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Block 1 Year 3 > Week 6 - Haemoptysis > Flashcards

Week 6 - Haemoptysis Flashcards

(95 cards)

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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
Which type of lung cancer is most responsive to chemo ?
Small cell
26
What do the NICE guidelines recommend the indications are for a suspected lung cancer referral ?
- chest x-ray findings that suggest lung cancer, or - aged 40 and over with unexplained haemoptysis
27
What is the first line investigation following a lung cancer referral?
CT scan
28
What are 4 examples of paraneoplastic manifestations of *(typically small cell)* lung cancer ?
- lambert-Eaton syndrome - SIADH - Hypertrophic osteoarthropathy - Cushing syndrome
29
What is the MOA of lambert-Eaton syndrome ?
Autoantibodies that block acetylecholine being released
30
What is a symptom of lambert-Eaton syndrome ?
Muscle weakness
31
What is the MOA of SIADH ?
Release of ADH causing low sodium
32
What are the symptoms of SIADH ?
- nausea - vomiting - confusion - seizures (in severe cases)
33
What is the MOA of hypertrophic osteoarthropathy ?
New bone forming in periosteum in the forearms and lower legs
34
What are the symptoms of hypertrophic osteoarthropathy ?
- pain - marked clubbing
35
What is the MOA of Cushings syndrome ?
Ectopic secretion of ACTH *(adrenocorticotropic hormone)* by small cell tumour
36
What are the symptoms of Cushings syndrome ?
- hypertension - weight gain
37
What are the different ‘T’ stages of cancer staging and what does each mean ?
- *T0* = no primary tumour - **Tis** = carcinoma in situ *(adeno or squamous)* - **T1** = tumour 1 cm but 2cm but 3cm but 3cm but 4cm but 5cm but 7cm or, invading mediastinum/diaphragm/heart/great vessels/recurrent laryngeal nerve/carina/trachea/oesophagus/spine, or tumour nodules in different ipsilateral lobe
38
What are the different ‘N’ stages of cancer staging and what does each mean ?
- **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
39
What are the different ‘M’ stages of cancer staging and what does each mean ?
- **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
What does the stage TNM stage T0 mean ?
No primary tumour
41
What does the TNM stage Tis mean ?
Carcinoma in situ *adenocarcinoma or squamous cell cancer*
42
What does the TNM stage T1 mean ?
Tumour is 3cm or smaller
43
What does the TNM a stage T1mi mean ?
Minimally invasive adenocarcinoma
44
What does the TNM a stage T1a mean ?
Superficial spreading tumour in central airways Tumour is 1cm or less
45
What does the TNM a stage T1b mean ?
Tumour is >1cm but ≤ 2cm
46
What does the TNM a stage T1c mean ?
Tumour is >2cm but ≤ 3cm
47
What does the TNM stage T2 mean ?
Tumor >3 cm but ≤5 cm or tumor with any of the following features: - Visceral pleura - Main bronchus (not carina) - Atelectasis to hilum
48
What does the TNM stage T2a mean ?
Tumor >3 cm but ≤4 cm
49
What does the TNM stage T2b mean ?
Tumor >4 cm but ≤5 cm
50
What does the TNM stage T3 mean ?
Tumor >5 cm but ≤7 cm or: - Invading chest wall, pericardium, phrenic nerve - Separate tumor nodule(s) in the same lobe
51
What does the TNM stage T4 mean ?
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
What does the TNM stage N0 mean?
No regional lymph node metastasis
53
What does the TNM stage N1 mean?
Metastasis in ipsilateral pulmonary or hilar nodes
54
What does the TNM stage N2 mean?
Metastasis in the ipsilateral mediastinal or subcarinal nodes
55
What does the TNM stage N3 mean?
Metastasis in contralateral mediastinal, hilar or supraclavicular nodes
56
What does the TNM stage M0 mean?
No distant metastasis
57
What does the TNM stage M1a mean?
Malignant pleural or pericardial effusion or nodules, or separate tumour nodules in a contralateral lobe
58
What does the TNM stage M1b mean?
Single extra thoracic metastasis
59
What does the TNM stage M1c mean?
Multiple extrathoracic metastases in one or more organs
60
What does the ECOG performance status scale measure ?
The patients ability to look after themselves, daily activity and physical ability
61
How many levels are there on the ECOG performance status scale ?
0-5
62
What does the ECOG grade 0 mean?
Patient is fully active and capable of pre-disease activities without restriction
63
What does the ECOG grade 1 mean?
Patient is - able to walk around (ambulatory) - able to carry out work of a light or sedentary nature - restricted in physically strenuous activity
64
What does the ECOG grade 2 mean?
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
What does the ECOG grade 3 mean?
Patient is - confined to bed or chair >50% waking hours - capable of only limited self care
66
What does the ECOG grade 4 mean?
Patient is - totally confined to bed or chair - completely disabled - cannot carry out any self care
67
What does the ECOG grade 5 mean?
Patient is dead
68
How long before a PET scan must he patient stop eating ?
6 hours before the scan
69
How long before a PET scan must he patient stop doing strenuous exercise ?
24 hrs before the scan
70
What is the injected radiotracer called that’s used in a PET scan ?
Fluorodeoxyglucose (FDG) *it’s similar to naturally occurring glucose so the body treats it in a similar manner*
71
How do PET scans work ?
- 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
What ‘normal’ structures will also show up brighter on a PET scan, other than a cancer ?
- kidneys - vocal cords - brown fat
73
Which other type of scan is often paired with a PET scan ?
CT scan
74
How is a lung biopsy performed ?
- guided by CT scan - local anaesthetic to the area - insert needle between ribs - take biopsy
75
When is a CT lung biopsy performed instead of a biopsy guided by specialist imaging e.g EBUS ?
When the cancer is **too peripheral** to be accessed via bronchoscopy or endobronchial ultrasound (EBUS)
76
What’s re the 2 most common complications of a CT guided biopsy ?
- pneumothorax - haemoptysis
77
What are the long term harms of nicotine ?
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
How many chemicals are released when cigarettes burn ?
Around 5000
79
What proportion of smokers will die early due to a smoking related illness ?
1 in 2
80
What is a good oral drug to help smokers stop ?
Varenicline
81
What is the MOA of varenicline ?
Nicotine receptor agonist and antagonist Releases domain via agonist action Prevents dopamine release from cigarettes
82
What is a good immunotherapy option to treat small cell lung cancers with a high PDL-1 levels ?
Pembrolizumab
83
When does immunotherapy related pneumonitis classically present ?
Within the first 3 months after starting immunotherapy
84
How does immunotherapy related pneumonitis classically present ?
- Cough - SOB On investigation: - mildly raised inflammatory markers - reticular shadowing on CXR - innumerable, centrilobular micronodules throughout both lugs on CT
85
How is immunotherapy related pneumonitis treated ?
- steroids - IV methylprednisolone *(in severe cases)* - oral prednisolone *(in milder cases)*
86
What respiratory examination findings are consistent with pleural effusion ?
- reduced chest expansion - reduced breath sounds - reduced vocal resonance - dull percussion - finger clubbing
87
What are the clinical signs of pneumothorax?
- absent breath sounds - hyper resonant percussion - no/reduced vocal resonance
88
What respiratory examination findings are consistent with pneumonia ?
- dull percussion - bronchial breathing - increased vocal resonance
89
Is transudative effusion A) high in protein? B) low in protein?
Transudative = **LOW** in protein *(less than 30)* *plus low/normal LDH*
90
Is exudative effusion A) high in protein? B) low in protein?
Exudative = **HIGH** in protein *(more than 30)* *plus raised LDH*
91
What causes transudative effusion ?
High hydros**T**atic pressure pushing fluid out of vessels into pleural space
92
What causes exudative effusion ?
Inf**E**ction causing leaky vessels, letting fluid and cellular substances into pleural space
93
Is transudative effusion usually A) bilateral ? B) unilateral ?
**Trans**udative = **Bi**lateral *way to remember: transition between 2 different things*
94
Is exudative effusion usually A) bilateral ? B) unilateral ?
Ex**udative = **Uni**lateral *way to remember: your ex is 1 person*
95
What are pleural effusions broadly categorised into, and what is this based on ?
Transudative and exudates Based on pleural fluid protein and LDH content

Block 1 Year 3 (7 decks)

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