Lung Pathology and Disease Quiz

Introduction to head and neck cancer, awareness of interstitial lung disease & COVID pathology, diagnosis of lung cancer, types of neoplasms in lung, classification of lung cancer, paraneoplastic syndromes, understanding TNM, evolving treatment of lung cancer, importance of molecular pathology, ongoing importance of asbestos in mesothelioma, and background on smoking-related diseases and inter-individual susceptibility factors.

Male gender, tobacco use, alcohol consumption, HPV infection, poor hygiene, and repeated trauma.

HPV infection is found in 10-50% of cases and is used as a biomarker. Non-HPV cases with p53 mutation are more aggressive.

The text mentions COVID-19 in the context of whether it is a viral or immunological disease.

Hypersensitivity pneumonitis (extrinsic allergic alveolitis), sarcoidosis, and idiopathic pulmonary fibrosis (UIP).

AAT, CYP1A1, GSTM1, and mEPH are mentioned as examples of pharmacogenomics and inter-individual susceptibility factors.

Passive smoking, E-cigarettes, heat not burn products, and vitamin E acetate are mentioned as factors related to lung diseases.

Mutational burden and immunologically 'cold' tumors

Squamous, adenocarcinoma, bronchoalveolar, large cell undifferentiated

Production of bioactive amines or peptides such as ADH, PTN-like peptides, and ACTH. Neurological effects like demyelination.

Benign: mesenchymoma, papilloma, inflammatory myoblastic tumor; Malignant: primary epithelial (squamous, adeno, small cell undifferentiated, carcinoid, large cell undifferentiated), secondary (sarcoma, renal carcinoma, lymphoma, and others)

Conventional chemotherapy, targeted small molecule therapy, and immuno-oncology with checkpoint inhibitors

Exposure to asbestos, particularly crocidolite, with a long lag period of 20-40 years. Male to female ratio is 5:1.

Understanding interstitial lung disease and COVID pathology, classification of lung cancer, paraneoplastic syndromes, TNM staging, evolving treatment, and the importance of molecular pathology and asbestos in mesothelioma.

Radiology for size changes, cytology, endobronchial ultrasound (EBUS) biopsy, assessment of PDL-1, circulating tumor cells, and circulating tumor DNA

The functions of the respiratory system include gas exchange (oxygen from environment to cells for utilization and removal of CO2), ventilation (breathing to move gas to the site of exchange), and cellular respiration (cells using oxygen in biochemical processes).

The upper division of the respiratory tract includes the nasal cavity, paranasal sinuses, nasopharynx, and larynx, while the lower division includes the trachea, bronchi, and lungs.

The main skeletal elements forming the roof, lateral wall, and septum of the nasal cavity include the nasal bones, frontal bone, maxillary bones, ethmoid bone, and vomer.

The neurovascular supply of the nasal cavity and paranasal sinuses involves branches of the internal and external carotid arteries, as well as branches of the trigeminal nerve (ophthalmic, maxillary, and mandibular divisions).

Clinical conditions that affect these areas include sinusitis, nasal polyps, deviated nasal septum, allergic rhinitis, nasopharyngeal carcinoma, and pharyngitis, among others.

The paranasal sinuses drain to the nasal cavity via different meatus and infundibulums.

Understanding the adjacent structures and clinical implications is important for understanding the surgical implications of paranasal sinuses.

Paranasal sinuses have different nerve and artery supplies.

The nasopharynx is the first part of the pharynx and communicates with the nasal cavity via choanae.

The tonsil tissue in the nasopharynx is important for immune surveillance and collectively termed Waldeyer's ring.

The respiratory mucosa in the nasal cavity is composed of ciliated pseudostratified columnar epithelium, goblet cells, and a rich vascular supply. It functions to humidify and warm the incoming air, as well as to trap and remove particles and pathogens from the air.

The nasal cavity is innervated by a mix of sensory and secretomotor nerves, including CN I for special sensory (smell), CN V1 and V2 for somatic sensory, CN VII for parasympathetic secretomotor, and sympathetic fibers from the superior cervical ganglion. This complex innervation allows for the detection of smells, regulation of nasal secretions, and sensation of touch, pain, and temperature.

The nasal cavity contains specialized olfactory mucosa on the roof, which houses the olfactory nerve (CN I) and is responsible for the sense of smell. Additionally, it contains various foramina and gateways for vascular and nerve supply, including the foramen cecum, cribriform plate, and sphenopalatine foramen, which facilitate the passage of nerves and blood vessels.

The nasal cavity receives arterial supply from branches of the external and internal carotid arteries, forming anastomoses in the Little's area. Venous drainage from the nasal cavity includes routes to the cavernous sinus, pterygoid plexus, and facial vein. The anastomoses in the Little's area are significant for providing collateral circulation and preventing potential ischemic events in the nasal cavity.

Nasal muscles, innervated by the facial nerve, control the flaring or constriction of the nostrils, which helps regulate airflow through the nasal cavity. This function is essential for adjusting the resistance to airflow and optimizing the process of breathing.

The components of the medical history structure include presenting complaint (PC), history of presenting complaint (HPC), past medical history (PMH), medication/allergies (DH), family history (FH), social history (SH), and systems enquiry/review (SE).

The medical history helps in forming a differential diagnosis, identifying risk factors for conditions, recognizing red flags, directing further clinical examination, guiding investigation and management, and developing a rapport between patient and health care worker.

The key learning outcomes include understanding the role of a medical history in making a clinical diagnosis, demonstrating an understanding of specific respiratory questions, showing awareness of the causes of common respiratory symptoms, understanding how different body systems interrelate, and comprehending how to take a detailed drug history.

The guidelines include allowing the patient the opportunity to speak, using initial open questions, establishing time-lines, interventions, and impact, and constantly considering possible diagnoses and the need for additional information to help decide the correct diagnosis.

Understanding how different body systems interrelate helps in recognizing the impact of conditions on multiple systems, identifying potential systemic causes of symptoms, and comprehending the holistic approach to patient care.

Medication history taking is crucial for improving patient safety and reducing medication errors in hospitals. It helps in identifying and preventing missed doses, delays in treatment, and errors in prescribing and administering medications. By accurately collecting current medications, allergies, and previous adverse drug reactions, healthcare professionals can ensure the safe and effective use of medications, leading to better therapeutic outcomes and cost savings for the healthcare system.

The key steps in medication history taking include methodically collecting current medications, allergies, and previous adverse drug reactions, engaging with the patient or their caregiver, using multiple sources of information to confirm medication history accuracy, and being alert to the use of high-risk medicines. Additionally, healthcare professionals should inquire about prescribed contraception for women of childbearing age and participation in clinical trials to gather comprehensive medication information.

Obtaining information from various sources, such as the patient, family/friends/carers, GP surgery staff, previous hospital notes, community pharmacy, and emergency care summaries, is essential for accurately confirming a patient's medication history. This approach helps in cross-referencing and validating the information, reducing the risk of missing important details and ensuring comprehensive medication history documentation.

Addressing non-prescribed and over-the-counter medicines during medication history taking is crucial for gaining a complete understanding of a patient's medication use. This includes identifying any potential interactions, adverse effects, or duplications with prescribed medications. Additionally, inquiring about complementary and alternative medicines, smoking, recreational drug use, and allergies helps in assessing the patient's overall medication and health status.

Assessing patient adherence and non-adherence to medications is essential for understanding the patient's medication-taking behavior and addressing potential barriers to adherence. This includes identifying intentional non-adherence, such as a definite decision to not take prescribed medicines, as well as unintentional non-adherence due to factors like physical dexterity, reduced vision, cognitive impairment, or poor understanding. By identifying and addressing adherence issues, healthcare professionals can optimize medication therapy and improve patient outcomes.

SOCRATES stands for Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/Relieving factors, and Severity. It is used to explore various aspects of chest pain and gather detailed information for assessment.

Three potential causes of dyspnoea are pulmonary embolism (PE), acute left ventricular failure (LVF), and acute asthma. They can be categorized based on onset as minutes to hours onset.

Cough assessment involves exploring duration, triggers, nature, expectoration, smoking, medication, and associated symptoms. Potential causes of cough include infections, asthma, chronic obstructive pulmonary disease (COPD), and red flags like haemoptysis and weight loss.

Sputum assessment involves exploring frequency, amount, color, and changes. Serous, mucoid, purulent, and rusty sputum types are listed with their respective causes.

Past medical history assessment involves exploring medical conditions, doctor visits, investigations/procedures, and operations to establish the timeline of events and medication history. It is important in respiratory symptoms assessment to understand the patient's medical background and potential contributing factors to the current symptoms.