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Lung Cancer
Rob Nicholson
Finals simplified
Every Condition:
What is it?
What causes it?
What do patients present with?
How do we investigate it?
How do we treat it acutely?
How do we treat it chronically?
COPD
What is it?
Smoking
Pollution
Alpha 1 antitrypsin
deficiency
COPD
Routine bloods:
ABG:
Absence of
other cause of
breathlessness
Greater than 7
anterior ribs
Flattened
Diaphragm
COPD
P-Pulmonale
COPD
Decreased FEV1
Dramatically decreased FEV1/FVC ratio
COPD
Steroids
Nebulisers
+/- antibiotics
Oxygen?
NIV?
COPD
Chronic:
Stop smoking!
COPD
Short acting B
FEV > 50 agonist/ Short acting FEV < 50
ant muscarinic
All three
COPD
Clinical examination:
Bloods:
Eosinophilia
Raised IgE
Asthma
Radiology:
Chest X-ray:
Technique
Avoidance
Monitor
Educate
Asthma
Asthma
Asthma
Asthma
Essentially:
Acute asthma:
Severity Symptoms
Mild asthma exacerbation Deterioration in normal resp
function
Moderate asthma 50-75% PEFR
exacerbation
Severe asthma exacerbation 33-50% PEFR, incomplete
sentences, RR>25, HR >110
Life threatening asthma O2 < 92%, pO2 < 8, silent
exacerbation chest, decreased conscious
level
Asthma
Treatment:
Nebs
Steroids
Theophylline
Magnesium sulphate
OXYGEN
Leukotriene
ITU
Lung Cancer
What is it?
Weight loss
Cough +/- haemoptysis
Chest pain
Recurrent pneumonia’s
Hoarse voice
Beware Horners syndrome….
Lung Cancer
Squamous:
Smokers
Centrally located
Metastasise late
Parathyroid hormone
Lung Cancer
Adenocarcinoma
Non smokers
Peripheral
Metastasise early
Lung Cancer
Starts centrally
Rapidly progressive
Ectopic hormone production
(Cushings, SIADH, Carcinoid)
Lung cancer
Investigations:
Treatment: BIOPSYCHOSOCIAL
MDT
Chemo
Radiotherapy
Surgery
Palliation
Example Case
pH 7.35-7.45
pCO2 4.5-6.1
pO2 12-14
HCO3 22-28
Example case
Any questions?
Thanks to:
Radiology masterclass
British lung foundation
Google images
BLS guidelines
NICE guidance
SIGN guidelines