chest x-ray imaging
what do we look at systematically in a chest x ray?
airways
breathing structures
circulation structures
diaphragm
everything else
what are three key quit smoking strategies
- behavioural
- nicotine substitution
- direct therapies
what part of the lungs do interstitial lung diseases primarily involve?
alveolar parenchyma
what type of infection are neutropaenic patients susceptible to?
fungal infection
bacterial infection
viral infection
what is a common adverse effect of biological therapies as a supportive therapy for malignancies
hypersensitivity
a patient has tension pneumothorax. describe what the trachea will look like in a chest x ray
deviates away from the pneumothorax
what is the main carcinogenic ingredient in cigarettes
tar
not tobacco!! -> tobacco is the main ingredient but the chemicals in cigarettes is the carcinogenic part
what are the characteristics of ARDS?
formation of edema and hyaline membranes
a patient has a round of chemotherapy and you're worried that they're going to vomit. what do you prescribe?
- metoclopramide (dopamine antagonist)
what is the most prevalent chronic occupational disease
silicosis
a patient does an AP chest xray and the heart is around 60% of the total chest width. is this concerning? why/ why not?
not concerning
AP has magnification of xray beam so heart will look enlarged however in a PA scan it'll normally be less than 50% of thoracic width
a patient has the most aggressive type of lung cancer. what kind of treatment do you use?
small cell carcinoma
use chemotherapy or radiation
NOT SURGERY
what is are three genetic factors of idiopathic pulmonary fibrosis?
telomerase mutation
surfactant mutation
MUC5B variant
a chemotherapy patient's Hb level is 10g/dL. what would you prescribe and how would you do so?
erythropoietin agonist (Epoetin-alfa, Epoetin-beta, Darbepoetin-alpha)
administered via IV, lowest dose and stop when chemotherapy is complete
what are hyaline membranes made of in ARDS?
proteins (protein rich edema fluid) and dead alveolar epithelial cells
in a patient's x ray the costophrenic angle becomes rounded. what does this suggest?
why is micropapillary type/ solid type pulmonary adenocarcinoma worse than lepedic type/ acinar type pulmonary adenocarcinoma?
lepedic: grows along existing walls of air sacs so doesnt destroy underlying lung structure- minimally invasive
acinar: cells form round structures and behaves less aggressively than micropapillary/ solid type
micropapillary: tiny, finger-like tufts that float loose without a central core, which promotes detachment, blood vessel invasion and spread through air spaces
solid: sheets of unorganized tumor cells grow densely with complete loss of glandular structure, indicating poor cellular differentiation and high aggressiveness
micropapillary and solid are associated with more aggressive mutation patterns as well
what is the pathogenesis of asbestosis?
asbestos fibres activate inflammasome and stimulate release of proinflammatory factors and fibrogenic mediators after phagocytosed by macrophages
describe filgrastim
for neutropenia
synthetic form of G-CSF (granulocyte - colony stimulating factor) for production and differentiation of granulocytes (neutrophils)
starts 24 hours post chemo
short half life- needs 5-10 injections every 24 hours (not good)
how has the rate of mesothelioma changed over the last few decades and why?
increased rate of mesothelioma
- increased renovation of structures built prior to 1980s therefore increased asbestos exposure which has increased mesothelioma diagnosis
eg asbestos in floor tiles, dry walls, ceiling tiles, insulation, fibro roofs etc becoming exposed
a patient comes in febrile with a productive cough for the last few weeks. they've also felt increasingly tired and aren't able to climb stairs anymore. what might you see in a chest x ray?
consolidation in the lung zones -> suggestive of pneumonia
what does a positive synaptophysin stain suggest?
target tissue contains the synaptophysin protein, which strongly suggests the presence of neuroendocrine (hormone-producing) or neuronal (nerve-related) cells
what is the pathogenesis of pneumoconiosis and how does it bypass normal lung defences?
nasal filtration for up to 5-10μm particles:
- most dangerous particle size is 1-5μm
removal of particles by macrophages:
- small particles: high solubility and toxicity- rapid onset
- large particles: fibrosis- persist for years
impaired muco-ciliary action/ clearance/ cough reflex:
- dust retention
- activation of inflammasome -> amplify intensity of local inflammatory reaction
- tobacco smoking
- particle uptake be endothelial cells
a patient is prescribed ondansetron and metoclopramide but is worried about the diarrhoea side effect. you think to prescribe codeine to help prevent the diarrhoea. is this a good idea or not and why?
no
codeine is an opioid that will slow down gut motility and metoclopramide increases gut motility so both will compete + both will enhance CNS effects so can cause extreme dizziness, drowsiness, confusion
codeine and ondansetron can lead to enhanced sedation
no
blue bloaters experience chronic hypoxemia -> kidney secretes high EPO already -> + EPO agonist = secondary polycythemia to maximise oxygen delivery therefore high hematocrit
- increased blood viscocity therefore thrombotic risk
- aggravation of cor pulmonale