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2015 - Current Deck > (transferred) RSP > Flashcards

Flashcards in (transferred) RSP Deck (69):
1

Pneumonia classified by region (include pathogen)

1) Lobar pneumonia
- S pneu, Kleb

2) Multi-lobar pneumonia

3) Bronchopneumonia
- S pneu, S aureus, HI, Kleb

4) Interstitial (i.e. atypical) pneumonia
- Virus (influ, RSV, adenov)
- Mycoplasma pneumoniae
- Legionella pneumophilia
- Chlamydophilia pneumoniae

 

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Clinical classification of pneumonia (include pathogen)

1) CAP (community, or within 72 hours of hospitalisation)
    - Typical CAP
    - Atypical CAP

2) HAP
   - MRSA
   - Kleb pneu
   - E Coli
   - Pseud aeru

   - S pneu
   - (HI, bacteroides)

3) VAP

4) aspiration
   - anaerobes (bacteroides)
   - Kleb pneu
   - Pseud aeru

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Anti-pseudomonal antibiotics

 - Extended spectrum penicillins (e.g. Piperacillin-tazobactam)
 - 3G cephalosporins (e.g. Ceftazidime)
 - Carbapenems (e.g. Meropenem)
 - Aminoglycosides (e.g. Amikacin)
 - Fluoroquinolones (e.g. Levofloxacin)

4

Sleep architecture

1) Enter Sleep at NREM

2) NREM & REM stages then alternate, one cycle lasting around 90 minutes

3) REM (~25% of total sleep) increase in later hours of sleep

4) NREM, from stage 1 to 4, with stage 3, 4 being deep sleep/slow wave sleep

5

REM vs NREM

REM
- 25% of total sleep time
- inhibits brainstem and motor neurons 
- dreaming
- body paralysed
- Erratic shallow breathing

NREM
- 75% of total sleep time
- actively regulated
- decreased mental activities
- body moveable
- decreased tidal volume with similar rate

6

Daytime sleepiness DDx

1) Lack of sleep
   - sleep deprivation
   - shift work

2) Sleep disruption
    - Sleep apnoea
    - Periodic limb movement disorder

3) Sleepiness despite normal sleep
    - Nacrolepsy
    - Idiopathic hypersomnolence
    - Neurological lesion
    - Drugs

4) Psychogenic
    - Depression

5) In fact fatigue
    - Fibromyalgia (Chronic fatigue syndrome)
    - Malignancy
    - Many medical conditions

7

Staging of Lung cancer

NSCLC
- TNM system
- T: tumour size & local invasion
- N: Lymph nodes (hilar, mediastinal, extra-thoracic; ipsilateral or contralateral)
- M: Distant metastasis

 

8

Investigations in suspected Lung cancer

4) Visualisation & Biopsy for Histology
- Fibreoptic bronchoscopy with endobronchial biopsy (for central lesions)
- VATS (video assisted thoracoscopy)
- Fluoroscopic or CT-guided Transthoracic needle biopsy (for peripheral lesions)
- percutaneous pleural biopsy; pleuroscopy (for peripheral lesions)
- upper abdomen mediatinoscopy

5) Lymph nodes cytology & histology
- Fine needle aspirate & excisional biopsy (better) for cervical LN
- Endobronchial ultrasound with Transbronchial Needle Aspiration (EBUS-TBNA) for mediatinal LN, with convex probe (i.e. CP-EBUS-TBNA)

 

9

Management of NSCLC

1) Tumour stage work-up, pre-operative cardio-pulmonary work-up, test for molecular target (EGFR mutation, ALK translocation)

a) Stage I or II (when there is no extension to trachea or outside the chest): resection if medically fit for surgery, with concurrent chemotherapy & Radiation therapy as adjunct

b) Stage III (locally advanced): Concurrent chemo & RT

c) Stage IV (Advanced metstatic): Chemotherapy

d)  Add on targeted therapy with TKI (gefitinib, erlotinib) if EGFR positive; ALK inhibitor (crizotinib) if ALK translocation

2) Supportive & Palliative Care
- analgesics, cough suppressants
- thoracocentesis & chest drain
- psychosocial support

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Chemotherapy regimen in NSCLC:
1 platinum drug (cisplatin, carboplatin)
PLUS
1 new gen cytotoxic drug (e.g. taxol, vinorelbine)

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