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Year 2 > Resp: Lung Cancer metastases, Mestholeioma, Goodpasture's Syndrome, Wegener's granulomatosis, Pulmonary thromboembolism, Upper Respiratory Tract Infections, Pharyngitis/Tonsilitis, Epiglottis > Flashcards

Resp: Lung Cancer metastases, Mestholeioma, Goodpasture's Syndrome, Wegener's granulomatosis, Pulmonary thromboembolism, Upper Respiratory Tract Infections, Pharyngitis/Tonsilitis, Epiglottis Flashcards

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1
Q

What macrophages tend to be involved in pneumoconiosis and out immune-mediated lung problems

A
  1. ALVEOLAR macrophage

2. INTERSTITIAL macrophages (which live in the lung parenchyma)

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2
Q

What is Caplan’s Syndrome

A

Caused in all types of pneumoconiosis:

  1. Rheumatoid Arthritis
  2. Pneumoconiosis

basically a person with RA has a bigger risk of developing pneumoconiosis, asbestosis, silicosis etc.

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3
Q

What particles size are most dangerous in pneumoconiosis and why

A

1-5 micrometers

This is because 5-10 won’t make it to the alveoli and less than 1 micrometers can be inhaled back out without causing difficulties

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4
Q

Sites of metastatic spread form lung cancer

A
  1. Liver (anorexia, nausea, weight loss, right upper quadrant pain)
  2. Bone (bony pain)
  3. Adrenal Glands
  4. Brain (space occupying lesions)
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5
Q

What cancers spread tot helpings

A
  1. Breast cancer
  2. Bowel cancer
  3. RENAL CELL CARCINOMA
  4. Bladder cancer
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6
Q

Clinical presentation of lung cancer

A
  1. Cough
  2. Breathlessness
  3. Haemoptysis
  4. Chest pain
  5. Wheeze
  6. Clubbing
  7. Recurrent pneumonia
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7
Q

Symptoms of metastictic disease

A
  1. Bone pain
  2. headaches
  3. Seizures
  4. Neurological deficit
  5. Hepatic pain
  6. Abdo pain
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8
Q

Factors of paraneoplastic changes in the lung

A
  1. PTH secretion
  2. Inappropriate ADH secretion
  3. Secretion of ACTH
  4. Hypertrophic pulmonary osteo-arthropathy
  5. Finger clubbing
  6. Non-infective endocarditis
  7. DIC
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9
Q

What is T1

A

< 3cm

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10
Q

What is T2

A

> 3 cm

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11
Q

What is T 3

A

Invades chest wall , diaphragm and mediastinum

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12
Q

What is T4

A

Invades mediastinum, heart, great vessels, teaches, oesophagus, vertebra, carina (bifurcation of the bronchi)

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13
Q

What is N0

A

No Nodes
N1 - hilar nodes
N2 - Same side as mediastinal nodes
N3 - Contralateral mediastinum effected

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14
Q

What is m1a

A

Tumour on same side

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15
Q

What is m1b

A

Tumour is elsewhere

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16
Q

Diagnosis of lung cancer

A
  1. CXR
  2. CT
  3. Bronchoscopy
  4. Cytology
  5. FBC
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17
Q

Appearance of lung cancer on CXR

A
  1. ROUND SHADOWS with spikes edges
  2. Hilar enlargement
  3. Lung collapse
  4. Pleural effusion
  5. Consolidation
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18
Q

Why is a CT used in lung cancer

A

STAGING

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19
Q

Role of bronchoscopy and endobronchial ultrasound for lung cancer

A

Histology and assess operability

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20
Q

Role of cytology in lung cancer

A

Sputum and pleural fluid analysis

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21
Q

How is non-small cell lung cancer treated

A
  1. SURGICAL EXCISISON
  2. Curative radiotherapy if pneumonitis and fibrosis is seen
  3. Chemotherapy and radiotherapy (CETUXIMAB)
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22
Q

How is small cell lung tumours treated

A 
1. CHEMO AND RADIO 
Usually results in relapses
2. Palliation to relief symptoms 
3. Superior vena cava stent + radiotherapy and dexamethasone to treat obstruction
4. Endobronchial therapy 
5. Pleural drainage
6. Drugs
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23
Q

Why is radiotherapy use din lung cancer

A
  1. Bronchial obstruction
  2. Haemoptysis
  3. Bone Pain
  4. Cerebral metastases
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24
Q

What is endobronchial therapy

A
  1. Tracheal stunting
  2. Cryotherapy
  3. Brachytherapy (radioactive source is placed close to tumour)
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25
What drugs are given in lung cancer
1. Analgesics 2. Steroids 3. Antiemetics 4. Codeine 5. Bronchodilators 6. Antidepressants
26
What is mesothelioma
1. Tumorus of mesothelial cells of the pleura
27
Where are mesothelial cells found other than lung pleura
1. Peritoneum 2. Pericardium 3. Testes
28
At what age does mesothelia present
1. 40-70 years
29
What causes mesothelioma
ASBESTOS
30
What is th latent period of mesothelioma
UP to 45 years
31
Pathophysiology of mesothelioma
1. Tumour begins as nodules in pleura which extend to surrounding lung and fissures 2. Chest wall invaded and infiltrate intercostal nerves = SEVERE PAIN 3. Invasion of lymphatics - hilar node metastases
32
Clinical presentation of mesothelioma
1. Chest pain 2. Dyspnoea 3. Weight loss 4. Finger clubbing 5. Recurrent pleural effusions 6. Breathlessness
33
Signs of mesothelioma metastases
1. Lymphadenopathy 2. Hepatomegaly 3. Bone pain 4. Abdo pain
34
Diagnostics of mesothelioma
1. CXR + CT 2. Bloody pleural fluid 3. Pleural biopsy
35
Role of CXR and CT in mesothelioma
1. Unilateral pleural effusion | 2. Pleural thickening
36
Treatment of mesothelioma
1. Surgery excision | 2. RESISTANT to chemotherapy and radiotherapy
37
What is the average diagnosis to death in mesothelioma
8 months
38
Why are conducting airways (bronchi) in the lungs worse for drug delivery than respiratory regions (alveoli etc)
Have a smaller surface area and lower regional blood flow
39
What makes an effective drug
1. RAPID ABSORPTION (small hydrophobic molecules) 2. PARTICLE SIZE (not too small as they will be exhaled or too big as they will deposit in th upper airways) 3. Inhalation technique
40
Advantage of a spacer
1. Slows down particles of the drug and allow more time for evaporation of the propellant so more of the drug can be inhaled
41
What is the inhaler's full name
PRESSURISED METERED-DOSE INHALERS
42
What are dry powder inhaler
1. The device releases a small amount of drug in powder form which is inhaled (must have high inspiratory effort)
43
Pro of nebulisers
No coordination required by user High dose delivery
44
Why do inhaled medications have to be done multiple times a day
They are absorbed and cleared from th blood very fast
45
What characteristics of inhaled drugs allow them to stay in th body for a long time
1. SOLUBILITY 2. Charge and tissue retention can increase half-life 3. Encnapsulation
46
Advantages of inhaled drugs
1. RAPID ABSORPTION 2. LARGE SA 3. NON-INVASIVE 4. FEW METABOLISING ENZYMES
47
How do B2 adrenoceptor agonists work (2)
1. Smooth muscle relaxation | 2. Inhibit histamine release by mast cells
48
What drug is given when bronchoconstriction is being caused by parasympathetic nerve stimulation
ATROPINE
49
In what conditions are glucocorticoids (corticosteroids) not given and why
INEFFICIENT: COPD. CF and IPF
50
What ICS is commonly used
BECLOMETASONE DIPROPIONATE
51
Why are SABAs given alongside ICS
1. ICS increases transcription of B2 receptors and B2 agonists increase translocation of GR from cytoplasm to nucleus
52
What condition is bronchiectasis associated with
CF
53
What antifriobtic medication is given in IPF
1. PIRFENIDONE | 2. NINTEDANIB
54
How does PIRFENIDONE work
REDUCES: 1. Fibroblast proliferation 2. Collagen production 3. Production of fibrogenic mediators
55
How is Pirfenidone taken
Orally
56
What is NINTEDANIB
Tyrosine Kinase inhibitor
57
How do Tyrosine Kinsase inhibitors work
1. Inhibit VEGFR)
58
How is NINTEDANIB taken
Orally
59
What cause type I respiratory failure
1. AIRWAY AND PERFUSION problems
60
What causes type II respiratory failure
Failure of ventiltion
61
Clinical presnetation of airflow obstruction
1. Obstructive sleep apnoea 2. Relaxation of the pharynx during sleep 3. Occlusion causes waking
62
What causes continuous positive airways pressure
1. Pulmonary oedema | 2. Obstructive sleep apnoea
63
What respiratory failure is caused in Bi-level positive airway pressure
TYPE II
64
What causes Bi-level positive airway pressure
1. COPD exacerbation | 2. MND
65
What is good pasture's syndrome
1. Co-existence of acute glomerulonephritis and pulmonary alveolar haemorrhage due to the presence of antibodies directed against antigens of the basement membrane of the kidney addling
66
When is good pasture's syndrome common
Over 16 in men
67
Type hypersensitivity in good pasture's
Type II
68
Clinical presentation of good pasture's syndrome
1. Upper resp infection (sneezing, nasal discharge, runny nose and fever) 2. Cough 3. Intermittent haemoptysis 3. Tiredness 4. Anaemia 5. Acute glomerulonephritis
69
Differential diagnosis of good pasture's syndorme
Idiopathic pulmonary hemaosiderosis SLE RA
70
How is good pasture's diagnosed
1. Anti-basement membrane antibodies in the blood 2. CXR (shows shadows due to haemorrhage in lower zones) 3. Kidney biopsy (crescentic glomerulonephritis)
71
How is good pasture's treated
1. Some improve 2. Treat shock and renal failure 3. IMMUNOSPRESSION (PREDNISOLONE AND PLASMAPHERESIS)
72
What is plasmapheresis
Remove blood and clean to remove offending antibodies before inserting it back
73
What is WEGENER's GRANULOMATOSIS
1. ANCA-associated vasculitis Multisystem disorder of unknown origin where there are necrotising granulomatous inflammation and vasculitis of small and medium sized vessels
74
What does ANCA stand for
Anti-neutrophil cytoplasmic antibody
75
What causes vasculitis in WGENER's
GRANULOMAS
76
Pathophysiology of WGeNER's
As neutrophil rolls along blood vessel before emigrating into tissues, autoantibodies bind to it and activate neutrophils inappropriately causing more recruitment when there is no infection 2. Production of reactive oxygen species and neutrophil degranulation 3. Microabcessess, recruiting of monocytes, macrophages and lymphocytes
77
Clinical presentation of WEGENER's
1. Leisons of URT, Lnugs and kidneys 2. SEVERE RHINORRHEA 3. Casal mucosal ulceration due to rihnorhhea- CHARACTERISTIC 'saddle-nose deformity' 3. Cough 4. Pleuritic chest pain 5. Haemoptysis 6. Renal disease 7. Skin purport or nodules, peripheral neuropathy and arthritis
78
Differential diagnosis of wagerer's
CHURG-STRAUSS syndrome
79
What is Churg-strauss syndrorme
Small arteries effected but causes asthma and eosinophilia
80
Diagnosis of WEGENER's
1, FBC (c-ANCA is positive, elevated PR3 antibodies, raised ESR and CRP) 2. CXR (nodular masses and pneumonic infiltrates with cavitation) 3. CT (diffuse alveolar haemorrhage) 4. Urinalysis (Proteinuria and haematuria - follow with biopsy)
81
Treatment of WEGENER's
1. CORTICOSTEROIDS | 2. AZATHIOPRINE and METHOTREXATE as maintenance
82
What does the thoracic aorta branch into
Internal thoracic artery -> superior epigastric artery
83
Where does bronchial circulation originate from
Aorta
84
When do we suspect pulmonary embolism
Sudden collapse following 1-2 weeks after surgery
85
Describe the production of pulmonary thromboembolus
1. Clots break off and pas through veins to the IVC then to the right side of the heart before lodging in the pulmonary circulation
86
Where do most pulmonary emboli come from
1. Pelvic and abdominal veins 2. Femoral DVT 3. Axillary thrombosis
87
Rar causes of pulmonary embolisms
1. Fat embolism 2. Septic emboli (right sided endocarditis) 3. Fat embolism 4. Air embolism 5. Amniotic fluid embolism 6. Neoplastic cells 7. Parasites 8. Foreign material during IV drug misuse
88
Risk factors for pulmonary embolisms
Change in blood flow: - Immobility - Obesity - Pregnancy Change in blood vessel: - Smoking - Hypertension Changes in blood constituents - Dehydration - Malignancy - High oestrogen (combined oral contraceptive pill) - Polycythaemia - Nephrotic syndrome - Protein C/S deficiency or Factor V leiden Recent surgery (hip/knee replacement) Leg fracture Age over 60
89
What three main factors predispose you to a lot
1. Circulatory stasis 2. Endothelial injury 3. Hypercoagulable state
90
Where do pulmonary embolisms get lodged
Alveoli
91
How is V/Q effected in the lungs
1. Lung tissue ventilated and NOT PERFUSED resulting in dead space + impaired gas exchange
92
What happens to the non-perfused alveoli after a while
Surfactant production stops = alveolar collapse and hypoxia
93
How does PE affect pulmonary pressure
1. Increases Reduction in CO
94
How can right Ventricular ischaemia be detected
Elevation of troponin and creatine kinase
95
Clinical presentation of pulmonary embolisms
1. Pleuritic chest pain 2. Dizziness 3. Haemoptysis (infarction) 4. Past history 5. Pyrexia 6. Tachypnoea 7. tachycardia 8. Raised jugular venous pressure 9. Pleural rub 10. Pleural effusion
96
What is pleural rub
Rubbing together of the pleural lining (they inflame
97
Differential diagnosis of central chest pain
1. Asthma 2. COPD 3. MI 4. Pneumonia 5. Heart Failure
98
How's PE diagnosed
1. CXR 2. ECG 3. ABG 4. Plasma D-dimer 5. Ultrasound 6. CT pulmonary angiography (GOLD STANDARD)
99
What is seen on a CXR for PE
1. NORMAL 2. Decreased vascular markings 3. Blunting of costophrenic angles (small effusion) 4. Wedge-shaped areas of infarction 5. Pulmonary oligaemia (reduction in blood perfusion) in massive embolism 6. MI or pneumothorax
100
ECG in PE
1. Sinus tachicardia 2. RA dilation with tall-peaked P waves in lead II 3. Right bundle branch block 4. Right ventricular strain (inverted T waves V1- V4)
101
Ultrasound for PE
Leg and pelvic clots
102
How is PE treated
1. High flow Oxygen (60-100%) 2. Anticoagulant with low molecular weight heparin 3. IV fluids and inotropic agents 4. Thrombolysis 5. Surgical embolectomy 6. Vena cava filter
103
Preventative treatment of DVT
1. Patients mobilised 2. TED stockings 3. Warfarin for 3-6 months (2-3 INR)
104
How does Warfarin work
Stops Vit K being used by liver to produce 2,7,9,10 factors
105
How is emergency PE treated
1. OXYGEN THERAPY 2. MOrphine with anti-emetic 3. Immediate thrombolysis with alteplase 4. IV heparin
106
What is given is systolic BP is less than 90 mmHg
Start colloid infusion Then dobutamine Then IV noradrenaline Then Thrombolysis
107
How is systolic BP of more than 90mmHg treated
Warfarin
108
What is the upper respiratory tract
Nose to larynx
109
What microbes colonise the upper respiratory tract
Staphylococcus aureus | Streptococcus pneumoniae
110
What protects against upper respiratory tract infections
1. Mucosal defences: Cough reflex 2. Mucus barrier + respiratory cilia 3. Surface secretions (defensives and complement) Innate immune defences Macrophages Neutrophils Adaptive immune defences
111
What conditions are caused by rhinovirus
Common cold
112
What commonly causes sore throat
Adenvirus | Epstein-Barr virus
113
What causes bronchitis
Adenvirus - acute | Rhinovirus - Chronic
114
Conditions caused by adenovirus
1. Upper respiratory tract infection 2. Pharyngitis 3. Bronchitis 4. Pneumonia
115
What is Severe Acute respiratory syndrome
1. Severe respirartoy illness and failure
116
What virus causes SARS
Coronavirus
117
What is the new form of influenza virus called
Avia influenza
118
How is avian influenza spread
Poultry
119
Tonsilitis vs pharyngitis
Tonsils | Throat
120
What virus commonly causes pharyngitis
Adenovirus!! Rhinovirus EBV HIV
121
Bacterial causes of pharyngitis
1. Lancefield Group A Beta-haemolytic streptococci (strep pyogenes)
122
Clinical presentation of tonsillitis and pharyngitis
11. Tender glands in neck 2. Temperature = 38.5 3. Vital signs stable 4. Large tonsils with exudates 5. Tender anterior cervical lymph nodes
123
How is pharyngitis and tonsillitis treated
1. ONLY if persistent = phenoxylmethypenicillin or cefaclor
124
Diagnosis of pharyngitis and tonsillitis
1. Sore throat 2. fever 3. Oropharynx and soft palate are red 4. Tonsils inflamed and swollen 5. Tonsils lymph node enlarge in 1-2 days
125
Define sinusitis
1. Infection of paranasal sinuses
126
What causes sinusitis
1. Strep. pneumoniae | 2. Haemophilus influenza
127
Clinical presentation of sinusitis
1. Fever (sometimes present) 2. Facial pain 3. Prurient nasal discharge 4. Pain in left ear into teeth and no fever 5. No dental problems 6. Cold for 10 days and facial pain for same duration 7. Allergic rhinitis past history
128
Diagnosis of sinusitis
1. Forntal headache 2. Prurulent rhinorrhoea (mucus fluid in nasal cavity) 3. Bacterial sinusitis (unilateral pain and discharge with or without fever for 10 days) 4. Facial pain with tenderness 5. Fever
129
Treatment of sinusitis
1. Nasal decongestants (xylometazoline) 2. CO-amoxiclav 3
130
Complications of sinusitis
1. Brian abscess 2. Sinus vein thrombosis 3. Orbital cellulitis
131
Define acute epiglottitis
Inflammation of the epiglottis
132
What people are effects day epiglottis
1. Children under 5 years of age
133
Clinical presentation of epiglottis
1. Sore throat 2. Odynopahgia 3. Febrile 4. Inspiratory stridor (high pitched wheezing on breathing in) 5. Unwell for 6 months 6. Fatigue 7. Weight loss 8. Diarrhoea 9. Oral thrush Severe airflow obstruction Meningitis Septic arthritis Osteomyelitis
134
What causes epiglottis
Haemophilus influenza type B
135
How is epiglottis treated
1. Endotracheal intubation | 2. IV antibiotics (ceftazidime

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