17 - lung cancer Flashcards
What are the red flags for lung cancer?
Haemoptysis
weight loss
Persistant cough
SoB
pain
hypertrophic osteoarthropathy
> 40 years with unexplained haemoptysis
What is hypertrophic oestoarthropathy?
Clubbing and pain in the small joints of the hands, the is most commonly from lung cancers.
What is the acronym SPIKE used for?
breaking bad news
What does SPIKES stand for?
Setting
Perception
Invitation
Knowledge
Emotions/ Empathy
Stratergy amd Summary
What is ment by perception in SPIKES?
- understand the events leading up to the diagnosis
- understand patients current knowledge
- explain why the test is being done
What to say during invitaition of SPIKES?
Would you like me to explain the results to you now
What to do in knowledge of SPIKES
Feed infomation with chunking and pausing and eventually revealing the diagnosis.
What stage of SPIKES way the prognosis be revealed?
Emotions and Empathy
What does bat wings sign on a CXR indicate?
Acute heart failure, This is an emergency
What are the complication of lung cancer?
Pancostal tumour - pain in arm, horners syndrome
Superior vena cava obstruction
metastesis
Immune responce and inflammation
Hormones - PTH, ADH, ACTH
Which type of lung cancer is associated with hypertrophic osteoarthropathy?
Squamous cell carcinoma
What type of lung cancer is associated with hypercalcaemia?
squamous cell carcinoma
How does squamous cell carcinoma cause hypercalcaemia?
Secretion of parathyroid hormone-related protein (PTHrP)
A CXR shows an opacity on the lung which is thought to be a potential lung cancer. What investigation is most appropriate next?
CT
Why might PET be used during lung cancer investigations?
Establish if cancer is currable and assment of distal or local metastesis has occured?
What is Lambert-Eaton syndrome?
Autoimmune condition against calcium channels from Hu antibodies released by small cell carcinoma. This results in peripheral neuropathy.
What can exposer to asbestosis cause?
Plaques on CXR
Asbestosis
Mesothelioma
A patient has SoB. On examination the left chest is dull to precussion with decreased breath sounds and vocal resonance. What is the clinical diagnosis?
Pleural effusion
A patient has a pleural effusion and undergoes thoracocentesis. How is it established that the fluid is a transudate or exudate?
Light’s criteria
What symptoms are there for hypercalcaemia?
STONES, BONES, GROANS, MOANS, THRONES, AND PSYCHIATRIC MOANS
Why is the corrected calcuim used and not just calcium on the whole.
Serum calcium is carried by albumin and therefore calcium levels are effected by albumin availibitly.
What can cause a raised ALP when investigating hypercacaemia?
Thyrotoxicosis
Bone mets
lithium (increased bone turnover)
muiltiple myeloma etc..
What are the causes of exudative pleural effusion?
Inflammation
malignancy
infection
What are the causes of tansudative pleural effusion?
hypoalbuminuria - cirrhosis, nephrotic syndrome
CCF + fluid overload
hypothyroidism
How does an exudate cause a pleural effusion?
protein is against its concentration gradient as they are released into the pleural space.
What is Talc pleurodesis?
Used to managed a pleural effusion, causes inflammation leading to a fussion of the pleura. This sticks the lung to the thorax
What is hereditary haemorrhage talengecia
venous-arterial malformation
Seen on lips
What to ask when risk stratisfication for HIV.
Travel history - where, length, water supply, swimming, medical care
Sexual history - new partners last 3 months, protection, same sex, type of sex, paid for sex.
IVDU
“considering what we talked about today I think it would be sensible to do a HIV test. This is would involve taking blood from your arm…”
