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

Respiratory disorders and their management III Flashcards

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1
Q

Lung cancer prevalence?

A

Main cause of cancer related death

2nd most common cancer

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2
Q

Lung cancer features?

A 
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
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3
Q

Lung cancer - NSCLC subtypes?

A

Squamous Cell
Adenocarcinoma
Adenocarcinoma in situ (aka bronchoalveolar carcinoma)

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4
Q

Lung cancer symptoms?

A 
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
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5
Q

Lung cancer - paraneoplastic syndromes causes and effects?

A

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

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6
Q

Effects of lung cancer being a metastatic disease?

A

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

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7
Q

Signs of lung cancer?

A 
Finger nail clubbing
Cachexia
Horner's syndrome
Neck nodes
Chest signs
Palpable liver
SVCO
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8
Q

How to diagnose lung cancer?

A

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
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9
Q

WHO performance status for lung cancer?

A 
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
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10
Q

What does lung cancer treatment depend on?

A

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

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11
Q

How to treat SCLC?

A

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

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12
Q

Classification of interstitial lung disease?

A

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

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13
Q

Symptoms of lung disease?

Types of it?

A 
Dyspnea
Cough
Constitutional symptoms (fevers, weightloss, headaches)
EAA - post exposure
IPF - chronic
AIP -  rapid onset
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14
Q

Signs of lung disease?

A

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

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15
Q

Idiopathic pulmonary fibrosis features?

A 
Male
Older population
Median survival 3yrs
Associated with clubbing
Restrictive spirometry and reduced transfer factor
Diagnosis by CT
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16
Q

How to treat Idiopathic pulmonary fibrosis?

A 
Supportive
Pulm rehab
Pirfenidone when FVC <80%
Nintenadib FVC 50-89%
Palliative care
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17
Q

EAA triggers?

A

Occupation - baker, farmer, moulds

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18
Q

Where is EAA mainly located?

A

Predominant upper zone predominance

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19
Q

EAA treatment?

A

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

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20
Q

What is sleep apnea?

Prevalence?

A

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

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21
Q

How is the severity of sleep apnea measured?

A

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

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22
Q

Name the types of sleep apnea

A

Obstructive sleep apnea
Central sleep apnea
Mixed apnea

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23
Q

Risk factors for OSA?

A 
Obesity
>17 inch collar
Men x2-3 likely
Age
Cranio-facial and upper airway abnormalities e.g. short mandible, wide craniofacial base
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24
Q

What does sleep apnoea cause?

A 
Excessive daytime sleeping
Impaired conc
Snoring
Unrefreshing sleep
Choking episodes during sleep
Restless sleep
Nocturia
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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)
31
Continuous positive airway pressure - how does this treat OSA?
Delivery of constant pressure by face/nasal mask Abolition of apneas/hypopneas with improvement in oxygen saturation Very effective Adherence variable Essential to maintain licence validity
32
When to use a mandibular advancement device for treating OSA?
Role when CPAP not tolerated Mild-Moderate OSA Adherence is key to success
33
How does the mandibular advancement device work? | When is MADD, CPAP and UPPP better to use?
Anterior displacement of mandible MAD better than no-MAD - CPAP better than MAD for reduction of AHI/ODI MAD better than CPAP for pt preference MAD better than UPPP for AHI/ODI but snorindg same for both
34
Give examples of short acting bronchodilators?
Salbutamol, terbutaline
35
How to short acting bronchodilators work?
``` Relief of symptoms For PRN use Use in COPD & Asthma Immediate bronchodilation 4-6hour duration Increase in cAMP with reduction in cell Ca2+ leading to relaxation of smooth muscle ```
36
Side effects of short acting bronchodilators?
``` Increased HR & palpitations Tremor Hypokalaemia Headache Nervousness ```
37
Give examples of long acting bronchodilators?
Salmerterol, formoterol
38
How do long acting bronchodilators work?
Alternative to increasing dose of steroids Given by inhaled route Not to be used in monotherapy in Asthma High selectivity for B2 adenoceptor in pulmonary tissue Can increase glucocorticord receptor availability Concern of sudden cardiac death when used in monotherapy
39
Examples of anticholinergic agents?
Ipratropium, tiotropium, glycoporronium, aclindinium
40
How to anticholinergic agents work?
Relief of symptoms Primarily for COPD Reduction in exacerbation frequency in COPD Improvement in FEV1 Mode of action Blockade of muscarinic receptors M1-3 Systemic absorption low
41
Side effects of anticholinergic agents?
Possible effect on urinary retention Dry mouth Possible adverse cardiovascular effects (seen in severe cardiac disease)
42
Given examples of inhaled steroids
Beclomethasone, Budesonide, Fluticasone, Ciclesonide
43
How do inhaled steroids work?
Mainstay of asthma medication Prevent symptoms Reduces risk of exacerbations and death Usually twice daily medication Not useful in acute attack Binds to cytosolic GR with reduction in cytokines Reduces bronchoconstriction and airway inflammation
44
Side effects of inhaled steroids?
Oral candida Voice change Risk of skin bruising, bone mineral density change and cataracts with high dose
45
Examples of oral steroids
Prednisolone, deflazacort
46
How do oral steroids work?
Given in acute asthma or chronically in severe asthma Avoid if possible as long term therapy but essential if asthma worsens Clearer role in eosinophilic asthma Time to efficacy 4hours for IV & PO routes
47
Side effects of oral steroids?
``` Weight gain Hyperglycaemia Skin change Hypertension Eye change Mood change Reduce bone mineral density ```
48
Examples of theophyllines?
Nuelin SA, Slophyllin
49
How do theophyllines work?
``` Tablets and intravenous Useful in acute and chronic asthma Method of action unclear Possibly acting upon cAMP via PDE inhibition Possibly acting upon HDAC pathway Requires serum level monitoring Drug interactions ```
50
Side effects of theophyllines?
``` Nausea Vomiting Palpitations Headaches Dyspepsia Arrhythmias Confusion ```
51
Examples of Antileukotrienes? (treatment taken at night)
Montelukast, Zafilukast
52
How do antiluekotrines work?
Oral Useful in chronic asthma Not useful in acute asthma Role in exercise induced asthma & patients with aspirin hypersensitivity Leukotrienes within phospholipid cell membranes and derived from inflammatory cells Can promote smooth muscle contraction and inflammatory changes in airway wall
53
Side effects of antileukotrines?
``` Headache N&V Sleep disturbance Sore throat GI disturbance ```
54
What is the 1st line treatment for asthma and COPD?
Short acting B2 agonists PRN
55
When are long acting B2 agonists used in asthma and COPD?
``` Asthma = always with ICS COPD = symptomatic relief ```
56
When are anticholinergics used?
``` Asthma = adjunct with ICS COPD = symptomatic relief ```
57
When are inhaled steroids used?
Asthma = 2nd line COPD = not licensed in monotherapy Used to reduce exacerbation frequency and symp relief
58
When is LAMA/LABA (long acting beta agonists) used?
``` Asthma = not licensed COPD = reduce exacerbation freq and symp relief ```
59
When to use theophylline?
``` Asthma = 3rd line defence COPD = symp relief ```
60
When to use Oral Leukotriene Antagonist?
``` Asthma = symp relief COPD = no obvs role ```
61
When to use oral steroids?
``` Asthma = long term low dose for difficult asthma and short term high dose for exacerbations COPD = Short term for exacerbations ```
62
How does oxygen therapy work?
Delivered by mask, nasal cannulae or ET tube Controlled i.e. concentration known Venturi systems, e.g. 24,28,35,60…% Uncontrolled i.e. concentration guessed Full face masks Cannulae – highly dependent on respiratory rate
63
How to do O2 therapy in acutely unwell pts?
SpO294-98% unless concern of hypercapnea
64
How to do O2 therapy in COPD?
SpO2>88-92% until ABG taken

RESP SYSTEM DEN303 (7 decks)

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