is an effective and safe smoking cessation tool. It comes in two forms: short acting and long acting.

Short acting NRT comes in many forms, whereas long acting NRT is available in patches. If patients need a cigarette within 30 minutes then they require a __ hour patch, rather than a __ hour patch.

A
  • 24
  • 16
24
Q

____________ is a drug treatment which is highly effective with smokers over three times more likely to stop when using this medication. It’s both a nicotine receptor agonist and antagonist which release dopamine via its agonist action which alleviates cravings. It prevents dopamine release from nicotine in cigarettes which prevents the positive impact from smoking.

A

Varenicline

25
Q

what is raised in a primary hepatocellular carcinoma?

A

serum alphafetaprotein (AFP)

26
Q

what is a vascular cause of multiple liver lesions?

A

hepatic haemangiomas — asymptomatic, MRI liver with contrast

non cancerous mass

27
Q

what is immunotherapy related pneumonitis and how is it treated?

A

Immunotherapy related pneumonitis classically happens within the first 3 months after starting therapy and presents with cough and shortness of breath.

It can cause a variable degree of symptoms and in some cases can result in significant respiratory failure. It is a relatively uncommon side effect but is increased in combination therapy.

It is treated with steroids, intravenous methylprednisolone in more severe disease, or oral prednisolone in milder disease.

28
Q

what is vocal resonance like in pleural effusion vs pneumothorax vs pneumonia

A

pleural effusion = reduced vocal resonance
pneumothorax = no/reduced vocal resonance
pneumonia = increased vocal resonance

29
Q

describe mesothelioma

A

Mesothelioma is a malignant tumour of the mesothelium. 90% of cases arise in the pleura but it can develop in the peritoneum, pericardium and testes.

It is strongly associated with asbestos exposure. High risk occupations include shipyard workers, construction workers and boiler engineers. Exposure can be household eg family washing the asbestos covered clothes.

Classic presentation is shortness of breath, chest pain and a pleural effusion. It can metastasise however more commonly progresses locally.

Overall, there is no cure and treatments are supportive and can include chemotherapy and immunotherapy. Surgery doesn’t have a defined role in the disease.

30
Q

what are the 3 subtypes of mesothelioma? which has the poorer prognosis?

A

epithelioid, sarcomatoid and mixed

  • sarcomatoid carries a poorer prognosis
31
Q
A

urinary sodium

32
Q
A
33
Q

urine osmolality vs serum osmolality in SIADH

A

urine osmolality is greater

34
Q

A middle aged lady presents with mild dizziness due to vertigo and examination reveals grade 2 nystagmus. She is otherwise well and brain scanning is normal. Anti Hu antibodies are present. What is the most likely cause?

A

small cell lung cancer : antigens released by the tumour cause an immune response that attacks neurones

35
Q

Anti Yo antibodies?

A

Breast cancer can cause this Paraneoplastic Cerebellar degeneration but results in Anti Yo antibodies

36
Q
A
37
Q
A
38
Q
A

small cell lung cancer — due to ACTH secretion causing hyperpigmentation, HTN, impaired glucose tolerance and hilar region on CXR

YEAR 3 TCD (15 decks)

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