Respiratory disorders and their management III Flashcards Preview

RESP SYSTEM DEN303 > Respiratory disorders and their management III > Flashcards

Flashcards in Respiratory disorders and their management III Deck (64)
Loading flashcards...
1

Lung cancer prevalence?

Main cause of cancer related death
2nd most common cancer

2

Lung cancer features?

85% NSCLC
15% SCLC
10% operable at diagnosis
Risk of spread from primary tumours to nodes and distal organs (bone,liver, lung pleura cavity)
T N M1A/1B predicts survival

3

Lung cancer - NSCLC subtypes?

Squamous Cell
Adenocarcinoma
Adenocarcinoma in situ (aka bronchoalveolar carcinoma)

4

Lung cancer symptoms?

Depend on stage of disease
Sob - lobar collapse, effusion, lymphangitis
Chest pain - rib involvement, chest wall invasion
Cough
Haemoptysis
Weight loss
Low appetite
Low energy levels

5

Lung cancer - paraneoplastic syndromes causes and effects?

High Ca (PTH release/bone involvement) - nausea, confusion, abdo pain and constipation
SIADH - confusion, fits
Lambert eaton syndrome - neuromuscular weakness

6

Effects of lung cancer being a metastatic disease?

SVCO due to mediastinal disease
Brain mets - confusion, nausea, headache
Bone mets - path fracture, pain
Liver mets - abdo pain

7

Signs of lung cancer?

Finger nail clubbing
Cachexia
Horner's syndrome
Neck nodes
Chest signs
Palpable liver
SVCO

8

How to diagnose lung cancer?

Chest X-ray:
- Cheap
- Won't detect mediastinal disease or small nodules
- Not a staging tool, but a screening tool

CT:
- Staging tool
- Detailed info
- Requires IV contrast (not allowed in pts with CKD)
- Cannot detect microscopic disease

PET scan for radical treatable disease;
- Infusion of FD glucose
- Detects cancer, infec, vasculitis
- Expensive
- Very sensitive
- False positive rate

Tissue biopsy:
- Image guided
- Bronchoscopy +/- endobronchial US
- Thoracoscopy for pleural disease
- Surgical

9

WHO performance status for lung cancer?

0 = carry out normal activity
1 = restricted in strenuous activity
2 = capable of self care but unable to do work activities
3 = symptomatic, in chair or bed for 50% of day
4 = disabled, cannot care for self

10

What does lung cancer treatment depend on?

Stage and WHO performance status
RT or surgery for WHO 1/2
Chemo for extensive disease
Immunotherapy - inhibition of PDL suppression by tumours on T-ells
Oral EGFR mAB for EGFR positive disease WHO PS 0-3
BSC for pts not fit for active treatment

11

How to treat SCLC?

Systemic Cisplatin based Chemotherapy - disease extensive at presentation
Treat within 7/7 of diagnosis to due speed of deterioration
If localised disease – f/u RT

12

Classification of interstitial lung disease?

Idiopathic
Drug reaction
Extrinsic allergic alveolitis/hypersensitivity pneumonitis
Associated with rheumatological disease

13

Symptoms of lung disease?
Types of it?

Dyspnea
Cough
Constitutional symptoms (fevers, weightloss, headaches)
EAA - post exposure
IPF - chronic
AIP - rapid onset

14

Signs of lung disease?

Nail clubbing
Sclerodactyly
Signs of steroid use
Chest - audible crackles, distribution may influence diagnosis, squeaks - suggest small airways disease

15

Idiopathic pulmonary fibrosis features?

Male
Older population
Median survival 3yrs
Associated with clubbing
Restrictive spirometry and reduced transfer factor
Diagnosis by CT

16

How to treat Idiopathic pulmonary fibrosis?

Supportive
Pulm rehab
Pirfenidone when FVC <80%
Nintenadib FVC 50-89%
Palliative care

17

EAA triggers?

Occupation - baker, farmer, moulds

18

Where is EAA mainly located?

Predominant upper zone predominance

19

EAA treatment?

Antigen avoidance
Trail of corticosteroid therapy
Calcium and vitamin supplementation
Possible bisphosphonate

20

What is sleep apnea?
Prevalence?

Excessive daytime sleepiness with disordered nocturnal irregular breathing
0.5-4% population prevalence cf Type 1 DM

21

How is the severity of sleep apnea measured?

Apnea-hypopnea index
Mild - AHI 5-14/hr
Mod - AHI 15-30/hr
Severe - AHI >30/hr

22

Name the types of sleep apnea

Obstructive sleep apnea
Central sleep apnea
Mixed apnea

23

Risk factors for OSA?

Obesity
>17 inch collar
Men x2-3 likely
Age
Cranio-facial and upper airway abnormalities e.g. short mandible, wide craniofacial base

24

What does sleep apnoea cause?

Excessive daytime sleeping
Impaired conc
Snoring
Unrefreshing sleep
Choking episodes during sleep
Restless sleep
Nocturia

25

Obstructive sleep apnoea?

Upper airway collapses = snoring and apnoeas

26

Epworth Sleepiness Scale

Questionnaire with 0-24 scale
11-14 mild sleepiness
15-18 moderate sleepiness
>18 severe sleepiness
Screening tool when assessing daytime somnolence

Other tests
Sleep latency test & Maintenance of Wakefulness

27

Causes of excessive daytime sleepiness in adults?

Fragmented sleep
Sleep deprivation
Shift work
Depression
Hypothyroidism
Restless leg syndrome
Excessive alcohol
Neurological conditions - Previous head injury, parkinsons

28

How to diagnose sleep apnea?

Pulse oximetry:
Cheap
Easy to use
Can be used at home
Can show false negative
Less sensitive in thin patients/issues with tissue perfusion
Measure 4% desaturation rate (ODI) - >10 events per hours suspicious

Polysomnography:
Limited vs Full
Full considered Gold standard
Full PSG requires hospital admission
Measurement of EEG, eye & limb movements, nasal flow, thoraco-abdominal movement, ECG & oxygen saturation

29

Morbidity associated with OSA?

Untreated x2-3 risk of RTA (DVLA)
Associated with CHD, CCF, PAH & Hypertension & CVD
Insulin resistance (Metabolic syndrome) & T2 DM
Concurrent obesity is a confounding factor in studies
Increased risk of post-operative complications

30

Treatment of OSA?

Weight loss/lifestyle change
Continuous Positive Airway Pressure (CPAP)
Mandibular Advancement Device (MAD)