Resp Flashcards by Amordei .

which lung cancer has the strongest association with smoking

squamous cell carcinoma ( NSCLC)

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what are the potential consequences of desmoid tumours ( fibrous growths) in retroperitoneal space

compression of surrounding structures

invasion into surrounding structures

S: suprarenal (adrenal) gland
A: aorta/IVC
D: duodenum (second and third part)
P: pancreas (except tail)
U: ureters
C: colon (ascending and descending)
K: kidneys
E: (o)oesophagus
R: rectum

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what are the 5 categories of lung cancer

1) small-cell lung cancer (SCLC) - 20%

non-small-cell lung cancer ( 80%
2 Adenocarcinoma (40%)
3 Squamous cell carcinoma (20%)
4 large cell carcinoma (10%)
5 other (10%)

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what is the difference in location between squamous cell lung carcinomas and lung adenocarcinomas

squamous cell - close to large airways “lung nodule in close proximity to his left main bronchus.”

adenocarcinomas: peripheral lung

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which type of lung cancer is a diagnosis of exclusion

large cell lung cancer

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which type of lung cancer metastisises early, is associates with para-neoplastic syndromes and is found near the larger airways?

squamous cell carcinoma

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what lung csncer is associated with an electrolyte disturbance

squamous cell

paraneoplastic syndrome –>

releases parathyroid hormone-related protein ( PTHrP) –> hypercalcaemia

ADH –> SIADH –> hyponatraemia

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which lung cancer is most strongly assocaited with finger clubbing

squamous cell cancer

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which lung cancer is most associated with cavitating lesions

squamous cell carcinoma

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which lung cancer is most common in non-smokers

adenocarcinomas

(most non-smokers –> adenocarcinoma, but most adenocarcinomas are from smokers)

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give 2 types of lung cancers that are located peripherally in the lung

adenocarcinoma
large cell lung carcinoma

( SCC is central, near the large airways)

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which lung cancer secretes β-hCG

large cell lung cancer

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what lung cancer has poorly differentiated tummours & poor prognosis

large cell lung carcinoma

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which lung cancer is strongly linkedt to asbestos

mesothelioma ( mesothelial cells of pleura)

latent period - approx 45 yrs
poor prognosis

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what are the features of lung cancer

Shortness of breath
Cough
Haemoptysis (coughing up blood)
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy – often supraclavicular nodes are the first to be found on examination

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phrenic nerve palsy is an extrapulmonary manifestation of lung cancer, how does it present

diaphragm weakness & SOB

caused by compression on the phrenic nerve

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pt with history of lung cancer presents with facial swelling and difficulty breathing. the neck is distended, and so ar =e the uper chest veins. what complication has coccured

superior vena cava compression

SVC compression = medical emergency

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pembertons sign

in SVC compression in lung cancer, raising hands over the head causes facial congestion & cyanosis

SVC compression = medical emergency

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what is the name of the lung cancer which causes Horner’s syndrome

Pancoast tumour ( tumour in pulmonary apex pressive on sympathetic gaglion)

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give 3 things that small cell lung cancer secreats

parathyroid- like peptide hormone ( causes hypercalcaemia)

ADH ( causes SIADH -hyponatraemia)

ACTH –> cushings syndrome

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what neurological paraneoplastic syndrome occurs in lung cancer and how does it present

limbic encephalitis

antibodies to brain tissue (limbic system)–> inflammation –> short term memory impairment
- hallucinations
- confusion
- seizures

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what antibodies are associated with limbic encephalitis

anti-Hu antibodies

(limbic encephalitis = paraneoplastic syndrome of the brain resulting in short-term memory impairment, hallucinations, confusion, seizures

what neurological condition ( not limbic encephalitis) may occur in lung cancer

lambert-eaton myasthenic syndrome

Abs against small-cell lung cancer cells

also damage voltage-gated Ca 2+ chnnels in presynaptic terminals in motor neurones –> proximal muscle weakness, intraocular muscle weakness ( diplopia), levator muscle weakness (prtosis), pharyngeal muscle weakness (slurred speech/dysphagia), autonomic dysfunction (dry mouth, blurred vision, impotence, dizziness)

NICE: offer CXray within 2 wks in pts >40 with (x5 features)

Clubbing
Lymphadenopathy (supraclavicular or persistent abnormal cervical nodes)
Recurrent/ persistent chest infections
Raised platelet count (thrombocytosis)
Chest signs of lung cancer

*finger clubbing,, supraclavicular lymphadenopathy - key to remember

1st lune Ix in lung cancer

CXRay may find - hilar enlargment (mid, central chest) unilateral/assymetrical =? malignancy (bilateral typical of sarcoidosis) - peripheral opacity (visble lesion) - pleural effusion (unilateral in cancer) - collapse

1st line Tx in NSCLC (isolated to 1 area)

surgery radio/chemo offered as aduvants

Tx in SCLC

chemo/radio (surgery mostly for NSCLC)

Pneumonia with lymphopenia, hyponatraemia & deranged LFTs suggests

legionella

what are the 3 pneumonia classifications

CAP - community acquired HAP >48hrs of being in hospital VAP - intubated on ICU ( Ventilator-acquired

give 3 chest signs of pneumonia on examination

Bronchial breath sounds ( harsh insp/expiratory breath sounds focal coarse crackles dullness to percussion ( lung tissue filled with sputum/ collapsed0

what are is the scorign system used to determin adx in pneumonia

CURB 65 confusion urea >6mmol RR >/=30 BP <90 >/=65

interpreting the CURB-65 score

* Score 0/1: at home * Score ≥ 2: hospital admission * Score ≥ 3: intensive care

what is atypical pneumonia

pneumonia caused by organisms which cannot be cultured in the normal way/detected using a gram stain

what tx is used in atypical pneumonia

(typical - penecillin) atypical macrolides, fluoroquinolones (levofloxacin) tetracyclines (doxycycline)

which organism is associated with cavitating lesion on CXRay in pneumonia presentation?

staph. aureus cavitating lesion: hollow, air-filled space within the lung parenchyma. Staphylococcus aureus -propensity for causing abscesses and cavitating lesions within the lung tissue

what are the 2 most common causes of bacterial pneumonia

strep. pneumonia ( most common- 80%) H. influenza

what 2 causes of pneumonia are more likely in immunocompromised pts

Morexella catarrhalis pcp

What causative organisms are associated with pneumonia in pts with CF

Pseudomonas aeruginosa ( CF & bronchiectasis) Staph. aureus ( causes cavitating lesions, most common after influenza infection )

what organisms are associated with CAP

strep pneumonia ( pneumococcus - most common) H. influenza Staph. aureus atypical pneumonias viruses

what organism is most associated with pneumonia in alcoholics

Klebsiella pneumoniae

what are the characteristic features of pneumococcal pneumonia

rapid onset high fever pleuritic chest pain herpes labialis ( cold sores)

give 2 common causes of legionella

-inhaling infected water ( e.g. air conditioning units)

what endo condition can legionella cause

SIADH (low sodium) typical exam patient has recently had a cheap hotel holiday and presents with pneumonia symptoms and hyponatraemia ( lymphopenia, hyponatraemia & deranged LFTs)

what are the features of pneumonoia caused by mycoplasa pneumoniae

mild pneumonia erythema multiform ( varying-sized target lesions (pink rings with pale centres)) which causes neuro Sx in young pts

what are the featurees of pneumonia by chlamydophila pneumniae

mild-mod chronic pneumonia and wheezing in school-aged children

what causes Coxiella burnetii pneumonia ( atypical pneumonia)

body fluids of animals typical example - farmer with flu-like illness

what causes Chlamydia psittaci i pneumonia ( atypical pneumonia)

contact with infected birds typical pt: parrot owner

give the 5 causes of atypical pneumonia

"legions of psittaci MCQs) * Legions – Legionella pneumophila (hyponatraemia, air conditioning) * Psittaci – Chlamydia psittaci (infected birds eg parrots) * M – Mycoplasma pneumoniae (erythema multiform - target lesions) * C – Chlamydophila pneumoniae (children, chronic pneumonia & wheeze) * Qs – Q fever (coxiella burnetii - bodily fluids of animals)

pneumonia with anosmia suggests

COVID-19 pts may have silent bhypoxia (low sats w/o SOB

tx of COVID-19 pneumonia

resp support dex monoclonal ab

Tx for mild CAP

5days oral Abx ( amoxicillin/doxycycline/ clarithromycin)

FEV1 and FVC in obstructive vs restrictive lung disease

obstructive disease FEV1:FVC ratio <70% (FEV1 - forced expiratory is slowed in obstruction hence <70% of FVC - the total) restrictive FEV1:FVC are equally reduced ( so FEV1:FVC ratio >70% e.g. FEV1 0.62l and FVC 0.64l) obstructive lung disease - OBSTRUCTION of air OUTFLOW restrictive lung disease - RESTRICTED expansion of lungs OR chest wall ( so FEV1 & FVC poor)

low FVC AND low FEV1:FVC ratio indicates....

combined obstructive and restrictive lung disease