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12. Respiratory > 7. Tuberculosis and Lung Cancer > Flashcards

7. Tuberculosis and Lung Cancer Flashcards

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1
Q

Why is acid-fast staining needed for mycobacteria?

A

They have a lipid-rich cell wall that retains some dyes and even resists decolourisation with acid.

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2
Q

How does tuberculosis spread?

A

Person to person by aerosol route.

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3
Q

What is the first site of infection for tuberculosis?

A

The lungs.

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4
Q

What is the primary complex of tuberculosis?

A

The resolution of most infections with local scarring at the first site of infection.

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5
Q

What is post-primary infection?

A

The development of tuberculosis beyond the first few weeks.

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6
Q

What is miliary spread of tuberculosis?

A

Infection that progresses throughout the body.

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7
Q

What are the possible outcomes of miliary spread of tuberculosis?

A

Spontaneous resolution or developing into localised infection.

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8
Q

What causes the cavitation in the lungs in tuberculosis?

A

Intense immune response causes local tissue destruction.

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9
Q

What causes the fever and weight loss associated with tuberculosis?

A

Intense immune response causes cytokine-mediated systemic effects.

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10
Q

How does mycobacterium tuberculosis invade?

A

It is ingested by macrophages, but escapes from the phagolysosome to multiply in the cytoplasm.

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11
Q

What are the symptoms of pulmonary tuberculosis?

A

Chronic cough, haemoptysis, fever, weight loss.

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12
Q

What is the presentation of TB like if it affects every organ of the body?

A

Like inflammatory and malignant diseases.

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13
Q

How does tuberculosis meningitis present?

A

With fever and slowly deteriorating levels of consciousness.

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14
Q

How does tuberculosis spread to kidneys present?

A

Signs of local infection, fever and weight loss, complicated by ureteric fibrosis and hydronephropathy.

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15
Q

What is a complication of tuberculosis spread to lumbosacral spine?

A

It may cause vertebral collapse and nerve compression.

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16
Q

What is a complication of tuberculosis spread to large joints?

A

Destructive arthritis.

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17
Q

How does the host respond to TB infection?

A

Ingest it by macrophages. Immune reaction stimulates release of IL-12 which drives release of IFN-y and TNF-a from NK and CD4 cells. These activate and recruit more macrophages to the site of infection, and forms granulomas.

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18
Q

What are the primary changes in TB?

A

Few symptoms, lymph nodes may be enlarged in young people.

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19
Q

What is the classical presentation of post-primary TB?

A

Cough (not always productive), fevers towards the end of the day or at night, weight loss and general debility.

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20
Q

What would the features of a chest X ray be in TB?

A

Pulmonary shadowing - in patchy solid lesions, cavitated solid lesions, streaky fibrosis, or flecks of calcification.

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21
Q

What are the signs of TB?

A

Non-specific, pallor, fever, weight loss, clubbing, palpable lymph nodes.

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22
Q

What are the symptoms of TB?

A

Primary is usually asymptomatic. But otherwise: tiredness and malaise, weight loss and anorexia, fever, cough, breathlessness, haemoptysis occasionally.

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23
Q

What are the X rays changes of TB?

A

Shadowing, cavities, consolidation, calcification, cardiomegaly, miliary seeds.

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24
Q

Which gender is pleural tuberculosis more common in?

A

Males.

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25
What are the pulmonary disease present in pleural tuberculosis?
Hypersensitivity response in primary infection, tuberculous empyema with ruptured cavity.
26
Which populations is lymph node tuberculosis most common in?
In children, women, and Asiasns.
27
What are the symptoms of lymph node tuberculosis?
Often painless and occurs in the neck.
28
What is the most common form of osteo-articular TB?
Tuberculous spondylitis.
29
What is the disease progression of tuberculous spondylitis?
Starts in sub-chondral bone and spread to vertebral bodies and joint space, then follows the longitudinal ligaments anterior and posterior to the spine.
30
Which vertebrae is tuberculous spondylitis most common in?
Lower thoracic and lumbar spine.
31
What is the risk of paraplegia and quadriplegia in cases of tuberculous spondylitis?
25% of cases.
32
What is Poncet's disease?
Aseptic polyarthritis in the knees, ankles, and elbows.
33
What causes miliary tuberculosis?
Bacilli spreading through the blood stream in primary infection or in reactivation.
34
What do headaches suggest in miliary tuberculosis?
Meningeal involvement.
35
What are the symptoms of miliary tuberculosis?
Headaches if meningeal involvement, few respiratory symptoms, ascites can be present, retinal involvement in children.
36
What can diagnose TB?
Clinical features, radiological features, microbiology.
37
What clinical features diagnose TB?
Cough, night fever, weight loss.
38
What radiological features diagnose TB?
Shadowing, cavities, consolidation, cardiomegaly, miliary seeds.
39
What microbiology findings diagnose TB?
Identification of bacillus, direct smear and subsequent culture of appropriate body fluid.
40
Why is it important to take cultures in TB cases?
To isolate the organism and determine its susceptibility to drugs.
41
What is the outline of treatment for TB?
In the first two months, four drugs are taken. Then the following four month, two drugs are taken.
42
Which drugs are given in the first two months of TB treatment?
Rifampicin, isoniazid, pyrazinamide, ethambutol.
43
Which drugs are given in the 3-6th months of TB treatment?
Rifampicin, and isoniazid.
44
Why are multiple drugs used in TB treatment?
To combat resistance.
45
What is a main problem with TB treatment?
It is a long course of multiple drugs, so compliance is a problem.
46
How can poor compliance in TB treatment be tackled?
Patients can receive directly observed therapy, where a clinician will watch them take the drugs.
47
What are the side effects of the anti-TB drug, rifampicin?
Hepatitis, rash, flu-like symtpoms, shock, ARF, thrombocytopenic purpura.
48
What are the side effects of the anti-TB drug, isoniazid?
Rash, peripheral neuropathy, hepatitis.
49
What are the side effects of the anti-TB drug, pyrazinamide?
Rash, hepatitis, arthralgia.
50
What is the main side effect of anti-TB drug, ethambutol?
Optic neuritis.
51
What is the BCG vaccine?
A vaccination against tuberculosis that is prepared from a strain of attenuated live bovine tuberculosis bacillus.
52
What are the issues with the BCG vaccine?
It has variable efficacy, depending on the genetic variation of populations and BCG strains. Efficacy only lasts for a maximum of 15 years.
53
Who does the UK give BCG vaccines to currently?
High-risk groups.
54
Who is at high-risk of TB in the UK?
HIV, silicosis, malnutrition, overcrowding, IV drug abusers, chronic lung disease, ethnicity, diabetes, corticosteroids.
55
How much of a problem is TB in patients with HIV?
A big one, it's the leading cause of morbidity and mortality in those patients and they have 20-37 times great a risk of developing it than others.
56
What is the protocol with TB suspicion?
Immediately contact TB radiology, patient goes straight to TB clinic and has samples taken. Treatment begins with 7 days.
57
What is the incidence of lung cancer in males?
Commonest male cancer, mortality is 100 per 100000, incidence is falling due to reduction in smoking.
58
What is the incidence of lung cancer in females?
Causes more deaths than breast cancer, mortality rate is 40 per 100000, incidence is steadily rising.
59
How does lung cancer incidence vary in socio-economic groups?
Rate is three times higher in lowest groups than highest.
60
What causes lung cancer?
90% in men and 80% in women cases are due to smoking. Otherwise due to asbestos exposure, radon exposure, genetic factors, dietary factors.
61
What are the symptoms of primary lung cancer?
Cough, dyspnoea, wheezing, haemoptysis, chest pain, post-obstructive pneumonia, weight loss, lethargy/ malaise.
62
What are the symptoms of regional metastases lung cancer?
Superior vena cava obstruction, hoarseness from left recurrent laryngeal nerve palsy, dyspnoea from phrenic nerve palsy, dysphagia.
63
What are the symptoms of distant metastases lung cancer?
Bone pain and fractures, CNS symtpoms - headache, double vision, confusion etc.
64
What is paraneoplastic syndrome?
Te presence of a symptom or disease due to presence of cancer in the body, but not due to local presence of cancer cells.
65
What are the endocrine symptoms from paraneoplastic syndrome?
Hypercalcaemia, Cushing's syndrome.
66
What are the neurological symptoms from paraneoplastic syndrome?
Encephalopathy, peripheral neuropathy.
67
What are the skeletal symptoms from paraneoplastic syndrome?
Finger clubbing.
68
What are the haematological symptoms from paraneoplastic syndrome?
Anaemia, thrombocytopenia, disseminated intravascular coagulation.
69
What are the other symptoms from paraneoplastic syndrome?
Nephrotic syndrome, anorexia or cachexia.
70
How is lung cancer diagnosed and staged?
CT scan, PET scan, isotope bone scan.
71
What are the two staging systems for lung cancer?
Number staging and TNM staging.
72
What are the number stages of lung cancer?
Stage 1 - small cancer, localised to one area of the lung. Stage 2 and 3 - larger cancer, may have grown into surrounding tissues, like lymph nodes. Stage 4 - cancer has metastasised.
73
What are the T stages of lung cancer?
T1 - cancer contained within lung, <3cm. T2 - cancer 3-7cm diameter. T3 - cancer >7cm diameter. T4 - cancer invading mediastinum, heart, major blood vessel, trachea, carina, oesophagus, spine, recurrent laryngeal nerve or nodule in more than one lobe of lung.
74
What are the N stages of lung cancer?
N0 - no cancer in lymph nodes. N1 - cancer in lymph nodes nearest affect lung. N2 - cancer in lymph nodes in mediastinum, on same side. N3 - cancer in lymph nodes on the opposite side of the mediastinum/ supraclavicular lymph nodes.
75
What are the M stages of lung cancer?
M0 - no evidence of distal cancer spread. | M1 - lung cancer cells in distant parts of the body.
76
How is tissue for biopsies of lung cancer obtained?
Bronchoscopy, needle biopsy of lung, or surgical biopsy.
77
What is biopsy important for in lung cancer?
For confirmation of diagnosis, and distinguish cell type for prognosis and treatment.
78
What are the two groups of lung cancers based on cells?
Non-small cell lung cancer, and small cell lung cancer.
79
What is the presentation of non-small cell lung cancer at first?
More than 2/3rds have inoperable disease at presentation.
80
What is the presentation of small cell lung cancer at first?
3/4 have metastatic disease at presentation.
81
What does the prognosis of lung cancer depend on?
Cell type - worse if small cell than non-small cell. Stage of disease, performance status, biochemical markers, and co-morbidities.
82
What are the treatments available for lung cancer?
Surgery, radiotherapy, chemotherapy, combination therapy, biological targeted therapies, palliative care.
83
What type of lung cancer is more suited to surgical treatment?
Non-small cell, still only 20% of cases are suitable at presentation though.
84
What are the types of radiotherapy available for lung cancer?
Radical for curative treatment or palliative for symptom control.
85
How does chemotherapy affect the two types of lung cancer?
Small cell can potentially be cured in the minority of cases, non-small cell has a modest survival increase but mostly for symptom control.
86
What is combination therapy of lung cancer?
Chemotherapy and radiotherapy.
87
What are some biological markers for lung cancer?
EGFR, and VEGF.
88
How is non-small cell lung cancer normally managed?
Multiple modality therapy - palliative radiotherapy for local symptoms, chemotherapy with 50-60% response rates, combination therapy for locally advanced disease, targeted agents - EGFR and VEGF.
89
What is the management of small cell lung cancer?
Rarely operable, combination therapy can add a year, palliative chemotherapy for the symptoms.
90
What causes death in small cell lung cancer usually?
Cerebral metastases.

12. Respiratory (10 decks)

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