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Block 1 Year 3 > Week 6 - Haemoptysis > Flashcards

Week 6 - Haemoptysis Flashcards

1
Q

What routes can cancer metastasise through?

A
  • lymphatics
  • blood
  • transcoelomic (seen in peritoneal and tumours)
  • along epithelial-lined surfaces
  • within epithelium (e.g Paget’s disease of nipple)
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2
Q

What other symptoms can be mistaken for haemoptysis?

A
  • oral bleeding when brushing teeth
  • haematemesis - vomiting blood
  • epistaxis - further back in the nose can affect phlegm/snot
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3
Q

What are some vascular causes of haemoptysis?

A
  • PE leading to pulmonary infarction
  • rupture of telangiectatic vessels
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4
Q

What are some infectious causes of haemoptysis?

A
  • TB
  • necrotising pneumonia
  • lung abscess
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5
Q

What are some autoimmune causes of haemoptysis ?

A

inflammation to pulmonary vessels leading to rupture and bleeding (via conditions like SLE and Wegeners granulomatosis)

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6
Q

What are some iatrogenic causes of haemoptysis ?

A
  • drugs (e.g crack cocaine)
  • prescription drugs (e.g anti platelets/coags)
  • endobronchial procedures
  • lung biopsy
  • pulmonary artery catheterisation
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7
Q

What are some neoplastic causes of haemoptysis?

A

lung cancer / metastases

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8
Q

What are some congenital causes of haemoptysis?

A

Cystic fibrosis

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9
Q

What are some degenerative causes of haemoptysis?

A
  • COPD
  • Bronchiectasis
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10
Q

What are the 2 main (broad) categories of lung cancer?

A
  • small cell (15-20%)
  • non-small cell (80-85%)
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11
Q

What are the main subtypes of non-small cell lung cancer?

A
  • adenocarcinoma
  • squamous cell
  • large cell
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12
Q

What type of lung cancer can resemble pneumonia on imaging?

A

Adenocarcinoma

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13
Q

Which type of cell do adenocarcinomas originate in?

A

Glandular cells in the small airways/peripheries

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14
Q

Are adenocarcinomas fast or slow to become invasive?

A

Often slow (years)

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15
Q

What is the most common subtype of lung cancer to develop in non-smokers ?

A

Adenocarcinomas

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16
Q

Which cell type does squamous cell cancer develop in?

A

The squamous cells lining the central airways

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17
Q

Are squamous cell carcinomas smoking related cancers ?

A

Yes

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18
Q

Which type of non-small cell cancer is often seen in the periferal lung fields ?

A

Adenocarcinoma

And large cell - seen anywhere within lung

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19
Q

Which type of non-small cell cancer is often seen in the central lung fields ?

A

Squamous cell

And large cell - seen anywhere within lung

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20
Q

Which type of non-small cell cancer can be seen anywhere in the lungs ?

A

Large cell

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21
Q

Which is the fastest growing/spreading type of non-small cell lung cancer ?

A

Large cell

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22
Q

Which type of non-small cell cancer often form a cavity ?

A

Squamous cell

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23
Q

Which type of lung cancer is the fastest to grow and spread ?

A

Small cell

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24
Q

What stage do small cell cancers often present at ?

A

Stage 4

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25
Q

Which type of lung cancer is most responsive to chemo ?

A

Small cell

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26
Q

What do the NICE guidelines recommend the indications are for a suspected lung cancer referral ?

A
  • chest x-ray findings that suggest lung cancer, or
  • aged 40 and over with unexplained haemoptysis
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27
Q

What is the first line investigation following a lung cancer referral?

A

CT scan

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28
Q

What are 4 examples of paraneoplastic manifestations of (typically small cell) lung cancer ?

A
  • lambert-Eaton syndrome
  • SIADH
  • Hypertrophic osteoarthropathy
  • Cushing syndrome
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29
Q

What is the MOA of lambert-Eaton syndrome ?

A

Autoantibodies that block acetylecholine being released

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30
Q

What is a symptom of lambert-Eaton syndrome ?

A

Muscle weakness

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31
Q

What is the MOA of SIADH ?

A

Release of ADH causing low sodium

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32
Q

What are the symptoms of SIADH ?

A
  • nausea
  • vomiting
  • confusion
  • seizures (in severe cases)
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33
Q

What is the MOA of hypertrophic osteoarthropathy ?

A

New bone forming in periosteum in the forearms and lower legs

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34
Q

What are the symptoms of hypertrophic osteoarthropathy ?

A
  • pain
  • marked clubbing
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35
Q

What is the MOA of Cushings syndrome ?

A

Ectopic secretion of ACTH (adrenocorticotropic hormone) by small cell tumour

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36
Q

What are the symptoms of Cushings syndrome ?

A
  • hypertension
  • weight gain
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37
Q

What are the different ‘T’ stages of cancer staging and what does each mean ?

A
  • T0 = no primary tumour
  • Tis = carcinoma in situ (adeno or squamous)
  • T1 = tumour </= 3cm
  • T1mi = minimally invasive adenocarcinoma
  • T1a = superficial spreading tumour in central airways, tumour </= 1cm
  • T1b = tumour >1 cm but </= 2cm
  • T1c = tumour >2cm but </= 3cm
  • T2 = tumour >3cm but </= 5cm, or tumour with visceral pleura, main bronchus (not carina) or atelectasis to hilum
  • T2a = tumour >3cm but </= 4cm
  • T2b = tumour >4cm but </= 5cm
  • T3 tumour >5cm but </= 7cm, or invading chest wall/pericardium/phrenic nerve, or separate nodules in the same lobe
  • T4 = tumour >7cm or, invading mediastinum/diaphragm/heart/great vessels/recurrent laryngeal nerve/carina/trachea/oesophagus/spine, or tumour nodules in different ipsilateral lobe
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38
Q

What are the different ‘N’ stages of cancer staging and what does each mean ?

A
  • N0 = no regional lymph node metastases
  • N1 = metastases in ipsilateral pulmonary or hilar nodes
  • N2 = metastases in ipsilateral mediastinal or subcarinal nodes
  • N3 = metastases in contra lateral mediastinal, hilar or supraclavicular nodes
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39
Q

What are the different ‘M’ stages of cancer staging and what does each mean ?

A
  • M0 = no distant metastases
  • M1 = Malignant pleural or pericardial effusion or pleural or pericardial nodules or separate tumor nodule(s) in a contralateral lobe
  • M1a = single extrathoracic metastases
  • M1b = multiple extrathoracic metastases in one or more organs
40
Q

What does the stage TNM stage T0 mean ?

A

No primary tumour

41
Q

What does the TNM stage Tis mean ?

A

Carcinoma in situ

adenocarcinoma or squamous cell cancer

42
Q

What does the TNM stage T1 mean ?

A

Tumour is 3cm or smaller

43
Q

What does the TNM a stage T1mi mean ?

A

Minimally invasive adenocarcinoma

44
Q

What does the TNM a stage T1a mean ?

A

Superficial spreading tumour in central airways

Tumour is 1cm or less

45
Q

What does the TNM a stage T1b mean ?

A

Tumour is >1cm but ≤ 2cm

46
Q

What does the TNM a stage T1c mean ?

A

Tumour is >2cm but ≤ 3cm

47
Q

What does the TNM stage T2 mean ?

A

Tumor >3 cm but ≤5 cm or tumor with any of the following features:
- Visceral pleura
- Main bronchus (not carina)
- Atelectasis to hilum

48
Q

What does the TNM stage T2a mean ?

A

Tumor >3 cm but ≤4 cm

49
Q

What does the TNM stage T2b mean ?

A

Tumor >4 cm but ≤5 cm

50
Q

What does the TNM stage T3 mean ?

A

Tumor >5 cm but ≤7 cm or:
- Invading chest wall, pericardium, phrenic nerve
- Separate tumor nodule(s) in the same lobe

51
Q

What does the TNM stage T4 mean ?

A

Tumor >7 cm or:
- Invading mediastinum, diaphragm, heart, great vessels, recurrent laryngeal nerve, carina, trachea, esophagus, spine
- Tumor nodule(s) in a different ipsilateral lobe

52
Q

What does the TNM stage N0 mean?

A

No regional lymph node metastasis

53
Q

What does the TNM stage N1 mean?

A

Metastasis in ipsilateral pulmonary or hilar nodes

54
Q

What does the TNM stage N2 mean?

A

Metastasis in the ipsilateral mediastinal or subcarinal nodes

55
Q

What does the TNM stage N3 mean?

A

Metastasis in contralateral mediastinal, hilar or supraclavicular nodes

56
Q

What does the TNM stage M0 mean?

A

No distant metastasis

57
Q

What does the TNM stage M1a mean?

A

Malignant pleural or pericardial effusion or nodules, or separate tumour nodules in a contralateral lobe

58
Q

What does the TNM stage M1b mean?

A

Single extra thoracic metastasis

59
Q

What does the TNM stage M1c mean?

A

Multiple extrathoracic metastases in one or more organs

60
Q

What does the ECOG performance status scale measure ?

A

The patients ability to look after themselves, daily activity and physical ability

61
Q

How many levels are there on the ECOG performance status scale ?

A

0-5

62
Q

What does the ECOG grade 0 mean?

A

Patient is fully active and capable of pre-disease activities without restriction

63
Q

What does the ECOG grade 1 mean?

A

Patient is
- able to walk around (ambulatory)
- able to carry out work of a light or sedentary nature
- restricted in physically strenuous activity

64
Q

What does the ECOG grade 2 mean?

A

Patient is
- able to walk around (ambulatory)
- capable of all self care
- unable to carry out any work activities
- up and about >50% waking hours

65
Q

What does the ECOG grade 3 mean?

A

Patient is
- confined to bed or chair >50% waking hours
- capable of only limited self care

66
Q

What does the ECOG grade 4 mean?

A

Patient is
- totally confined to bed or chair
- completely disabled
- cannot carry out any self care

67
Q

What does the ECOG grade 5 mean?

A

Patient is dead

68
Q

How long before a PET scan must he patient stop eating ?

A

6 hours before the scan

69
Q

How long before a PET scan must he patient stop doing strenuous exercise ?

A

24 hrs before the scan

70
Q

What is the injected radiotracer called that’s used in a PET scan ?

A

Fluorodeoxyglucose (FDG)

it’s similar to naturally occurring glucose so the body treats it in a similar manner

71
Q

How do PET scans work ?

A
  • inject FDG radiotracer
  • body takes FDG up in a similar way to natural glucose
  • scan analyses where the FDG does/doesn’t build up in the body

cancers use glucose at a faster rate to normal cells, so will light up on the scan

72
Q

What ‘normal’ structures will also show up brighter on a PET scan, other than a cancer ?

A
  • kidneys
  • vocal cords
  • brown fat
73
Q

Which other type of scan is often paired with a PET scan ?

A

CT scan

74
Q

How is a lung biopsy performed ?

A
  • guided by CT scan
  • local anaesthetic to the area
  • insert needle between ribs
  • take biopsy
75
Q

When is a CT lung biopsy performed instead of a biopsy guided by specialist imaging e.g EBUS ?

A

When the cancer is too peripheral to be accessed via bronchoscopy or endobronchial ultrasound (EBUS)

76
Q

What’s re the 2 most common complications of a CT guided biopsy ?

A
  • pneumothorax
  • haemoptysis
77
Q

What are the long term harms of nicotine ?

A

Addiction

Other than that, nicotine is relatively harmless. The harm comes when it is paired with other chemicals in a cigarette as they are what cause the cancer, strokes, CVD etc

78
Q

How many chemicals are released when cigarettes burn ?

A

Around 5000

79
Q

What proportion of smokers will die early due to a smoking related illness ?

A

1 in 2

80
Q

What is a good oral drug to help smokers stop ?

A

Varenicline

81
Q

What is the MOA of varenicline ?

A

Nicotine receptor agonist and antagonist

Releases domain via agonist action
Prevents dopamine release from cigarettes

82
Q

What is a good immunotherapy option to treat small cell lung cancers with a high PDL-1 levels ?

A

Pembrolizumab

83
Q

When does immunotherapy related pneumonitis classically present ?

A

Within the first 3 months after starting immunotherapy

84
Q

How does immunotherapy related pneumonitis classically present ?

A
  • Cough
  • SOB

On investigation:
- mildly raised inflammatory markers
- reticular shadowing on CXR
- innumerable, centrilobular micronodules throughout both lugs on CT

85
Q

How is immunotherapy related pneumonitis treated ?

A
  • steroids
  • IV methylprednisolone (in severe cases)
  • oral prednisolone (in milder cases)
86
Q

What respiratory examination findings are consistent with pleural effusion ?

A
  • reduced chest expansion
  • reduced breath sounds
  • reduced vocal resonance
  • dull percussion
  • finger clubbing
87
Q

What are the clinical signs of pneumothorax?

A
  • absent breath sounds
  • hyper resonant percussion
  • no/reduced vocal resonance
88
Q

What respiratory examination findings are consistent with pneumonia ?

A
  • dull percussion
  • bronchial breathing
  • increased vocal resonance
89
Q

Is transudative effusion
A) high in protein?
B) low in protein?

A

Transudative = LOW in protein (less than 30)

plus low/normal LDH

90
Q

Is exudative effusion
A) high in protein?
B) low in protein?

A

Exudative = HIGH in protein (more than 30)

plus raised LDH

91
Q

What causes transudative effusion ?

A

High hydrosTatic pressure pushing fluid out of vessels into pleural space

92
Q

What causes exudative effusion ?

A

InfEction causing leaky vessels, letting fluid and cellular substances into pleural space

93
Q

Is transudative effusion usually
A) bilateral ?
B) unilateral ?

A

Transudative = Bilateral

way to remember: transition between 2 different things

94
Q

Is exudative effusion usually
A) bilateral ?
B) unilateral ?

A

Ex**udative = Unilateral

way to remember: your ex is 1 person

95
Q

What are pleural effusions broadly categorised into, and what is this based on ?

A

Transudative and exudates

Based on pleural fluid protein and LDH content

Block 1 Year 3 (7 decks)

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