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35 Cards in this Set
- Front
- Back
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Lung cancer risk factors x6 |
-Smoking (all except adeno) -Occupational (coal, asbestos) -Lung disease (COPD, fibrosis, TB=>adeno) -Genetic (FHx, a1AT) -Radiation (medical) -Radon (environmental) |
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Lung cancer paraneoplastic syndromes x6 |
-Small cell: =ACTH, ADH, LEM, cerebellar -Squamous: =PTHRH, HPOA |
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Lung cancer features x6 |
-Lung: cough, haemoptysis, dyspnoea, PE, infection, effusion, collapse -Local: rib, SVCO, pericardium, nerves (3) =Nerves: Horner, RLN, C8/T1 -Metastatic: bone, liver, brain, adrenals -Paraneoplastic: ACTH, ADH, LEM/neuro, Ca -Cytokine: cachexia, anorexia, immune -Derm: poly/dermatomyo, ACTH, acanth nigric |
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Pancoast tumour x5 features |
-Claw hand (C8/T1) -Interossei wasted (T1) -Horner's (sympathetic chain) -Hoarse voice (RLN) -Thoracic outlet syndrome |
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Clubbing x4 |
-Bronchiectasis -Cancer -Empyema/abscess -Fibrosing alveolitis |
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Asthma treatment x5 |
-SABA -Add steroid -Add LABA, then inc steroid, +/-combination -Add monteleukast or theophylline -Inc steroid +/- PO steroid & refer to specialist |
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COPD treatment x7 |
-MDT, stop smoking, vaccinations, pulm rehab -SABA or SAMA -LABA or LAMA -Combination +/- LAMA -Theophylline -Mucolytics, home nebs/O2, diuretics for RVF -Surgery: bullectomy |
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Bronchiectasis 4x3 |
-Congenital: CF, Kartagener's, yellow nail -Infection: TB, pertussis, measles -Obstruction: foreign body, cancer, LN -4 letter words: COPD, ABPA, CVID |
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Cystic fibrosis features |
-Genetics: auto rec, CFTR, F508, chrom 7, 1/25 -Mech: dec Na+ efflux=>osmotic pull into cells -Systems: =Lungs: bronchiectasis, ABPA, cor pulmonale =GI: chronic pancreatitis, DM, cirrhosis, GS =Repro: male & female subfertility =Other: osteoporosis, sinus/polyps |
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Cystic fibrosis management |
-Tests: Guthrie; sweat; genetic; malabs screen -C: MDT, chest physio, vaccinations, counselling -M: abx, mucolytics, creon, vitamins -S: lung transplant |
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TB risk factors x7 |
-Elderly -HIV -Co-morbidities (DM, cancer, CKD) -Drugs (anti-TNF) -Country of origin -Homelessness -Prison |
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Pulmonary fibrosis x 6+4 |
-Apical = TRASHE =TB, Radiation, Ank spond/ABPA, Sarcoid, Histiocytosis/plasmosis, EAA/pneumoconiosis -Basal = CIDA = Conn tissue, Idiopathic (UIP), Drugs, Asbestosis |
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Fibrosing drugs x6 |
-Amiodarone -Bleomycin / busulphan -Cyclophosphamide -Nitrofurantoin -Methotrexate -Gold |
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Idiopathic interstitial pneumonia x4 +1 |
-IPF: UIP pattern; NOT for steroids; poor prognosis; honeycombing on CT -Non-specific IP: more ground glass, some reversibility, seen in idiopathic & known cause -Acute IP: Hamman-Rich, rapid & fatal -Cryptogenic organising pneumonia: assoc with RA/conn tissue & drugs; treat with steroids -Drugs: pirfenidone (??), nintedanib (TYRK) delay reduction of FVC, don't reverse honeycombing |
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Extrinsic allergic alveolitis x4 |
-Features: symptoms within 6hrs, fever, granulomas if chronic, lymphocytes on BAL, treat with steroids -Types: farmer (hay mould), bird, byssinosis (cotton dust), malt (barley mould) |
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Pneumoconiosis x4 |
-Berryliosis: aircraft/nuclear; granulomas -Silicosis: desert/miners; egg-shell calcification; inc TB and lung Ca -Coal: miners; fibrosis, lung Ca, bronchitis -Asbestosis: worst are straight (blue & brown) vs serpentine (white) |
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Rheumatoid lung x5 |
-Basal fibrosis -Caplans (coal worker lung + RA) -Nodules -Pleural effusion (low G, high lymph) -COP/BOOP |
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Pleural effusions (1) - causes x3 x3 |
-Transudate =3 failures: liver, kidney, heart =3 other: hypoalbumin, hypothyroid, Meig's -Exudate =3 Is: infection (TB, pneumonia), infarction (PE), inflammation (RA, conn tissue, pancreatitis, sarcoid) =3 other: cancer, drugs (MTX), yellow nail -3 more: haemothorax, chylothorax, empyema |
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Pleural effusions (2) - investigations x5 |
-Light's: protein>0.5, LDH>0.6, LDH>2/3 normal -G<2mmol/l: malig, empyema, RA, TB -High lymphocytes: malig, TB, sarcoid, RA -Amylase: pneumonia, malig, pancreatitis -pH<7.2: empyema |
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Cor pulmonale x5 |
-Def: RVF 2ary to pulm HTN (>25) due to lung -Pulm art HTN = 1ary, PE, sickle, vasculitis -Pulm venous HTN = 2ary to LVF -Airways = COPD -Parenchyma = interstitial lung disease -Hypoventilation = obesity, kyphosis, neuromusc -Mx: LTOT, veno/bronchodilators, diuretics |
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Primary pulmonary hypertension |
-Ix: ECG, CXR, echo (RVF), CTPA (?PE), R heart cath (>25mmHg, cap wedge P <15mmHg) -Mx: MDT (cardio), nitrates, prostacyclin, Ca-block, bosentan (ETrec), sildenafil, transplant |
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SHIPs x4+2 |
-Sarcoid -Histiocytosis -Infection (TB) -Pneumoconiosis/EAA -Bilat hilar LN = SHIP + malignancy (lymphoma) -Granulomas = SHIP + vasculitis (Wegener's, Churg Strauss) |
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Sarcoid |
-Lung: BHL (1-2), infiltrates (2-3), fibrosis (4) -Eye: uveitis -Metabolic: hyperCa, renal stones -Cardio: myopathy, arrhythmias -Abdo: hepatosplenomegaly -Skin: erythema nodosum, lupus pernio -Neuro: polyneuropathy, Bells -Ix: ACE, ESR, Ca, LFT, HRCT, biopsy -Mx: steroids for eyes/lungs |
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Dull lung base x7 |
-Effusion (trachea pushed away) -Collapse (trachea pulled towards) -Consolidation (inc VR; also PE/Ca/vasculitis) -Pleural thickening (inc/normal VR) -Raised hemidiaphragm (phrenic N) -Pneumonectomy (whole lung) -Mass |
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Spirometry x4 |
-Obstructive = COPD, asthma, bronchiectasis -Restrictive = ILD, skel/neuromusc -Diffusion capacity (KCO = CO+He) =inc in haem/PE, dec in ILD/emphysema -TLC = inc in obstructive, dec in restrictive |
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Complications of TB x5 |
-Aspergilloma -Bronchiectasis -Cancer (adenoCa) -Pleural thickening -Apical fibrosis |
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Complications of bronchiectasis x4 |
-Haemoptysis -Amyloid -Recurrent infection -Cor pulmonale |
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Complications of COPD x7 |
-Pneumothorax -Polycythaemia -Infection -Cancer -Resp failure (T1 or T2) -R heart failure -Bronchiectasis |
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Anti-TB drugs |
-Treatment: 2mxRIPE, then 4mxRI -Chemoproph: 3mxRI or 6mxI -Rifampicin: hepatitis, drug metab, orange -Isoniazid: hepatitis, neuropathy (pyridoxine) -Pyrazinamide: hepatitis, arthralgia -Ethambutol: hepatitis, optic neuritis |
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Lung cancer investigations |
-Imaging: CXR => CT CAP / PET-CT -Bloods: FBC, LFT, Ca, Na (cortisol/osmol), INR -Tissue: bronchoscopy / EBUS / CT-guided -Lung function tests (?suitable for resection) |
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Lung cancer types x5 |
-NSCLC (80%): adeno>squam>alv>large -SCLC (20%) |
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Lobectomy / pneumonectomy indications x5 |
-Lung ca (NSCLC -Symptomatic lung disease (bronchiectasis, CF, amyloid = e.g. recurrent bleeding/infection) -COPD (bullectomy) -Old TB -Lung transplant |
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Haemoptysis x8 |
-Infection (TB, abscess) -Bronchiectasis -Lung cancer (carcinoid, bronchogenic) -Vasculitis (Goodpastures, Wegener's) -AVM -PE -Coagulopathy -Trauma |
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Lung cancer treatment |
-NSCLC Stage I-IIIa: surgery OR radical chemorad -NSCLC Stage IIIb-IV: palliative chemo &/or radio -Erlotinib (EGFR TKI): for EGFRTK mut NSCLC -SCLC: platinum-based chemo +/- radio |
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Lung transplant |
-COPD -CF -IPF -1ary pulmHTN |
