Respiratory 5

oelomar's version from 2016-05-16 23:07


Question Answer
What is the most common malignant tumour worldwide?Bronchial carcinoma.
Small-cell carcinoma (SCLC) and non-small cell carcinoma (NSCLC) are both types of lung cancer. What is the difference between them?Compared to NSCLC, SCLC has a shorter doubling time, higher growth fraction, and earlier development of metastases. NSCLC is any type of epithelial lung cancer other than SCLC, and accounts for about 85% of all lung cancers. As a class, NSCLCs are relatively insensitive to chemotherapy, compared to small cell carcinoma. When possible, they are primarily treated by surgical resection with curative intent, although chemotherapy is increasingly being used.
What are the different types of non-small cell carcinoma?Squamous cell carcinoma, large cell carcinoma, and adenocarcinoma.
What are the clinical features of lung cancer?Cough, weight loss, haemoptysis, dyspnoea, “coin lesion” on CXR.
A Pancoast tumour is a complication of lung cancer. What is a Pancoast tumour?This is a tumour that occurs in the apex of the lung, which may compress various structures, leading to Horner’s syndrome.
What is Horner’s syndrome?A combination of symptoms that arises when the sympathetic trunk is damaged (which may be due to a Pancoast tumour). The signs and symptoms occur on the same side as the lesion of the sympathetic trunk. It is characterised by myosis, ptosis, apparent anhidrosis (decreased sweating), with or without enophthalmos.
Name some of the structures that may be compressed by a Pancoast tumour.Brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, vagus nerve, a sympathetic ganglion.


Question Answer
Where are the common sites to which bronchial carcinomas can metastasise to?Hilar lymph nodes (most common), brain (epilepsy), adrenals, bone (pathologic fracture), and liver (jaundice, hepatomegaly).
One of the non-metastatic extra-pulmonary manifestations of bronchial carcinoma is Lambert-Eaton syndrome. What is Lambert-Eaton syndrome?This is a rare autoimmune disorder characterised by muscle weakness of the limbs, which is the result of an autoimmune reaction in which antibodies are formed against presynaptic voltage-gated calcium channels.
Squamous cell carcinomas and small cell carcinomas are located centrally whereas adenocarcinomas are located peripherally. True or false?True.
How is non-small cell carcinoma treated?Excision with lobectomy is the treatment of choice. Radiotherapy and post-operative chemotherapy are also indicated.
How is small cell carcinoma treated?Chemotherapy for limited disease, palliative care for extensive disease.
Cisplatin is a chemotherapy drug that can be used to treat various cancers including lung carcinomas. What are the effects of its toxicity?Nephrotoxicity and acoustic nerve damage.


Question Answer
What is a mesothelioma?A cancer affecting the thin layer of tissue that covers many organs known as the mesothelium, most commonly affecting the pleurae.
What is the link between asbestos and mesotheliomas?Asbestos exposure is especially associated with the development of mesotheliomas (note that a time lag of 20 years or more between asbestos exposure and the mesothelioma is usual).
What are the sign and symptoms of mesotheliomas?Most commonly presents as a pleural effusion, typically with persistent chest pain.
How are mesotheliomas treated?Small survival advantages have been reported following the use of chemotherapy (pemetrexed + cisplatin). Highly selected patients may be considered for radical surgery; but in general, a palliative approach is all that is possible.
What is the prognosis of mesotheliomas?The prognosis is poor (usually in the order of 12-18 months).


Question Answer
What is a typical patient presenting with obstructive sleep apnoea?An obese, middle-aged man who snores loudly or has daytime sleepiness.
Name some of the complications of sleep apnoea.Cardiovascular disease, aortic disease, hypertension, stroke, diabetes, weight gain.
What is polysomnography?Polysomnography, also called a sleep study, is a test which records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements. It is used to diagnose sleep disorders.
In order for sleep apnoea to be diagnosed, how many episodes must occur in an hour?Over 5.
What is central sleep apnoea?Sleep apnoea in which the effort to breathe is diminished or absent, usually due to an instability in the body’s feedback mechanisms that control respiration, as opposed to obstructive sleep apnoea which is caused by complete or partial obstructions of the upper airway.
How is sleep apnoea managed?CPAP via a nasal mask during sleep is effective and recommended by NICE. Surgery can be undertaken in order to relieve pharyngeal obstruction. Otherwise, Weight loss is advised, as well as avoidance of alcohol and tobacco.


Question Answer
Aspergillus fumigatus – a fungus of the genus Aspergillus, is a cause of extrinsic asthma in atopic individuals. True or false?True.
What is allergic bronchopulmonary aspergillosis (ABPA) and what are its features?A condition characterised by an exaggerated response of the immune system (a hypersensitivity response) to the fungus Aspergillus (most commonly Aspergillus fumigatus). It occurs most often in patients with asthma or cystic fibrosis. ABPA causes airway inflammation, leading to bronchiectasis. Left untreated, the immune system and fungal spores can damage sensitive lung tissues and lead to scarring.
What is an aspergilloma and what are its signs and symptoms?Also known as a fungus ball, this is a clump of mould which exists in a body cavity such as a paranasal sinus or an organ such as the lung. By definition, it is caused by fungi of the genus Aspergillus. It ranges from being asymptomatic to massive haemoptysis.
What is the “air crescent” sign seen on CXR?An air crescent sign describes the crescent of air that can be seen in invasive aspergillosis, semi-invasive aspergillosis, or other processes that cause pulmonary necrosis. It is normally a sign of recovery and is the result of increased granulocyte activity.
How is aspergillosis treated?Amphotericin B (antifungal) can be used. Surgical resection can be used for aspergilloma, and steroids can be used for ABPA.


Question Answer
Name the SIRS (systemic inflammatory response syndrome) criteria.Temperature >38 degrees or <36 degrees. Respiratory rate >20/min. Heart rate >90bpm. Acutely altered mental state. Blood glucose >7.7mmol/L in absence of diabetes. WCC >12 or <4x109/L.
How is sepsis diagnosed?Two or more SIRS criteria AND presumed infection.
What is “sepsis six”?The name given to a bundle of medical therapies designed to reduce the mortality of patients with sepsis, which are the following (3 in, 3 out): Oxygen, IV antibiotics, fluid resuscitate (if hypotensive, give up to 3 boluses of 500ml Hartmann’s/0.9% saline to maintain MAP>65/systolic 100mmHg). Blood cultures (take at least two sets plus samples from sputum, urine, wound swab etc. as appropriate), plasma lactate (plus all relevant blood tests e.g. FBC, U&E, LFT, clotting, glucose, ABG), fluid balance (consider catheterisation).
What is pulmonary Langerhans cell histiocytosis and what are its clinical features?Langerhans cell histiocytosis (LCH) is a rare disease involving clonal proliferation of Langerhans cells. Pulmonary LCH occurs exclusively in smokers, and chest X-rays (and HRCT) show multiple small cysts (honeycomb lung), fibrosis or widespread nodular shadows.
How is pulmonary Langerhans cell histiocytosis treated?Treatment is with stopping smoking, corticosteroids and immunosuppressive therapy. For advanced progressive disease, lung transplantation is the only option.
What does a chest x-ray show in Goodpasture’s syndrome?Transient blotchy shadows that are due to intrapulmonary haemorrhage.
What is granulomatosis with polyangiitis, and what test can aid in the diagnosis?This is a systemic disorder that involves both granulomatosis and polyangiitis (inflammation of multiple blood vessels or lymph vessels). There is autoimmune attack by an abnormal type of circulating antibody termed ANCAs against small and medium-sized blood vessels, and testing for this antibody therefore aids in the diagnosis.

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