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respiratory > resp from Kelly's ppt > Flashcards

resp from Kelly's ppt Flashcards

1
Q

describe the characteristics of a squamous cell Lung Ca

A

may px as obstructive lesion leading to infection

occasionally cavitates

local spread is common

widespread mets occur LATE

secrete PTH - hypercalcaemia
STRONGLY assoc with finger clubbing

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2
Q

describe the characterisitc features of a large cell lung Ca

A

met early

often peripheral in lungs

anaplastic (poorly differentiated) tumours with a poor prognosis

may secrete B-HCG

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3
Q

features of a lung adenocarcinoma???

A

associated with asbestos exposure

most common Lung Ca assoc with asbestos exposure - but most who get it are smokers…

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4
Q

features of small cell lung cancer

how would you manage it?

A

often metastatic at Dx

causes (almost all) the weird syndromes -

ectopic ADH secretion - SIADH and hyponatraemia

ACTH secretion - Cushings

Lambert-eaton syndrome - antibodies to the voltage gated Ca2+ channels causing a myathenic syndrome (that is sort of the opposit of M.Gravis - ie movements are initially helped by doing them a bit more…)
- PX with proximal muscle weakness / reduced tendon reflexes.

managment of SCLC?

most will be with chemo + radio

some with very early stage disease - considered for surgery;..

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5
Q

what symptoms can a pancoast tumour cause..?

think apical tumour…..

A
  1. horner’s syndrome (pre-ganglionic) - TRIAD OF: anhidrosis of face/ meiosis / ptosis of eyelid or apparent enopthalmos)
  2. local nerve effects - Ipsilateral reflex sympathetic dystrophy in arm (increased sensitivity to touch / skin changes etc..)
  3. Brachial plexus invasion - (C8-T1) - wasting of the intrinsic hand muscles / parasthesiae on medial side of arm
  4. unilateral recurrent laryngeal nerve palsy - hoarse voice etc..

rarely:
oedema in arm / SVC obstruction 2y to compression of blood vessels….

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6
Q

palliative trreatment options for symptomatic management of lung cancer…

A

If airway narrowing symptomatic:

  1. endoscopic laser therapy
  2. transbronchial stenting

malignant pleural effusions?

  1. aspirate to dryness
  2. give sclerosing agent eg. tetracycline / belomicinm in pleural space

general QOL?

  1. counselling
  2. opiates
  3. benzos for anxiety due to breathlessness? - eg. use lorazepam.
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7
Q

features of a bronchial carcinoid tumour?

A

neuroendocrine ecreting cells - so the standard carcinoid syndrome stuff

recurrent hamoptysis

can also make ACTH sometimes - Cushing’s syndrome

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8
Q

how do you investigate suspected active tb?

and what would the investigations show?

how would you screen for latent tb?

A

CXR - might show cavitationin the upper lobes / mediastinial or hilar lymphadenopathy /pleural effusion

3 sputum samples - spontaneously produced deep cough symptoms -

  1. send for microscopy - acid fast bacilli (sputum smear microscopy is the fast one..)
  2. NAAT testing (for quick results)
  3. mycobacteria culture (weeks…)

HIV test all

screening for latent TB:
1. Mantoux test:
tuberculin injected intradermally - inspect for signs of skin reaction after 2-3 days

  1. Interferon gamma release assay test
    RAPID RESULT
    more reliable
    use in under-served groups etc.

tx with 6 months isoniazid with pyroxidine

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9
Q 
what are the side effects of:
rifampicin
isoniazid
pyrazinamide
ethambutol
A

R - liver and secretions (S+L=R)
I - p neuropathy (prevent with pyridoxine) + haemo
P - rheumatoid stuff (gout / arthralgia / rash)
E - eyes - optic neuritis and colour blindness

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10
Q

features of pneumoccal pneumonia in particular?

A

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

URINARY ATG TEST FOR PNEUMOCCOCUS

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11
Q

who gets h. influenzae pneumonia

A

COPD pts

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12
Q

who gets s auerus pneumoniae

A

post influenza

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13
Q

feATURES of mycoplasma pneumonia

A

dry cough
atyipcal CXR findings
AIHA as well?
erythema multiforme?

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14
Q

legionella pneumonia features?

A

hyponatraemia
lymphopenia
URINARY ATG TEST FOR LEGIONELLA

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15
Q

who gets klebsiella pneumonia?

A

alchoholics?

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16
Q

who gets pneumocystis pneumonia and what are the signs?

A

hiv patients

dry cough
exercise induced desaturations
lack of chest signs

17
Q

management of CAP

A
  1. amox is first line for mild CAP (or erythomicin if pen-allergic)
  2. if mod - can use amox + erythomicin / clarithromicin
  3. if mod-severe can use co amoxiclav + erythromicin or another macrolide to cover for the atypicals…)
18
Q

management of HAP

A

If non-severe - 1. Co-amoxiclav ORAL

If severe / at high risk of resistance - Ceftriaxone IV + Vancomycin IV if suspecting MRSA infection…

19
Q

treating aspiration pneumonia

A

Ceftriaxone (other cephalosporins ok)

+ Metronidazole

20
Q

patient presents with ENT, respiratory and kidney involvement - what do you suspect (or what do you have to rule out…)

A

wegener’s granulomatosis

21
Q

describe the three stages of churg-strauss syndrome:

A
  1. ALLERGY

patients ahve asthma / allergic rhinitis / nasal polyps

  1. EOSINOPHILIA
  2. VASCULITIS
    - small/medium vessel vasculitis
  • damage to kidneys / lungs, the digestive tract and most dangerously, the heart.
    may have associated petechial rash

pANCA antibodies often detected
may be precipitated by LTRAs

22
Q

what are the two first line treatments for OSA?

A

weight loss

obstructive sleep apneoa

23
Q

common cause of pneumonia in bird keepers?

A

Chlamydia psittaci is a cause of pneumonia in bird keepers

24
Q

what test should you do before starting azithromicin?

A

ECG to rule out prolonged QT

baseline LFTs

25
Q

pleural inflammation (and fluid collection) in response to infection (usually pneumonia but can also be BE / abcess) can be described in terms of:

simple parapneumonic effusion

complicated parapneumonic effusion

empyema

A

simple - no infection

compicated -infection has spread to the pleural space

empyema - frank pus in the pleural space

26
Q

what is a lung abcess?

A

a cavitating area of localised suppurative (pus producing) infection within the lung…

27
Q

what are the causes of a lung abcess?

A 
inadequaetly treated pneumonia
aspiration
bronchial obstruction
aspiration
pulmonary infarct / emboli
28
Q

swinging fever and chest signs?

A 
LUNG ABCESS!
cough
purulent foul smelling sputum
pleuritic chest pain
haemoptysis
clubbing 
malaise
wt loss
29
Q

major or minor PE - how do you decide?

A

minor tends to be peripheral with just a bit of pleuritic chest pain…

MAJOR tends to be central - signs of shock / imminent circulatory collapse / hypoxia / central chest pain

30
Q

what would progressive exertional dyspnoea + lethargy + fatigue make you suspect?

A

PAH
(but pretty much sounds like many HF style things..)

may also have:
extertional syncope 
exertional chest pain
periph oedema
weakness
31
Q

what is the management of PAH?

A
  1. treat the underlying cause
  2. oxygen
  3. anticoagulation

THEN:
acute vasodilator therapy dictates where to go next - if the vasodilator therapy shows a signficant fall in PA pressure post vasodilator administration eg. with NO - then can treat with Ca2+ channel blockers (though this is the minority of patients…)

if negative response to acute vasodilator test:
- prostacyclin analogues - treprostinil / iloprost
- endothelin receptor antagonists - bosantan
PDEis - sildenafil

if progressive Sx - heart lung transplant..

32
Q

what is the ‘double burden’ of lung infections that patients with HIV suffer with

A
  1. increased susceptibility to pneumonia regardless of CD4 count
    just more likely to get them…
  2. opportunistic infections with a low CD4 count
    eg. PCP
33
Q

how would you describe interstitial lung disease?

what are the causes of upper lobe ILD?

what are the causes of lower lobe ILD?

what must you ensure in phyical examination and what might you find…?

what Ix in ILD?

what bloods in particular for ILD?

A

a problem of gas echange betweeen the capillaries and the alveoli..

Upper:
CHARTS
(coal workers’ / EAA / Radiation / TB / Sarcoid)

Lower:
IPF
CTDs
Drugs

OE: - full body for systemic disease
clubbing
fine end insp crackles
skin eye joints for systemic disease

Ix:
Pulmonary function tests - restrictive pattern / low gas transfer / low to normal PaCO2
Blood tests
High res CT scan 
Bornco-alveolar lavage

FBC – eosinophilic pneumonia
U&Es – Wegener’s
Total IgE – eosinophilic pneumonia
Aspergillus and avian precipitins (ABPA, EAA)
ACE (Sarcoid)
ANA, ENA, dsDNA, Rh factor (rheum disease)
ANCA (Wegener’s)

34
Q

non-caseating granuloma in a young adult of african descent - what do you think…?

A

Sarcoidosis

35
Q

diagnostic criteria for ARDS

A

acute onset (w/in 1wk of known RF)
pulmonary oedema - bilateral infiltrates on CXR not FULLY explained by effusions / lobarcollapse etc….
Non-cardiogenic
PULMONARY ARTERY EDGE PRESSURE IF IN DOUBT…
Hypoxaemia

respiratory (3 decks)

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