Lung cancer

Question 1

3 main histological types of lung cancer

Answer 1

• Squamous cell (35%)
• Small cell (20%)
• Adenocarcinoma (27%)

Question 2

most common lung cancer in non smokers

Answer 2

Adenocarcinoma

Question 3

what can horners syndrome be caused by

Answer 3

apical pancoats tumour

Question 4

pathway between asbestos exposure and mesothelioma

Answer 4

pleural plaques on parietal & diaphragmatic pleura –> risk of mesothelioma

Question 5

endocrine cells that SCLC arises from

Answer 5

APUD/ Kulchitsky cells

Question 6

3 types of non SCLC

Answer 6

• adenocarcinoma
• squamous cell carcinoma
• large cell carcinoma

Question 7

peripherally located lung ca

Answer 7

adenocarcinoma

Question 8

lung ca associated with asbestos exposure?

Answer 8

adenocarcinoma

Question 9

which lung ca metastasises early

Answer 9

large cell lung ca

Question 10

ectopic secretion of PTH like peptide in which lung Ca?

& what does this cause?

Answer 10

• squamous cell carcinoma

- ectopic PTH –> high Calcium –> renal stones, bony pain & altered mental state

Question 11

type of tumour that releases serotonin?

Answer 11

carcinoid tumour

Question 12

symptoms of carcinoid tumour & why?

Answer 12

• facial flushing
• diarrhoea

due to serotonin/5-HT release

Question 13

signs of tumour compression of jugular vein

Answer 13

• upper limb oedema
• facial congestion
• distended neck veins

Question 14

tumour compressing recurrent laryngeal nerve causes what ?

Answer 14

• hoarse voice

- bovine cough

Question 15

what does tumour compressing phrenic nerve cause?

Answer 15

• diaphragmatic paralysis

- raised hemidiaphragm

Question 16

what do mutated tumour suppressor genes result in?

Answer 16

inactivates them therefore allowing cells to proliferate

Question 17

genes than contribute to cancer development

Answer 17

oncogenes

Question 18

ectopic secretion in small cell lung ca (2)

Answer 18

ADH

ACTH

Question 19

electrolyte imbalance caused by ADH ectopic secretion

Answer 19

hyponatraemia

Question 20

patho behind lambert eaton syndrome

Answer 20

autoimmune, blockage of Ach at neuromuscular junction

Question 21

decision for surgery on lung cancer depends on?

Answer 21

• local/distant spread

- Staging CT or EDG-PET scan

Question 22

protein found in high amounts on certain cancerous cells?

Answer 22

eGFR

Question 23

what do eGFR mutation positive cells predict response to?

Answer 23

chemotherapy - gefitinib

Question 24

management of palliative cough

Answer 24

opiates (codeine/morphine)

Question 25

relief for bronchial obstruction?

Answer 25

external bean radiotherapy or brachytherapy

Question 26

management of cerebral mets?

Answer 26

- corticosteroids | - radiotherapy

Question 27

4 imaging investigations for lung ca

Answer 27

- CT staging w/ contrast - PET scan - EBUS - FNA ultrasound guided

Question 28

what is EBUS

Answer 28

Endobrachial ultrasound guided biopsy trans bronchial needle aspiration to obtain tissue to diagnose and stage lung ca

Question 29

tests for pleural effusion secondary to lung ca?

Answer 29

- biochemistry analysis & | - cytology to analyse cells

Question 30

lung nodule on CXR differentials

Answer 30

- malignancy - abscess - carcinoid tumour - AVM - foreign body - skin tumour

Question 31

CXR findings in lung ca

Answer 31

- hilar enlargement - peripheral opacity - pleural effusion - collapse

Question 32

how does PET-CT work

Answer 32

injecting a radioactive tracer & imaging is used to visualise how metabolically active various tissues are

Question 33

what does phrenic nerve palsy present as

Answer 33

shortness of breath

Question 34

what is pemberton's sign

Answer 34

raising the hands over head causes facial congestion & cyanosis

Question 35

what does pancoats tumour compress?

Answer 35

sympathetic ganglion, in the pulmonary apex

Question 36

what cancer is assoc with ectopic PTH

Answer 36

squamous cell lung carcinoma

Question 37

small cell lung cancer causes immune system to make antibodies to tissues in the brain

Answer 37

limbic encephalitis

Question 38

symptoms of limbic encephalitis (4)

Answer 38

- short term memory impairment - hallucinations - confusion - seizure

Question 39

what antibodies is limbic encephalitis assoc. with

Answer 39

anti-hu

Question 40

pattern of muscle weakness in lambert eaton?

Answer 40

weakness gets worse with prolonged use

Question 41

muscles predominantly affected in lambert eaton?

Answer 41

proximal muscles

Question 42

other muscles affected & subsequent symptoms in lambert eaton?

Answer 42

- extraocular muscles --> diplopia - levator muscles in eyelid --> ptosis - pharyngeal muscles --> dysphagia & slurred speech