cardio resp.txt

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  1. what are the different types of non small cell lung cancer?
    • sqaumous cell lung carcinoma
    • adenocarcinoma
    • large cell carcinoma
  2. which are more common, small or non small cell lung cancer?
    non small cell lung cancer
  3. what are the respiratory causes of clubbing?
    • tumours: bronchial cancer, mesothelioma, ,large cell lung cancer
    • interstitial lung disease
    • fibrosing alveolitis
    • TB
    • supparative lung disease: abscess, empyema, cystic fibrosis, bronchiectasis
    • AV fistula
  4. what are the cardiac causes of clubbing?
    • congenital cyanotic heart disease
    • subacute bacterial endocarditis
    • atrial myxoma
    • any disease featuring chronic hypoxia
  5. what are the GI & HPB causes of clubbing?
    • IBD: esp Crohns
    • Cirrhosis: esp PBC
    • lymphoma
    • Malabsorption - eg coeliac
    • polyposis
    • oesophageal cancer
    • laxative abuse
  6. what is cirrhosis?
    • irreversible liver damage
    • loss of normal hepatic architecture
    • fibrosis
    • nodular regeneration
  7. what are the 3 most common causes of cirrhosis?
    • chronic alcohol abuse
    • HBV infection
    • HCV infection
  8. name 4 risk factors for lung cancer
    • smoking
    • asbestos
    • arsenic
    • radioation - radon gas
  9. name 4 main symptoms of lung cancer
    • cough
    • haemoptysis
    • dyspnoea
    • chest pain
  10. give 6 general signs found in a pt with lung cancer
    • cachexia
    • clubbing
    • anaemia
    • HPOA (hypertrophic pulmonary osteoarthropathy) wrist pain due to periostis of long bones
    • supraclavicular LN
    • axillary LN
  11. where do lung cancers metastasise to? and what signs and symptoms does this make?
    • brain: confusion, fits, focal CNS signs, cerebellar syndrome
    • bone: pain, anaemia, increased calcium
    • liver: hepatomegaly
    • adrenals: Addison's
  12. what are the chest signs of lung cancers? 4 options
    • none
    • consolidation
    • collapse
    • pleural effusion
  13. what are the local complications of lung cancer?
    • NERVE: recurrent laryngeal nerve palsy, phrenic nerve palsy
    • VESSELS: SVC obstruction causing oedema
    • HORNERS SYNDROME: pancoast's tumour at apex of lung, can grow into sympathetic ganglion, brachiocephalic vein, subclav artery
    • BONE: rib erosion
    • HEART: pericarditis (central chest pain to back, better when lean forward, pericardial friction rub, saddle ST elevation, AF
  14. what are the metastatic complications of lung cancer?
    • BONE: bone pain, anaemia, inc calcium
    • liver: hepatomeg
    • adrenals: Addison's
    • Brain: focal neurology or general confusion, fits..
  15. What are the endocrine complications of lung cancer?
    • ectopic hormone secretion:
    • causing SIADH (high ADH, low Na)
    • Cushings: small cell lung cancer secrete ACTH
    • hypercalcaemia: as PTH released by SQUAMOUS cell tumours
  16. what are the non metastatic neuro complications?
    • confusion
    • fit
    • cerebellar syndrome
    • proximal myopathy
    • neuropathy
    • polymyositis
    • Eaton-Lambert syndrome: autoimmune disorder affecting VG calcium channels on presynaptic memb of NMJ so no ACh release and so no muscle contraction, muscle weakness
  17. other paraneoplastic syndromes of lung cancer
    • dermatomyositis
    • acanthosis nigricans
    • HPOA, wrist pain
    • clubbing
    • thrombophlebitis migrans
  18. what are the different investigations used to diagnose lung cancer?
    • CYTOLOGY: sputum and pleural fluid at least 20ml
    • CXR: peripheral, circular opacity; hilar enlargement, consolidation, collapse, pleural effusion, bony secondaries
    • FNA OR BIOPSY: superficial LN and periph lesions
    • BRONCHOSCOPY: histology and assess if operable
    • CT: stage
    • PET scan: help staging
    • Radionuclide bone scan if suspect mets
    • Lung function tests
  19. what is the treatment for non small cell tumours if a) low stage, b) poor resp reserve, c) advanced disease
    • a) low stage: excision for peripheral tumours with no mets
    • b) if resp reserve poor: curative radiotherapy
    • c) advanced: chemo and radio
  20. what is the treatment for small cell tumours and why is it different?
    • small cell tumuors are disseminated at presentation
    • treat: chemo and or radio
  21. what are the different options for palliative treatment of lung cancer?
    • Radiotherapy: if bronchial or SVC obstruction, haemoptysis, bone pain, cerebral mets
    • SVC obstruction: SVC stent + radiotherapy + dexamethasone
    • Endobronchial therapy: tracheal stenting, cryotherapy, laser, brachytherapy
    • symptomatic pleural effusion: pleural drainage or pleurodesis
    • Pain: analgesia
    • steroids
    • Antiemetics
    • Cough: cough linctus (codeine)
    • Bronchodilators
    • anti depressant
  22. Other than small cell and non small cell lung tumours, name 3 others:
    • bronchial adenoma: most are carcinoid
    • hamartoma
    • mesothelioma: tumour of mesothelial cells in the pleura related to asbestos exposure. may have v.long latent period between exposure and tumour development
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cardio resp.txt
lung cancer and more
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