Flashcards in Respiratory disorders and their management III Deck (64)
Lung cancer prevalence?
Main cause of cancer related death
2nd most common cancer
Lung cancer features?
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
Lung cancer - NSCLC subtypes?
Adenocarcinoma in situ (aka bronchoalveolar carcinoma)
Lung cancer symptoms?
Depend on stage of disease
Sob - lobar collapse, effusion, lymphangitis
Chest pain - rib involvement, chest wall invasion
Low energy levels
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
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
Signs of lung cancer?
Finger nail clubbing
How to diagnose lung cancer?
- Won't detect mediastinal disease or small nodules
- Not a staging tool, but a screening tool
- 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
- Very sensitive
- False positive rate
- Image guided
- Bronchoscopy +/- endobronchial US
- Thoracoscopy for pleural disease
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
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
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
Classification of interstitial lung disease?
Extrinsic allergic alveolitis/hypersensitivity pneumonitis
Associated with rheumatological disease
Symptoms of lung disease?
Types of it?
Constitutional symptoms (fevers, weightloss, headaches)
EAA - post exposure
IPF - chronic
AIP - rapid onset
Signs of lung disease?
Signs of steroid use
Chest - audible crackles, distribution may influence diagnosis, squeaks - suggest small airways disease
Idiopathic pulmonary fibrosis features?
Median survival 3yrs
Associated with clubbing
Restrictive spirometry and reduced transfer factor
Diagnosis by CT
How to treat Idiopathic pulmonary fibrosis?
Pirfenidone when FVC <80%
Nintenadib FVC 50-89%
Occupation - baker, farmer, moulds
Where is EAA mainly located?
Predominant upper zone predominance
Trail of corticosteroid therapy
Calcium and vitamin supplementation
What is sleep apnea?
Excessive daytime sleepiness with disordered nocturnal irregular breathing
0.5-4% population prevalence cf Type 1 DM
How is the severity of sleep apnea measured?
Mild - AHI 5-14/hr
Mod - AHI 15-30/hr
Severe - AHI >30/hr
Name the types of sleep apnea
Obstructive sleep apnea
Central sleep apnea
Risk factors for OSA?
>17 inch collar
Men x2-3 likely
Cranio-facial and upper airway abnormalities e.g. short mandible, wide craniofacial base
What does sleep apnoea cause?
Excessive daytime sleeping
Choking episodes during sleep
Obstructive sleep apnoea?
Upper airway collapses = snoring and apnoeas
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
Sleep latency test & Maintenance of Wakefulness
Causes of excessive daytime sleepiness in adults?
Restless leg syndrome
Neurological conditions - Previous head injury, parkinsons
How to diagnose sleep apnea?
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
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
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