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CP3 Medicine > RESPIRATORY - TB, Lung cancer, Pneumothorax and Pleural effusions > Flashcards

RESPIRATORY - TB, Lung cancer, Pneumothorax and Pleural effusions Flashcards

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1
Q

Peak incidence lung cancer

A

65 y/o

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2
Q

M:F lung cancer

A

3:1

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3
Q

RF lung cancer

A

Smoking
Passive smoking
Urban living
Occupational exposure

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4
Q

Which type of lung cancer do occupational exposures mostly lead to

A

Adenocarcinoma

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5
Q

% of lung cancer in regards to location

A

70% centrally (main bronchi/hilum)

30% peripherally

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6
Q

What are the 4 types of lung cancer

A

Squamous cell carcinoma (40-50%)
Adenocarcinoma (20-40%)
Small cell anaplastic carcinoma (20-30%)
Large cell anaplastic carcinoma (10%)

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7
Q

Where does squamous cell lung carcinoma arise form?

A

Sqamous metaplasia of pseudostratified ciliated columnar epithelium

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8
Q

What is SCC usually in response to

A

Cigarette smoke exposure

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9
Q

Where in the lungs do SCC;’s tend to arise

A

Central + close to carina

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10
Q

What substance can SCC’s secrete + what Sx does this lead to

A

PTH

Hypercalcaemia

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11
Q

Diagnosis SCC

A

CXR

Sputum cytology

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12
Q

Prognosis SCC

A

Slow growing

and may be resectable

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13
Q

Where do adenocarcinomas of the lung tend to arise

A

Peripherally 2/3

Areas of previous lung scarring

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14
Q

Why are non-smoking women at risk of developing lung adenocarcinoma

A

Because they have a high incidence of growth factor receptor

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15
Q

Which type of lung adenocarcinoma is associated with a better prognosis?

A

Bronchoalveolar carcinoma

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16
Q

Another name for small cell anaplastic carcinoma

A

Oat cell carcinoma

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17
Q

Where are small cell carcinoma’s usually located

A

Centrally

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18
Q

Spread small cell carcinoma

A

Grow rapidly

+ often mets at diagnosis

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19
Q

Origin small cell carcinoma

A

From bronchial epithelial

Which DDx into neuroendocrine/Kulchitsky cells

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20
Q

What do Kulchitsky cells do

A

Express markers + secrete ADH + ACTH

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21
Q

Small cell carcinoma can lead to which MG-like syndrome?

A

Eaton-Lambert syndrome

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22
Q

Sx Eaton-Lambert syndrome (5)

A 
Scapular/pelvic girdles 
Reduced tendon reflexes 
Dry eyes 
Sexual impotence 
Neuropathy
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23
Q

Prognosis Eaton-Lambert syndrome

A

usually gets better w/ usage

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24
Q

What are large cell anaplastic carcinomas

A

Show SCC/adenocarinomatous origins

But not DDx enough to be classified

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25
Where in lung do large cell anaplastic carcinomas present
Centrally
26
Prognosis large cell anaplastic carcinomas
Poor | Widely disseminated @diagnosis
27
Which grade Non-small cell lung cancers are operable?
T1NO - T3N2
28
Early catching non-small cell lung cancer 5y survival rate
55-67%
29
PS Lung cancer (7)
``` Persistent cough Haemoptysis Dyspnoea Chest pain B Sx Chest infections W loss ```
30
O/E - lung cancer (6)
``` Clubbing Cahexia Signs anaemia Hypertrophic pulmonary OA Chest signs - collapse/consolidation/effusion Signs of mets ```
31
What is hypertrophic pulmonary OA due to?
Paraneoplastic syndrome | = Clubbing + painful periostheitis of small joints of hands
32
Paraneoplastic syndromes which can arise due to lung cancer (5)
``` Hypertrophic pulmonary OA Lambert-Eaton syndrome SIADH 2' Cushings HyperPTH ```
33
Local invasion issues caused by lung cancers (7)
``` Rec laryngeal nn palsy Phrenic nn palsy SVC obstruction Pancoast syndrome Pericarditis Pericardium --> effusion/AF Oesophageal fistulas/dysphagia ```
34
When are phrenic nn palsies asymptomatic?
If unilateral
35
S+S of SVC obstruction
Raised JVP Raised arm BP/swelling Facial swelling Headache
36
What is Pancoast syndrome
Malignant neoplasm of lung apex --> destructive lesions of thoracic inlet
37
Sx Pancoast syndrome (4)
Horners syndrome Shoulder pain R along ulnar forearm + hand Atrophy hand/arm mm Oedema b/c BV occlusion
38
mets lung cancer (4)
Brain Bone Liver Adrenal gland
39
What condition can Adrenal mets PS as
Addison's
40
Skin conditions indicating lung cancer (2)
Acanthosis nigricans | Dermatomyositis
41
DDx lung mass
Granuloma | Aspergilloma
42
Ix lung cancer (10)
``` FBC (anaemia/polycythaemia) LFTs - mets U+E - hypercalcaemia/hyponatraemia CXR Sputum/pleural fl cytology Staging CT Biopsy CT via bronchoscopy Pulmonary fct tests PET scan (mets) ```
43
Why use pulmonary function tests when investigating lung cancer?
For planning surgery
44
If a lung cancer lesion is hidden by the heart, what should you look for on CXR
hilar lymphadenopathy
45
How do children present with 1' TB (2)
Enlarged mediastinal LN + cough
46
Natural Hx TB
1 - inhal TB 2 TB --> alveoli - taken up by macrophages + local consolidation occurs 3 --> Ghon focus (infective focus) --> nodes --> 1' complex 4 -Dissemination occurs --> foci at distant site (bronchi/pleura/pericardium) 5 - Further spread limited by CMI - IV HS 6 - Foci heal by fibrosis + calcify 7 - Viable bacteria remain walled off --> latent TB
47
In what ways can 1' TB come symptomatic (4)
Ghon focus can erode through visceral pleura --> TB pleurisy/pleural effusions Enlarge LN can --> bronchial obstruction + collapse LN can erode into bronchus + rupture --> TB bronchopneumonia Enlarging LN can erode into vessels --> military dissemination (lung) or systemic dissemination
48
What is post-primary TB?
M. TB reinfection in tuberculin-sensitive individuals
49
How can post-primary TB occur? (2)
From exogenous sources | Or reactivation from healed 1' complex (> common)
50
pathology post-primary TB
Lung: classical apical lesion = assmann focus w/ destruction lung parenchyma --> cavitation Lesion may heal w/ fibrosis or will progressively enlarge
51
Early Sx TB
``` B Sx Hence malaise Night sweats Anorexia W loss ```
52
Later Sx TB
Productive mucoid cough Repeated small haemoptysis PLeural pain Pneumonia/Pleural effusion
53
O/E TB
Fever Apical crepitations Clubbing in advanced disease
54
What % of the worlds population is infected by M TB
1/3
55
What are the greatest RF for being infected w/ TB
``` Social deprivation Non-white ethnicity Alcohol dependence HIV Increasing age Overcrowding Those on immunosuppressive therapies ```
56
Ix TB (6)
Sputum samples x3 incl 1 monring Microscopy PCR Lowenstein Jensen culture (gold standard) CXR Bronchoscopy + biopsy if culture negative
57
Mantoux test >5mm
= positive in immunosuppressed indiv or those w/ prior TB/recent contacts
58
Mantoux test >10mm
+ve in those w/ RF for YB
59
Mantoux test >15mm
Positive in any individual
60
What should every TB pt be screened for before starting Tx
HIV | Hep B/C
61
Examples of extrapulmonary features of RB
``` Lymphatic TB Potts Ileocecal TB Scrofulderma Meningism UG Pericardium Adrenal glands ```
62
What is Pott's disease
Spinal involvement of TB --> chronic back pain
63
If TB affects the pericardum, what is it associated with (4)
AF Elevated JVP Kussmaul's sign Pulsus paradoxus
64
What condition does TB mimic if it affects the adrenals
Addisons
65
Cutaneous TB e.g.s (2)
Erythema nodosum | Lupus vulgaris
66
Def pneumothorac
A tear in the lung --> air leaking out into pleural space
67
PS Pneumothorax
Asymp in young pt if small Or PS w/ sudden onset unilat pleuritic pain + progressive breathlessness
68
1' spontaneous pneumothorax - M:F
6:1
69
Cause of primary spontaneous pneumothorax
Rupture of apical bleb/bulla B/C congenital defects in CT alveolar walls Tall + thin pt
70
Main cause of 2' pneumothorax
COPD
71
Rarer causes of 2' pneumothorax (4)
Bronchial asthma Carcinoma Lung abscess Severe fibrosis (CF)
72
What % pt w/ 2' pneumothorax have recurrence
1/3
73
2 types of non-spontaneous pneumothorax
Traumatic pneumothorax | Iatrogenic pneumothorax
74
Mechanism of a tension pneumothorax
Intrapleural pressure = high Due to P differences air = sucked into pleural space during inspiration, but not expelled during exp Hence: lung deflates + vv return to heart decreases --> cardiac compromise
75
Who gets tension pneumothorax
Patients on +ve P ventilation
76
Features suggesting tension pneumothorax (7)
``` Tracheal deviation AWAY from the affected side Signs haemodynamic compromise +/- distended neck vv Reduced expansion Increased resonance on percussion Decr breath sounds Decr vocal resonance ```
77
Ix for pt w/ suspected pneumothorax
Expiratory CXR | ABG
78
Mx tension pneumothorax
100% O2 Needle decompression - insert large bore cannula into 2nd ICS, MCL CXR Insert chest drain + aspirate if >2cm
79
How does needle decompression work for Mx of pneumothorax
Large bore cannula into 2nd ICS MCL on side of suspected lesion Partially filled w saline Pull back on syringe to allow air to bubble out until a chest drain can be instered
80
Empyema
Accumulation of pus, due to infection
81
Chylothorax
Accumulation of lymph due to thoracic duct leakage
82
Haemothorax
Accumulation of blood due to trauma
83
Why does a transudate effusion occur?
Due to increased HSP or decreased oncotic P
84
Why does an exudate effusion occur>
Increased capillary permeability
85
Causes of transudate pleural effusion (4)
Cardiac failure Liver failure Renal failure Peritoneal dialysis
86
Causes of exudative effusion (8)
``` Bacterial pneumonia TB Neoplasms - lung 1/2' Mesothelioma PE RA/SLE Pancreatitis Subphrenic abscess ```
87
PS pleural effusion (3)
Asymp Dyspnoea Pleuritic pain
88
O/E Pleural effusion (5)
``` Decr chest expansion Stony dull to percussion Decr breath sounds Reduced vocal resonance Mediatinal deviation if massive ```
89
What is an empyema caused by?
Bacterial invasion of the pleural space, either by spreading an exudate effusion from adjacent pneumonia or by direct innoculation
90
PS empyema
Fever + signs pleural effusion
91
Aspirate empyema (5)
``` Yellow Turbid pH <7.2 Low glucose High LDH ```
92
Mx empyema (2)
IV Abx | CHest drain
93
Def Pleurisy
Inflammation of the pleura (usually due to an infection)
94
Ix pleural effusion (5)
``` CXR USS Aspiration Pleural tap Pleural biopsy ```
95
At what volume effusion can a chest xray begin to ID
300ml
96
Why is USS recommended in effusion
To guide aspiratoin
97
What 4 things happens to the aspirate from an effusion
--> microbiology for MCS Clinical chemistry - protein/LDH/glucose Cytology BG machine for pH
98
Featues of an exudate aspirate (2)
Protein >30g/L | LDH >200
99
Features of a transudate aspirate (2)
LDH <200 | Protein <30
100
When aspirate is borderline, how to ddx from transudate and exudate
1 positive element of lights criteria - exudate
101
When is a pleural biopsy useful in effusions
Abrams needle | When DDxc malignant effusions + TB
102
Mx effusion if fl is purulent/turbid or pH <7.2
Chest drain + consider ABx | Mx underlying cause

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