Lung cancer TC

Question 1

Name for a primary pleural cancer

Answer 1

mesothelioma

Question 2

Cause of mesothelioma

Answer 2

asbestos

Question 3

Two basic types of lung cancers

Answer 3

Small cell 24% and non small cell 76%

Question 4

Commonest type of non small cell carcinoma

Answer 4

squamous 48%

Question 5

small cell carcinoma look

Answer 5

Small cells, little cytoplasm, large nuclei, stain blue

Question 6

What is stridor

Answer 6

Expiratory wheeze

Question 7

Damage of the left mediastinum

Answer 7

left recurrent laryngeal nerve - horse voice

Question 8

On CXR raised hemi diaphragm?

Answer 8

phrenic nerve damage

Question 9

What does the position of the mediastinum tell you about the lung cancer?

Answer 9

If it is causing an effusion or a collapse

Question 10

Describe pancoast syndrome

Answer 10

Look at clavicals - a supraclavicular fossa has filled in. May effect the brachial plexus.

May have Hornors syndrome - causes a small pupil

Question 11

Superior vena caval obsturction symptoms

Answer 11

facial and hand sweating, worse in the mornings. Headaches

Question 12

Hormone from squamous carcinomas

Answer 12

parathyroid hormone - high calcium

Question 13

Hormones from small cell Cx

Answer 13

ACTH and ADH

Question 14

Treatment of choice for small cell Cx

Answer 14

chemotherapy

Question 15

Treatment of choice for non small cell

Answer 15

Surgery

Question 16

Which type of lung cancer is most aggressive

Answer 16

Small cell

Question 17

Lung cancer differentials

Answer 17

TB
2. Pneumonia
3. Lung metastases from other primary eg breast
4. Benign lung tumours
5. Rarities
egWegener’s granulomatosis

Question 18

Best investigation in 2/3rds of patients

Answer 18

fibroptic bronchoscopy

Question 19

Reasons why a patient might not be able to have surgery?

Answer 19

General issues
Respiratory fitness
Cardiovascular fitness

Question 20

Is the tumour good for surgery?

Answer 20

Staging CT scan and FDG-PET scan

Question 21

EGFR and lung cancer

Answer 21

Sample tumour, if Epithelial Growth Factor Receptor positive you can use specific chemo - gefitinib.

Question 22

Investigation to confirm or exclude intrathoracic lymph node mets?

Answer 22

PET scan

Question 23

How to determine if a person in suitable for a major operation?

Answer 23

Physical examination and resp function test

Question 24

treatment for small cell lung cancer

Answer 24

Chemotherapy and radiotherapy

Question 25

Vena cava impingement lung cancer type

Answer 25

small cell

Question 26

Commonest cause of hypercalcaemia

Answer 26

malignancy

Question 27

Three organs that normally cause tranudate?

Answer 27

Heart, liver, kidney

Question 28

Main difference between transudate and exudate?

Answer 28

Exudate has more protein, more LDH.

Question 29

Pleural effusion protein greater than 0.4

Answer 29

TB pleural effusion

Question 30

Pleural effusion protein 7-8g/dL

Answer 30

Think Waldenstrom's macroglobulinaemia and multiple myeloma

Question 31

Glucose less than 60 or less than half of serum indicates

Answer 31

``` Rhumatoid pleurisy empyema malignancy Lupus Eosophageal rupture ```