bronchogenic carcinoma

Question 1

what are the risk factors for lung cancer?

Answer 1

smoking 
atmosphere pollution 
individual variation 
effect of gender 
occupational exposure 
previous lung disease 
nutritional factors

Question 2

what is the clinical presentation of bronchogenic carcinoma?

Answer 2

may be
asymptomatic
extra thoracic
intra thoracic

Question 3

what are the presentations with extra thoracic presentation ?

Answer 3

metastatic- liver, brain, bone and adrenal gland
non metastatic - para neoplastic

non-metastatic - paraneoplastic syndrome

Question 4

what are the presentation of intra thoracic presentation

Answer 4

broncho-pulmonary manifestation
pleural manifestations
thoracic inlet syndrome
mediastinal syndrome

Question 5

what are the broncho-pulmonary manifestations ?

Answer 5

bronchial irritation ( cough and expectoration )
bronchial erosion/ulceration ( haemoptysis and dull aching chest pain )
bronchial obstruction

Question 6

what are the types of bronchial obstructions ?

Answer 6

-partial block :
localized wheeze
localized emphysema 

-complete block :
atelectasis and distal infection leading to unresolved pneumonia and lung abscess

Question 7

what is a pancoast tumor ?

Answer 7

malignant tumor of the superior pulmonary sulcus, involves the brachial plexus
and cervical sympathetic nerves

Question 8

what are the symptoms of rib erosion in pancoast tumor ?

Answer 8

Rib erosion ( 1st and 2nd ribs )
* Dull aching chest pain & severe shoulder pain radiating toward the axilla and scapula
* Dullness in kronig’s isthmus, clavicle & infraclavicular region * Apical mass in CXR

Question 9

what are the symptoms associated with infiltration of the subclavian artery ?

Answer 9

unequal pulse volume
unequal blood pressure
unilateral clubbing

Question 10

what are the symptoms associated with subclavian vein infiltration ?

Answer 10

edema of upper limbs and dilated veins

Question 11

what are the symptoms associated with brachial neuralgia ?

Answer 11

wasting of the small muscles of the hand especially ulnar distribution

Question 12

what are the symptoms associated with the affection of the cervical sympathetic chain ?

Answer 12

horner's syndrome 
ptosis 
anhidrosis 
myosis 
enopthalmos 
unilateral nasal obstruction 
loss of spino-ciliary reflex

Question 13

what structures are affected in the mediastinal syndrome?

Answer 13

affection of hollow organs :
trachea 
oesophagus 
bronchi 
vagus 
phrenic nerve 
left recurrent laryngeal nerve

Question 14

what does affection of the vagus result in ?

Answer 14

first bradycardia then tachycardia and dyspnea

Question 15

what does affection of the phrenic nerve result in ?

Answer 15

irritation leading to shoulder pain
later on diaphragm paralysis leading to dyspnea

later paralysis leading to dyspnea

Question 16

what is d’espine’s sign?

Answer 16

d’Espine sign is a bronchial breathing heard over the vertebral spines below the level of tracheal bifurcation
associated with mediastinal syndrome

Question 17

which paraneoplastic endocrinal abnormalities are seen with small cell lung carcinoma SCLC ?

Answer 17

ectopic ACTH syndrome
somatostatinoma
SIADH

somatostatinoma

Question 18

which paraneoplastic endocrinal abnormalities are seen with large cell carcinoma and adenocarcinoma ?

Answer 18

gynectomasia

Question 19

which paraneoplastic endocrinal abnormalities are seen with squamous cell carcinoma ?

Answer 19

1- hypercalcaemia
osteolytic metastatic disease

2- hypoglycaemia

hypoglycaemia

Question 20

what are the vascular and heamatogoneous manifestations that may occur with paraneoplastic syndromes?

Answer 20

migrating thrombosis
fibrinogen deficiency
anemia
eosinophilia

Question 21

what are the metastatic workup ?

Answer 21

Abd US
CT brain
Bone scan

Question 22

if we have central affection what type of investigation would we perform ?

Answer 22

bronchoscopy

Question 23

if we have mediastinal affection what type of investigation would we perform ?

Answer 23

lymph node biopsy

Question 24

in cases of pleural effusion what type of investigation would we perform ?

Answer 24

thoracoscopy

Question 25

what are the types of non-small cell carcinoma ?

Answer 25

squamous cell carcinoma
adenocarcinoma
large cell carcinoma

Question 26

what type of staging do we use for non small cell carcinoma ?

Answer 26

TNM staging
tumor
nodes
metastasis

Question 27

what is the staging used for small cell lung carcinoma ?

Answer 27

limited vs extensive

Question 28

what is the median survival of limited SCLC ?

Answer 28

1-2 years

Question 29

what is the median survival of extensive SCLC ?

Answer 29

6-12 months

Question 30

what is the treatment for NSCLC ?

Answer 30

surgery if there is a resectable mass and no metastasis
radiotherapy
chemotherapy

Question 31

what is the treatment of SCLC ?

Answer 31

metastasis is usually present at the time of presentation
chemotherapy
surgery is contra-indicated in most cases

Question 32

how is pack year calculated ?

Answer 32

packs/day x years of smoking

Question 33

what are the different paraneoplastic syndromes ?

Answer 33

Cushing syndrome – suggests small cell
syndrome of inappropriate ADH production (SIADH) – suggests small cell
Lambert–Eaton syndrome – suggests small cell
hyperparathyroidism – suggests squamous cell

Question 34

what are the two types of pleural manifestations ?

Answer 34

pleural effusion and pleuritic chest pain

Question 35

what are the different entities under pleural effusion ?

Answer 35

transudate - compressing SVC
exudate - infection distal to obstruction or malignant cells in pleural fluid
haemorrhagic - pleural invasion by tumor
chylothorax - mass compressing the thoracic duct
pyothorax - pyogenic infection on top