Investigations

Question 1

What do areas of pathologies on a CXR indicate for the location of the tumour?

Answer 1

• Consolidation in right middle/lower zones with heart border still defined - lower lobe
• Heart border not visible - middle lobe
• TB - calcification and fibrosis (pulls lung upwards)

Question 2

What are the differential diagnoses of lung cancer?

Answer 2

• TB
• Pneumonia
• Benign lung tumour
• Rare - Wegener’s granulomatosis

Question 3

What tests are used to determine the cell type?

Answer 3

• Fibreoptic bronchoscopy
• Percutaneous needle biopsy
• Node biopsy
• Mediastinoscopy/mediastinotomy
• Thoracotomy

Question 4

When is a tumour inoperable?

Answer 4

• Distant metastasis
• Mediastinal spread e.g. recurrent laryngeal nerve palsy or phrenic nerve palsy
• Poor pulmonary function
• Frequent angina/HF
• Psychological failure

Question 5

What is EGFR a measurement of?

Answer 5

Protein found in abnormally high levels on surface of many cancer cells, particularly NSCLC. Its mutation status can be confirmed using a sample of tumour tissue.
EGFR mutation positive cells predict response to specific chemotherapy - gefitinib.

Question 6

What is the Light’s criteria for exudate pleural fluid?

Answer 6

• Pleural fluid protein >0.5
• Pleural fluid LDH/serum LDH >0.6
• Pleural fluid LDH > 2/3 the upper limits of normal serum LDH

Question 7

What is the Light’s criteria for transudate pleural fluid?

Answer 7

Total protein > 3.0

Question 8

What causes an LDH of >1000?

Answer 8

• Empyema
• Rheumatoid pleurisy
• Malignancy

Question 9

What will lung cancer appear as on a CXR?

Answer 9

• Peripheral nodule
• Hilar enlargement
• Consolidation
• Lung collapse
• Pleural effusion
• Bony secondaries

Question 10

What investigations are done for lung cancer?

Answer 10

• CXR
• Cytology - sputum and pleural fluid
• Fine needle aspiration or biopsy
• CT
• Bronchoscopy
• PET scan - F-deoxyglucose or EBUS
• Lung function tests

Question 11

What tests are done for malignant mesothelioma?

Answer 11

• CXR/CT
• Pleaural thickening/effusion
• Bloody pleural fluid

Question 12

What does trachea towards white out mean?

Answer 12

• Pneumonectomy
• Complete lung collapse e.g. endobronchial intubation
• Pulmonary hypoplasia

Question 13

What does trachea away from white out mean?

Answer 13

• Pleural effusion
• Tension pneumothorax
• Diaphragmatic hernia
• Large thoracic mass