RESP

Question 1

Cancer that would cause pleuritic chest pain / pleural effusion?

Answer 1

Adenocarcinoma

Question 2

If a nodule is seen on Chest X-ray, what next?

Answer 2

Do cytology of sputum and pleural fluid ( FNA)
Nodule - peripheral -> percutaneous FNA or biopsy
Bronchoscopy biopsy for histology
CT to stage it or PET CT
Lung function tests to assess eligibility for lobectomy
Bone scan if suspect bone mets

also considering possible surgery

• u+e, urea cr for baseline renal fun
• FBC, LFTs - baseline
• ECG

Question 3

What are the different types of lung cancer?

Answer 3

Small cell or non small cell
non small cell includes 
- squamous cell 
- large cell undifferentiated
- adenocarcinoma

Question 4

What are the possible complications of lung cancers?

Answer 4

Local comps depending on location
- recurrent laryngeal nerve -> hoarseness
- Pancoast tumor -> Horner’s syndrome damage of brachial plexus sympathetic nerves
- pleuritis
- malignant pleural effusion
- post obstructive pneumonia
- Metastatic
-> bone pain
-> brain -> neurological disorder
Paraneoplastic syndromes
> PTH from SCC causing hypercalcaemia
> small cell can produce ACTH ->Cushingoid.
Small cell also can cause SIADH ( hyponatraemic and high ADH levels)

Question 5

What is the treatment of small cell carcinoma?

Answer 5

Chemotherapy

not surgery, has usually disseminated at diagnosis

Question 6

Patient with haemoptysis, swollen face and infection prone?

Answer 6

possible small cell carcinoma because of production of ACTH causing patient to become cushingoid.

Question 7

How would you stage a lung tumor?

Answer 7

Using the TNM staging
Tumor
Node
Metastasis

Question 8

If a patient with primary lung cancer has bony pain what could you think?

Answer 8

That they have a stage 4 lung cancer ie that it has metastasised

Question 9

If a nodule is seen on a chest xray what is the first thing you should do?

Answer 9

Look at an old Xray to see if the nodule was there before and if it has grown or changed since

Question 10

What are the differentials for a nodule in the lung on a chest xray?

Answer 10

1º or 2º malignancy 
abscess
granuloma - TB or sarcoid
Carcinoid tumor
Pulmonary haemartoma
Arterio-venous malformation
Cyst
Foreign body

Question 11

What is a T4 lung tumor?

Answer 11

• Involves the mediastinum, heart, great vessels, trachea, oesophagus, vertebral body
• or a malignant effusion is present

Question 12

What is a pleural effusion?

Answer 12

Fluid in the pleural space. Blood = haemothorax, pus = empyema, lymph + fat = chylothorax. Can be classified based on protein content as transudates <25g/L or exudates >35g/L

Question 13

What is the difference between a transudate and exudate?

Answer 13

Transudates have a protein conc <25g/L and exudates have conc >35g/L.
Can use Light’s criteria to differentiate, fluid is exudate if meets one or more criteria.

Question 14

What is Lights criteria

Answer 14

Used to diff trans vs exudates.
A pleural fluid is exudative if meets 1 or more;
- Pleu pro/ serum pro >0.5
- Pleu LDH/ Serum LDH >0.6
- Pleu LDH ≥ 2/3 the upper ref limit of serum LDH

Question 15

What causes transudative pleural fluids?

Answer 15

May be due to increased venous pressure (HF and fluid overload) or hypoalbuminaemia (cirrhosis, nephrotic syndrome, ]) Also hypothyroidism and Meig’s syndrome

Question 16

What is Meig’s syndrome

Answer 16

Right pleural effusion and ovarian fibroma

Question 17

What could cause an exudate?

Answer 17

Mostly due to leakiness of the capillaries 2º to infection, inflammation or malignancy. E.g. pneumonia, TB, pulmonary infarction, RA, SLE, bronchogenic carcinoma, malignant metastasis, mesothelioma.

Question 18

What would be seen if there was a pleural effusion on a chest xray?

Answer 18

Depending on severity

• blunted costophrenic angles
• water-dense shadows w/ concave upper borders
• if horizontal upper border => also a pneumothorax.

Question 19

What are the management options for a pleural effusion?

Answer 19

If cause known -> treat cause.
If symptomatic, drain the it repeatedly in necessary. slowly, no more than 2L in 24hrs.
Pleruodesis may be helpful for recurrent effusions. Tac is most effective for malignant effusions.
Drain an empyema using a chest drain inserted under US or CT guidance.

Question 20

What is asthma?

Answer 20

Asthma is a chronic inflammatory airway disease characterised by intermittent airway obstruction and hyperactivity.

Question 21

What is asthma?

Clinically?

Answer 21

Asthma is a chronic inflammatory airway disease characterised by intermittent airway obstruction and hyperactivity.
It manifests clinically as recurrent episodes of dyspnoea, cough and wheeze caused by reversible airway obstruction.

Question 22

What causes the airway narrowing in asthma?

Answer 22

3 things contribute

• bronchial smooth muscle contraction
• airway inflammation
• increased mucous production