Respiratory Flashcards

(138 cards)

1
Q

what is coryza

A

acute viral infection of the nasal passages; highly infectious due to rhinoviruses, coronaviruses and
adenoviruses. Spread via droplets, facilitated by overcrowding and poor ventilation.

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2
Q

symptoms of coryza

A
watery nasal discharge 
mild pyrexia
malaise
sneezing 
tiredness
sore nose and throat
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3
Q

complications of coryza

A

sinusitis
acute bronchitis
secondary infection
otitis media

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4
Q

treatments of coryza

A

bed rest
fluids
isolation
herbal extracts

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5
Q

what is sinusitis

A

bacterial/fungal infection of paranasal sinuses, usually preceded by coryza. Can occur with asthma.

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6
Q

symptoms of sinusitis

A

frontal headache, facial pain
purulent rhinorrhoea
fever

can be split into:
Acute: 1 week – 1 month
Subacute: 1-3 months
Chronic: >3 months

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7
Q

investigations for sinusitis

A

CT of paranasal sinuses, MRI to demonstrate bony landmarks

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8
Q

treatment of sinusitis

A

Nasal decongestants (xylometazoline)

Broad-spectrum antibiotics (co-amoxiclav)

Topical corticosteroid
(fluticasone propionate nasal spray)

FESS for ventilation and drainage

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9
Q

what is rhinitis

A

Sneezing attacks, nasal blockage/discharge occurring >1hr on most days.

can be split into seasonal and perennial

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10
Q

what is seasonal rhinitis

A

Limited period of the year; “hay-fever” but not restricted to grass pollen.
Intermittent rhinitis

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11
Q

symptoms of seasonal rhinits

A

Nasal irritation, rhinorrhoea, sneezing
Itchy eyes and ears
Irritated soft palate
Wheeze

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12
Q

what is perennial rhinitis

A

Throughout the whole year
Split into:

Allergic: caused by faeces of dust mites; cats; industrial dust and fumes.

Non-allergic: no identifiable stimulus, but eosinophilic granulocytes are present in secretions.

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13
Q

symptoms of perennial rhinitis

A

Nasal blockage, rhinorrhoea

Loss of smell and taste

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14
Q

treatment of general rhinits

A

Antihistamines (loratidine, cetirizine)

Topical corticosteroids (beclometasone,
fluticasone propionate)

CysLT antagonist (montelukast)

Anti-inflammatory (sodium
cromoglicate)

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15
Q

what is pharyngitis

A

Endemic adenovirus infection, causing reddened oropharynx and soft palate and inflamed tonsils.

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16
Q

symptoms of pharyngitis

A

Sore throat
Tonsillar lymph nodes enlargement
Localised endemics of fever and
conjunctivitis

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17
Q

treatment of pharyngitis

A

phenoxymethylpenicillin or cefaclor if severe

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18
Q

what is acute laryngotracheobronchitis

A

Occasional complication of URTIs, particularly those caused by parainfluenza viruses and measles.
Most severe in children < 3yrs. Inflammatory oedema usually present which can spread to vocal cords.

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19
Q

symptoms of acute laryngotracheobronchitis

A
Hoarseness
Barking cough (croup)
Stridor
Progressive airway obstruction
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20
Q

treatment of acute laryngotracheobronchitis

A

Nebulised adrenaline

Oral/IM corticosteroids (dexamethasone)

Oxygen and adequate fluids

Tracheostomy (rare!)

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21
Q

what is acute epiglottitis

A

Life-threatening airway obstruction in children aged 2-7yrs caused by H. influenzae.

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22
Q

symptoms of acute epiglottits

A

severe airflow obstruction

high fever

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23
Q

complications of acute epiglottitis

A
mostly of H. influenzae
meningitis
diptheria
osteomyelitis
septic arthritis
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24
Q

treatment of acute epiglottitis

A

Urgent endotracheal intubation

IV antibiotics (ceftazidime, ceftriaxone)

Prevention vaccine given to infants
Do NOT inspect epiglottis until airway is
patent

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25
what is influenza
Influenza A (pandemics) and Influenza B (localised outbreaks) incubate within 3 days. Not a cold!
26
symptoms of influenza
Abrupt fever Shivering and aching Severe headache Sore throat + dry cough
27
complications of influenza
Secondary bacterial infection/pneumonia | Encephalomyelitis (rare)
28
investigations for influenza
Increase in complement-fixing antibody (hemagglutinin) between onset and after 1-2 weeks Nasal/throat secretion analysis
29
treatment of influenza
Bed rest, fluids Paracetamol Neuraminidase inhibitors within 48hrs (zanamivir, oseltamivir)
30
what is acute bronchitis
acute infection of bronchi causing them to become inflamed | Usually arises from Strep. pneumoniae/H. influenzae infections, or in people with COPD.
31
symtptoms of acute bronchitis
Irritating dry cough; becomes productive Wheeze Breathlessness Mild fever
32
treatment of acute bronchitis
NO antibiotics unless there is underlying chronic lung disease (amoxicillin)
33
what is pneumonia
Acute infection of the lungs causing inflammation. Community, Hospital and Immunocompromised -acquired pneumonia. Main causes: Strep. pneumoniae, H. influenzae, Staph. aureus, Influenza A. Atypical causes: Mycoplasma, Legionella, Chlamydophila pneumoniae/psittaci, coxiella burnetti. HAP only diagnosed after 48hrs in hospital
34
symptoms of pneumonia
``` Fever and rigors Pleuritic chest pain Anorexia Breathlessness Cough – dry or productive ```
35
investigations for pneumonia
CXR consolidation, effusions, collapse FBC + U&Es, CRP Sputum culture to detect organisms CURB65 for CAP
36
treatment of pneumonia
CAP (see Antibiotic Man) Mild/Moderate: (7 days) PO amoxycillin If penicillin allergy PO doxycycline; if IV required IV clarithromycin Severe: (10 days) IV co-amoxiclav + IV clarithromycin/PO doxycycline If penicillin allergy IV levofloxacin HAP Severe: (7-10days) amoxicillin + metronidazole + gentamicin Non-severe: (7 days) amoxicillin + metronidazole Specific Staph. aureus flucloxacillin/vancomycin if MRSA Klebsiella cefotaxime Pseudomonas ceftazidime/ciprofloxacin + aminoglycide Mycoplasma clarithromycin/ciprofloxacin Legionella levofloxacin/moxifloxacin/consider rifampicin Chlamydophila doxycycline/clarithromycin Pneumocystis jiroveci co-trimoxazole Fungal amphoterecin
37
what is COPD
encompasses 2 main clinical syndromes: chronic bronchitis and emphysema characterised by airflow obstruction that is most reversible with bronchodilators
38
symptoms of COPD
productive cough wheeze breathlessness infective exacerbations
39
complications of COPD
Hypertension Osteoporosis Weight loss Cor pulmonale
40
investigations for COPD
Smoking history/chronic history of symptoms ``` Family history (α1-antitrypsin deficiency) ``` Lung function tests (↓FEV1/↓FVC, ↓PEFR) CXR classically normal ABGs de-saturate over time
41
treatment of COPD
Smoking cessation and lifestyle advice SABA (salbutamol) mild COPD, LABA (salmeterol) mod-sev COPD SAMA (ipratropium) or LAMA (tiotropium) Inh. corticosteroid (beclometasone), PO corticosteroid if severe (prednisolone) Seretide (salmeterol + beclometasone) Xanthine (theophylline) Anti-mucolytic (carbocysteine)
42
treatment of an acute exacerbation of COPD
``` ISOAP ipratropium (neb) salbutamol (neb) oxygen (24%) amocillin/doxyclycine is purulent sputum prednisolone (PO) ```
43
what is asthma
chronic inflammatory condition where reversible obstruction of the airways occurs. airflow limitation -> airway hyerresonsivemess -> bronchial inflammation
44
investigations for asthma
Allergen skin prick test Lung function tests (↓PEFR: mod<80%, severe<50%, life-threatening<30%) Bronchial challenge testing (histamine, methacholine) CO transfer (normal in asthma)
45
treatment for asthma
SABA (salbutamol) ``` LABA (salmeterol) + inhaled corticosteroid (beclometasone) + sodium cromoglicate + CysLT antagonist (montelukast) + oral corticosteroid (prednisolone) ```
46
treatment of acute asthma
``` O SHIT MAn oxygen salbutamol (neb) hydrocortisone (IV) ipratropium (neb) magnesium sulpahte (IV) prednisolone (PO) ```
47
characteristics of acute severe asthma
Unable to complete sentences Respiratory rate >25 per minute Pulse rate >110 beats per min PEFR <50 % predicted
48
characteristics of life threatening asthma
PEFR <33% predicted Bradycardia, hypotension, silent chest Exhaustion, confusion, coma ABG PaCO2 >5, PaO2 <8 or acidosis
49
what is OSA
airway becomes closed during sleep; muscles hypotonic during sleep and thus do not open airway. partial occlusion = snoring and complete occlusion = apnoea (cessation of breathing)
50
symptoms of OSA
``` Loud snoring Daytime sleepiness Unrefreshed/restless sleep Headache Large neck and tongue Small mandible ```
51
aetiology of OSA
Obesity Narrow pharyngeal opening Co-existent COPD Respiratory depre
52
investigations of OSA
Epworth Sleepiness Scale Overnight pulse oximetry Diagnose if >10-15 apnoeas in any 1hr of sleep
53
treatment of OSA
Nasal Continuous Positive Airway Pressure (via mask during sleep) CNS stimulant (modafinil
54
what is bronchiectasis
Abnormal permanent dilatation of airways, resulting inflammation and thickening of walls. Mucociliary transport mechanism is impaired and thus recurrent bacterial infections ensue. Cystic fibrosis = most common cause.
55
symptoms of bronhiectasis
``` Productive cough (yellow-green sputum, can become haemoptysis) Halitosis (bad breath) Recurrent febrile episodes, malaise Clubbing Coarse crackles, pneumonic episodes ```
56
complications of bronchiectasis
Pneumonia, pneumothorax Empyema Metastatic cerebral abscesses Life-threatening haemoptysis
57
investigations of bronchiectasis
CXR dilated + thickened bronchi CT thickened bronchi, cysts Sputum S. aureus, Pseudomonas, HiB IgA deficiency
58
treatment of bronchiectasis
Postural drainage! Antibiotics (mild: cefaclor/ciprofloxacin, flucloxacillin if S. aureus; persistent: ceftazidime) Bronchodilators + anti-inflammatory agents
59
what are lung abscesses
Localised suppuration assoc. with cavity formation on CXR/CT
60
aetiology of lung abscess
aspiration, TB, Stap/Klebs pneumonia, septic emboli, foreign body inhalation
61
symptoms of lung abscess
persisting pneumonia, foul sputum, malaise, weight loss, raised inf. markers
62
treatment of lung abscess
guided by culture results, surgical drainage
63
what is cystic fibrosis
autosomal recessive disorder in which there is a defect in the CFTR gene, a critical chloride channel. Failed opening of Cl channel -> ↑cAMP, resulting in ↓Cl and ↑Na -> ↑viscosity of airway secretions.
64
symptoms of CF
``` Recurrent infections Sinusitis, nasal polyps Breathlessness Haemoptysis Steatorrhoea Meconium ileus (SI obstruction) Malabsorption Abnormal teenage milestones ```
65
investigations in CF
``` Family history Gene testing (sweat test) ```
66
treatment of CF
Lifestyle (smoking, vaccines) Antibiotics (as per bronchiectasis) SABAs, ICS for symptoms Inh recombinant DNAse (dornase)
67
what is tuberculosis
Airborne infection spread by droplets by Mycobacterium species. Affects 1/3 of population. Caseating granulomatous inflammation (necrotic centre; surrounded by epitheloid cells and Langhan’s giant cells; formation of Ghon focus/complex). Primary=first infection. Latent=asymptomatic, smear – ve
68
symptoms of TB
Persistent productive cough (>3weeks) + occasional haemoptysis Weight loss, night sweats, fever, fatigue Hoarseness, pleuritic pain
69
investigations for TB
CXR consolidation +/- cavitation, fibrosis, calcification, pleural effusion, widening of mediastinum Latent: tuberculin skin test/Mantoux test (possible false –ve if previous BCG). If +ve do IFʎ test Active: obtain tissue/fluid (induced sputum, bronchoalveolar lavage if unproductive cough, aspiration of pleural fluid/biopsy, pus, ascites, urine, bone marrow, CSF) Culture > PCR > ZN stain (but culture takes weeks, PCR is rapid so it is 1st line)
70
treatment of TB
2 months RIPE, 4 months RI Rifampicin SE discolouration of urine/tears, hepatitis, flu-like illness Isoniazide SE neuropathy, agranulocytosis, allergic reaction Pyrazinamide SE hepatic toxicity (rare), reduced renal excretion of urate, gout Ethambutol SE colour blindness developing into blindness
71
what is sarcoidosis
Multisystem non-caseating granulomatous Type IV hypersensitivity disorder of unknown aetiology
72
symptoms of sarcoidosis
Erythema nodosum Fatigue, weight loss Uveitis Peripheral lymphadenopathy
73
investigations for sarcoidosis
CXR multiple abnormalities, BHL Restrictive lung pattern Hypercalcaemia, raised ACE level Transbronchial biopsy
74
treatment for sarcoidosis
corticosteroids (PO prednisolone)
75
what is wegners granulomatosis
Granulomatous disease predominantly affecting small arteries. Lesions in URT, lungs, kidney
76
symptoms of wegners granulomatosis
Severe rhinorrhoea ->nasal mucosa ulcer Cough, haemoptysis, pleuritic pain Occasionally involves skin and nervous system.
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investigations of wegners granulomatosis
CXR nodular masses/pneumonia infiltrates with cavitation Renal biopsy reveals necrotising microvascular glomerulonephritis
78
treatment of wegners granulomatosis
esponds well to cyclophosphamide or rituximab
79
what is churg-strauss syndrome
Eosinophilic infiltration with high blood eosinophil count, vasculitis of small arteries and veins. Predominately affects 40 year old males
80
symptoms of churg-strauss syndrome
``` Rhinitis and asthma, breathlessness Systemic vasculitis (fever, sweats, fatigue, weight loss, rash) Cough Difficulty passing urine Cold peripheries ```
81
investigations for churg-strauss syndrome
CXR pneumonic shadows (bilateral) | ANCA +ve
82
treatment of churg-strauss syndrome
responds well to corticosteroids
83
what is systemic lupus erythematosis
Chronic type III hypersensitivity disease that causes inflammation in various parts of body
84
symptoms of systemic lupus erythematosis
``` Joint pain, fatigue Skin rash Pleurisy with or w/o effusion Effusions (usually small/bilateral) Basal pneumonitis (restricted chest movement due to pleural pain) ```
85
what is idiopathic pulomary fibrosis
Patchy scarring of lung with collagen deposition and honeycombing. Late onset. Commoner in males.
86
symptoms of idiopathic pulomary fibrosis
``` Progressive breathlessness Dry cough Cyanosis Fine bilateral end-inspiratory crackles Clubbing Assoc. with autoimmune diseases ```
87
investigations for idiopathic pulomary fibrosis
``` CXR initially ground-glass -> honeycomb CT bilateral changes, thick-walled cysts Restrictive lung pattern, ↓CO transfer Anti-nuclear antibodies ```
88
treatment of idiopathic pulomary fibrosis
Corticosteroids (oral prednisolone) | Anti-fibrotic (pirfenidone)
89
what is extrinsic allergic alveolitis
Widespread diffuse inflammatory reaction in small airways and alveoli due to inhalation of foreign antigens, usually from animals. Cigarette smokers actually have decreased risk. Type III hypersensitivity
90
symptoms of extrinsic allergic alveolitis
Fever, malaise Cough, breathlessness, wheeze Coarse end-inspiratory crackles Weight loss and IPF features (chronic)
91
investigations for extrinsic allergic alveolitis
CXR fluffy upper zone nodular shadows CT ground glass opacity Restrictive lung pattern, ↓CO transfer Raised leucocytes + T cells
92
treatment of extrinsic allergic alveolitis
Prevent exposure | Oral prednisolone in early stages
93
what is coal workers pneumoconiosis
Dust particles typically 2-5 micrometres in diameter are retained in small airways and alveoli split into simple pneumoconosis progressive massive pneumoconiosis
94
what is simple pneumoconiosis and symptoms
More common form; refers to deposition of coal dust in lung. | Symptoms usually COPD-related. CXR fine micro-nodular shadowing.
95
what is progressive massive pneumoconiosis
Round fibrotic masses several cm in diameter develop in upper lobes -> apical destruction of lung. Necrotic central cavities.
96
symptoms of coal workers pneumoconiosis
Considerable effort dyspnoea | Cough + black sputum
97
investigations for coal workers pneumoconiosis
Rheumatoid factor and ANAs +ve; restrictive/obstructive pattern, ↓lung volume, ↓CO transfer
98
what is asbestosis
Fibrosis causes by asbestos dust exposure
99
symptoms of asbestosis
Progressive breathlessness, clubbing | Bilateral basal end-inspiratory crackles
100
treatment of asbestosis
No treatment alters progression, but corticosteroids can help symptoms
101
what is pneumothorax
Air in the pleural space. May be spontaneous (tall, thin males) or the result of trauma to the chest
102
symptoms of pneuothorax
``` Sudden onset pleuritic pain Increasing breathlessness Pallor, tachycardia Mediastinal shift (tension pneumothorax) ```
103
treatment of pneumothorax
Needle aspiration (2nd IC space, midclavicular line) Chest drain if recurs using large bore
104
what is empyema
Pus in the pleural space. Usually complication of pneumonia. Exudate of pH< 7.2 very suggestive.
105
symptoms of empyema
Ongoing fever | Persistent pneumonic symptoms
106
treatment of empyema
surgical drainage
107
what are pleural effusions
Excessive fluid in the pleural space. can be split into Transudate protein < 30g/l LDH < 200 Heart failure, nephrotic syndrome, pericarditis Exudate protein > 30g/l LDH > 200 Pneumonia, cancer, TB, autoimmunity, MI, pancreatitis
108
symptoms of pleural effusion
breathlessness, sometimes chest pain but rarely
109
investigations of pleural effusion
Clinically detect when >500ml present CXR detects when >300ml present, obliterated costophrenic angle, raised hemidiaphragm Lights’ criteria (differentiates between transudate and exudate between 25-35g/l
110
treatment of pleural effusions
treat underlying cause but drain if empyema (purulent fluid). Thoracocentesis 5th intercostal space, mid-axillary line
111
what is respiratory failure
Occurs when gas exchange is inadequate, resulting in hypoxia. It is defined as PaO2 <8kPa, subdivided according to PaCO2 level
112
what is type I respiratory failure
hypoxia (PaO2 < 8kPa) with normal or low PaCO2
113
aetiology of type I respiratory failure
o Pneumonia Pulmonary oedema PE, fibrosing alveolitis Asthma, emphysema, ARDS
114
treatment of type I respiratory failure
Treat underlying cause Oxygen (15L) non-rebreather (hypoxia) Assisted ventilation if PaO2 < 8kPa despite 60% O2
115
what is type II respiratory failure
hypoxia (PaO2 < 8kPa) + hypercapnia (PaCO2 > 6.0 kPa)
116
aetiology of type II respiratory failure
Pulmonary disease (asthma, COPD, pneumonia, fibrosis, obstructive sleep apnoea) Reduced respiratory drive (sedation drugs, CNS tumour/trauma) ``` Neuromuscular disease (cervical cord lesion, diaphragmatic paralysis, poliomyelitis, MG, Guillain-Barre Syndrome) ``` Thoracic wall disease (flail chest, kyphoscoliosis)
117
treatment of type II respiratory failure
Oxygen (24%), recheck ABGs after 20min If PaCO2 is steady/lower, increase O2 concentration to 28% If PaCO2 rises > 1.5kPa and patient is still hypoxic, consider a respiratory stimulant (doxapram) or assisted ventilation (NIPPV)
118
what is ARDS
Respiratory distress due to stiff lungs (reduce pulmonary compliance) and gas exchange impairment. Lung injury, severe sepsis and pneumonia result in fibrous exudate lining alveolar walls, impairing gas exchange and destroying alveoli.
119
symptoms of ARDS
Breathlessness Tachypnoea Increasing hypoxaemia, central cyanosis Fine bilateral crackles
120
treatment of ARDS
Treat underlying condition (sepsis, pneumonia), position patient prone Diuretics Inhaled nitric oxide (vasodilator improves V/Q) Aerosolized surfactant PEEP Inspired oxygen
121
what is pulmonary hypertension/cor pulmonare
Defined as mean pulmonary artery pressure of ≥25mmHg at rest. Cor pulmonale = right heart failure due to pulmonary hypertension. Can occur in advanced COPD: alveolar collapse (emphysema) results in hypoxia which causes vasoconstriction, increasing pressure in the right side of the heart.
122
symptoms of pulmonary hypertension/cor pulmonare
``` Progressive breathlessness Ankle oedema Parasternal heave, tricuspid regurgitation Pulmonary hypertension RV hypertrophy Elevated JVP, ascites ```
123
investigations of pulmonary hypertension/cor pulmonare
CXR enlargement of pul. arteries, atrial/ventricular enlargement ECG pattern of RVH
124
treatment of pulmonary hypertension/cor pulmonare
``` Encourage exercise, avoid overexertion Oxygen (2l) during plane travel Vaccination for influenza + pneumococcal pneumonia Oral anticoagulants Diuretics ```
125
what is PE
Thrombus, usually from systemic veins, lodges in pulmonary arteries. Virchow’s triad: endothelial damage, abnormal blood flow or hypercoagulable blood -> clot formation.
126
symptoms of PE
Sudden breathlessness Sudden chest pain + haemoptysis Tachypnoea Fever, pleural rub, raised JVP
127
investigations of PE
CXR usually normal, possible blunting of costophrenic angle D-dimer – if undetected, exclude diagnosis of PE V/Q scan shows underperfused areas Geneva score to predict PE likelihood
128
treatment of PE
Oxygen (60-100%) unless chronic lung disease Anticoagulant (IM LMWH, IV heparin + warfarin) IV fluids in massive embolus Fibrinolytic (streptokinase
129
what is pulmonary oedema
accumulation of fluid in the pleural space
130
symptoms of pulmonary oedema
Breathlessness, orthopnoea Cough + haemoptysis Leg/abdominal swelling Pale skin
131
treatment of pulmonary oedema
oxygen | diureticss
132
symptoms of lung cancer
Cough (3 week cough merits a CXR) Breathlessness(central tumours occlude large airways) Haemoptysis (tumour bleeding into airway) Chest pain (peripheral tumour invade the chest wall/pleuritic pain Wheeze (monophonic when due to partial obstruction of airway by tumour) Hoarseness (compression of the recurrent laryngeal nerve) Dysphagia (invasion of phrenic nerve/oesophagus)
133
describe small cell carcinoma
Arise from APUD cells; secrete ACTH Often centrally located Rapid metastasis
134
describe adenocarcinoma
Common in non-smokers; smoking can cause it Arises from mucus-secreting glandular cells Metastasises widely
135
describe squamous cell caricinoma
Most common. Arise from epithelial cells Occasionally cavitates; central necrosis Local, slow metastasis. Hypercalcaemia, PTH
136
describe large cell carcinoma
Poorly differentiated | Metastasises early on
137
investigations for lung cancer
CXR may be initially normal due to small lesion/confined to central structures Common presentations: mass lesions, pleural effusion (large, unilateral), mediastinal widening or hilar adenopathy, slow resolving consolidation, collapse, reticular shadowing CT indicates extent of disease. Includes liver, adrenal glands. TNM staging can be done PET characterises extent of mediastinal nodal involvement or distant metastases (2nd line to CT) PET + CT for best correlation Assess fitness for surgery
138
treatment of lung cancer
Surgery: early stage NSCLC surgery can be curative If Stage III, treat with chemotherapy to downstage then surgical resection Contraindicated if: - Tumour is near hilum - Evidence of metastasis - FEV1 > 1.5 L - Vocal cord paralysis Radical radiotherapy: for patients with early stage NSCLC but adequate lung function, this is ideal if surgery is not possible due to co-morbidities Chemotherapy: effective against SCLC only