CPC COPD/Lung cancer Flashcards
(40 cards)
smoker with chronic cough that was hospitalized many times in the past – why?
most probably due to either COPD exacerbation or LRT infections
what is JVP?
A physical examination technique to estimate jugular venous pressure. The patient is placed in supine position with the torso elevated to 45 degrees and the head rotated away from the examiner. Tangential lighting can help elicit the finding. Determine the vertical distance between the upper limit of visible distention of the internal jugular vein and the sternal angle. A distance > 4 cm is considered elevated. Conditions associated with elevated JVP include right-sided heart failure, fluid overload, pulmonary hypertension, cardiac tamponade, and constrictive pericarditis.
what is the pitting edema?
type of edema characterized by residual indentation left after applying pressure to the site of the swelling. Etiologies include fluid retention (e.g., in patients with heart failure or as an adverse effect of medications, such as calcium channel blockers), protein deficiency (e.g., hypoalbuminemia), venous insufficiency, and increased capillary permeability (e.g., from burns).
what are the causes of elevated JVP?
right heart failure, fluid overload, tricuspid valve dysfunction, SVC syndrome, pericardial effusion, tamponade, pulmonary hypertension
what is the parasternal heave?
- -a heaving motion felt over the left parasternal area (palpate with a right hand and straightened elbow)
- -Suggests RV hypertrophy (e.g., pulmonary hypertension)
coarse bilateral basal pulmonary crackles signify…
pulmonary edema
dullness on lung percussion suggests…
Sign of fluid inside the thoracic cavity: pneumonia, pleural effusion
wheezes on lung auscultation are heard in obstructive or restrictive diseases?
obstructive
what investigations should be performed in suspected COPD?
- Sputum culture: to rule out infection
- -FBC, LFT’s
- -Blood cultures –
- -CXR – to look for infection, edema
- -ABG –to assess acid-base status
- -ECG – to look for signs of RVH
How does FEVI / FVC ratio help separate obstructive and restrictive lung disease?
The ratio of FEV1 (maximum volume of air that can be forcefully expired within 1 second after maximal inspiration) to forced vital capacity expressed as a percentage. The normal value is 70–85%. FEV1/FVC is decreased in obstructive lung disease. In restrictive lung diseases, FEV1/FVC will be normal or increased.
type 1 vs 2 respiratory failure?
1) A type of respiratory failure characterized by hypoxemia (↓ PₐO₂) and normocapnia or hypocapnia (↓ PₐCO₂) on arterial blood gas analysis
2) A type of respiratory failure characterized hypercapnia (↑ PₐCO₂) and normoxemia or hypoxemia (↓ PₐO₂) on arterial blood gas analysis.
example of a cause of type 1 respiratory failure?
- -alveolar flooding
- It is typically caused by a ventilation/perfusion (V/Q) mismatch; the volume of air flowing in and out of the lungs is not matched with the flow of blood to the lungs.
- -This type of respiratory failure is caused by conditions that affect oxygenation such as:
1) Low ambient oxygen (e.g. at high altitude)
2) Ventilation-perfusion mismatch (parts of the lung receive oxygen but not enough blood to absorb it, e.g. pulmonary embolism)
3) Alveolar hypoventilation (decreased minute volume due to reduced respiratory muscle activity, e.g. in acute neuromuscular disease); this form can also cause type 2 respiratory failure if severe
4) Diffusion problem (oxygen cannot enter the capillaries due to parenchymal disease, e.g. in pneumonia or ARDS)
5) Shunt (oxygenated blood mixes with non-oxygenated blood from the venous system, e.g. right to left shunt)
example of a cause of type 2 respiratory failure?
- -COPD
- -Type 2 respiratory failure is caused by inadequate alveolar ventilation; both oxygen and carbon dioxide are affected. Defined as the buildup of carbon dioxide levels (PaCO2) that has been generated by the body but cannot be eliminated. The underlying causes include:
1) Increased airways resistance (chronic obstructive pulmonary disease, asthma, suffocation)
2) Reduced breathing effort (drug effects, brain stem lesion, extreme obesity)
3) A decrease in the area of the lung available for gas exchange (such as in chronic bronchitis)
4) Neuromuscular problems (Guillain–Barré syndrome,[3] motor neuron disease)
5) Deformed (kyphoscoliosis), rigid (ankylosing spondylitis), or flail chest
in COPD CXR shos…
- -Signs of hyperinflated lungs (barrel chest)
1) Hyperlucency of lung tissue (decreased lung markings)
2) Increased anteroposterior diameter
3) Diaphragm pushed down and flattened
4) Horizontal ribs and widened intercostal spaces
5) Long narrow heart shadow - -Can be used to determine the etiology for an acute COPD exacerbation (e.g., pneumonia, congestive heart failure)
what is the acute exacerbation of COPD?
An acute worsening of the manifestations of chronic obstructive pulmonary disease (typically characterized by increased frequency or severity of cough, increased sputum volume or change in sputum consistency, and/or increased dyspnea). Caused by an underlying infection (e.g., viral or bacterial pneumonia) in ~ 80% of cases.
what is the red hepatization of pneumonia?
An inflammatory stage of lobar pneumonia. Characterized by neutrophils, red blood cells, and fibrin in the alveoli, which results in a liver-like consistency of the affected lung. Precedes gray hepatization.
what is the gray hepatization of pneumonia?
An inflammatory stage of lobar pneumonia that follows red hepatization. Characterized by the destruction of red blood cells that have infiltrated the alveoli, which results in a fibrinosuppurative exudate that gives the affected lung a gray appearance on gross examination. Infiltration of macrophages and fibroblasts.
why culture and sensitivity are performed in acute exacerbation of COPD?
Culture and sensitivity of expectorated sputum to identify causative organisms and to determine its sensitivity to antibiotics +/- Blood culture
how a patient with acute exacerbation of COPD should be managed?
- -O2
- -Antibiotics
- -Physiotherapy
- -Bronchodilator
- -Advice regarding smoking cessation
Do we have to be careful administering O2 in respiratory failure?
1) if O2 < 92%, but be mindful that inappropriate O2 therapy poses a risk of life-threatening hypercapnia (CO2 narcosis)
2) Although the causes are not entirely understood, hypercapnia is theorized to occur via a combination of two mechanisms if too much O2 is given (inappropriate O2 therapy):
- -↓ Hypoxic pulmonary vasoconstriction: ↑ FiO2 → ↑ alveolar O2 tension → ↓ hypoxic pulmonary vasoconstriction → ↑ V/Q mismatch and hypercapnia
- -Haldane effect: ↑ FiO2 → ↑ oxygenated Hb, which has less affinity to bind CO2 (right shift in the CO2 dissociation curve) → CO2 is released from Hb and RBCs → ↑ PaCO2
3) Another commonly taught mechanism for O2-induced hypercapnia is that giving O2 causes hypercapnia by inactivating the hypoxic respiratory drive, but studies have disproven this theory.
what is a bronchoscopy?
An endoscopic procedure for visualizing the airways. Can be performed as a diagnostic (e.g., bronchoalveolar lavage, biopsies, cytology, transbronchial needle aspiration, and endobronchial ultrasound) or therapeutic (e.g., balloon dilatation, ablation, brachytherapy, and stent placement) measure.
what is the pathology of SCC of the lung?
- -Solid, epithelial tumor
- -Subtypes: keratinizing, nonkeratinizing, basaloid
- -Histology: intercellular bridges (desmosomes), keratin pearls
- -Immunohistochemistry: expression of cytokeratin subtypes CK5 and CK6
What factors determine the stage of lung carcinoma?
The staging of NSCLC is based on the UICC TNM staging system. This classification defines four stages from I to IV, corresponding to cancer spread.
- -Stages IA-IIB: Tumor size ≤ 7 cm, No lymph node involvement beyond the ipsilateral hilar nodes, No mediastinal invasion, No metastases
- -stage IIIA: Tumor size > 7 cm, Mediastinal lymph node involvement and/or regional spread, No mediastinal invasion or metastases
- -stages IIIB and IV: Mediastinal invasion, Distant nodes and/or distant metastases
How does lung cancer present?
1) Effect of the primary
- -Site dependent eg cough, hemoptysis, pneumonia, chest pain, Pancoast’s tumor
2) Effect of metastases
- -Lymph nodes, liver, adrenal glands, brain, bone, skin, other
3) General effects of malignancy
- -Weight loss, fatigue, etc.
4) Paraneoplastic effects
5) Hormone secretion
6) Asymptomatic – abnormal CXR
