Lung Cancer

Question 1

Physical examination elements to check for metastasis

Answer 1

Bony pain

Hepatomegaly

Question 2

Signs of previous treatment

Answer 2

Lobectomy scar

Radiotherapy square burn + tattoo

Question 3

Complications of lung cancer

Answer 3

Superior vena cava obstruction
Recurrent laryngeal nerve palsy
Horners sign and wasted small muscles of hand (T1): Pancoasts tumour
Gynaecomastia (ectopic bHCG)
Lambert Eaton myasthenia syndrome
Dermatomyositis

Question 4

SVCO sxs

Answer 4

oedematous face and upper limbs, dilated superficial thoracic veins, stridor

Question 5

Sign of recurrent laryngeal nerve palsy

Answer 5

Hoarseness, bovine cough

Question 6

Signs of dermatomyositis

Answer 6

Heliotrope rash on eyelids, Gottron’s papules on fingers

Question 7

Types of lung cancer by commonality

Answer 7

Squamous cell (35%)
Small cell (oat)(25%)
Adeno
Large
Alveolar

Question 8

Ix for diagnosing cell type

Answer 8

Induced sputum cytology

Biopsy via bronchoscopy if central, percutaneous needle if peripheral

Question 9

Pneumonectomy eligibility criterion

Answer 9

Lung function tests: contraindicated if FEV1 < 1.2L

Question 10

Electrolyte imbalance syndromes in lung ca

Answer 10

Metastasis: high Ca, LFTs, anaemia
SCLC: SIADH via high ACTH
NSCLC: high Ca via high PTHrP

Question 11

Treatment of lung ca

Answer 11

SCLC: benefit from chemo with six courses
NSCLC: benefit of chemo unknown, if EGFR pos - erlotinib. Pneumonectomy or lobectomy + radiotherapy.

Question 12

Two types of radiotherapy

Answer 12

Single fractionation (once weekly) or
Hyper fractionation (daily for 10 days)

Question 13

Palliative care therapies in lung cancer

Answer 13

Dexamethasone and radiotherapy for brain mets
SVCO: dexamethasone plus radio or stent
Radiotherapy for bone pain, haemoptysis and cough
Chemical pleurodesis for effusion using talc
Opiates for cough and pain