Lung Cancers

Question 1

Anatomical Point of bifurcation of trachea?

Answer 1

carina

Question 2

what is stridor?

Answer 2

inspiratory wheeze

Question 3

why can you get hoarseness in lung cancer?

Answer 3

can get local invasion into recurrent laryngeal nerve

Question 4

dysphagia for solids is often a pointer to a tumour where?

Answer 4

oesophagus

Question 5

local invasion to the pericardium is one of the causes of?

Answer 5

atrial fibrilation

Question 6

In lung cancer, wasting of the small mucsles in the hand is due to?

Answer 6

T1 root infiltration by a primary lung cancer in the apex of the lung

Question 7

what happens when the tumour invades the pleural space

Answer 7

generates a large volume of pleural fluid

Question 8

why would a patient with LC get puffy eyelids and a headache?

Answer 8

local invasion of the SVC obstructs drainage of the blood from the arms and the head

Question 9

why would you get distended veins visible on the abdomen and thorax?

Answer 9

the blood flow is bypassing the obstructed SVC by opening up the anastomosis with the IVC tributaries

Question 10

when will the patient often describe pain which is worse at night?

Answer 10

when there is bone erosion

Question 11

when would you get localised chest wall pain, worse with movement?

Answer 11

when there is chest wall invasion

Question 12

primary sites of metastases for a primary lung cancer?

Answer 12

brain, liver, bone, lung, adrenal, skin

Question 13

how could liver mets present as obstructive jaundice?

Answer 13

mets can obstruct biliary drainage

Question 14

common presentation of bone mets?

Answer 14

localised pain which is worse at night, pathological fracture

Question 15

what type of scan can demonstrate skeletal mets?

Answer 15

isotope bone scan

Question 16

what are paraneoplastic symptoms?

Answer 16

features result from the effects of biochemically active products from the primary tumour. They are NOT indicative of metastatic disease.
features result from the effects of biochemically active products from the primary tumour. They are NOT indicative of metastatic disease.

Question 17

why can you get hypercalcaemia?

Answer 17

the tumour can produce a substance which mimics the effects of parathyroid hormone

Question 18

features of hypercalcaemia?

Answer 18

bones, stones, groans, psychiatric moans

headaches, confusion, thirst and constipation

Question 19

calcium can cause confusion in an older person, mimic dementia

Answer 19

y

Question 20

why would you get low sodium ?

Answer 20

1y tumour can produce a substance which mimics ADH, causing a low plasma sodium

Question 21

syndrome that mimics myasthenia gravis and causes weakness?

Answer 21

eaton lambert syndrome

Question 22

anyone with a new presentation of finger clubbing must have ?

Answer 22

a chest x ray

Question 23

why is thrombophlebitis common in patients with lung cancer?

Answer 23

It is a reminder of the increased coagulability of blood in cancer patients

Question 24

hypercalcaemia pneumonic/

Answer 24

stones (renal/biliary calculi)
bones (bone pain)
groans (abdo pain, nausea, constipation)
thrones(polyuria)
psychiatric overtones ( depression, anxiety, reduced GCS, coma)
ALSO CARDIAC ARRYTHMIAS

Question 25

treatment of high calcium?

Answer 25

rehydration

if very high on admission, can use IV biphosphonate

Question 26

SIADH associated with which kind of lung cancer?

Answer 26

small cell

Question 27

how does SIADH result in low sodium?

Answer 27

there is a diltution of solutes, resulting in low sodium

Question 28

what does coughing in a cancer patient feel like?

Answer 28

tying to cough something up but it won’t come

Question 29

almost all smokers cough something up in the morning. what does this look like

Answer 29

clear sputum

Question 30

when do you get haemoptysis?

Answer 30

when tumour invades through mucosa and causes bleeding

Question 31

why is localised chest wall pain worrying?

Answer 31

it indicates local chest wall invasion

Question 32

how does Positron Emission Tomography work?

Answer 32

scan to assess the function of the lungs
analysis of uptake of radio labelled glucose
tissues with high metabolic activity light up

Question 33

what do you need to make the diagnosis with certainty?

Answer 33

tissue biopsy

Question 34

how can you get a biopsy?

Answer 34

bronchoscopy (biopsy and brush cytology)

Question 35

what is medical thorascopy?

Answer 35

Under sedation and with local anaesthetic the semi-rigid scope is inserted between the rib spaces. The lung is deflated to allow visualisation of the pleural surfaces. Biopsies can be taken from the pleura

Question 36

risk factors for lung cancer?

Answer 36

smoking 
asbestos - increases risk of lung ca by a factor of 5
arsenic
radon
nickel
chromate
aromatic hydrocarbon
cryptogenic fibrosing alveolitis

smoking and asbestos are synergistic i.e. a smoker with long term asbestos exposure has a 10*5 risk = 50x risk

Question 37

what is often the first investigation done in patients with suspected lung cancer?

Answer 37

chest x ray (in patients who are diagnosed, 10% had a normal chest x ray)

Question 38

what is the investigation of choice for suspected lung cancers?

Answer 38

CT

Question 39

when would you do a PET scan?

Answer 39

non SCLC. aw my. are you eligible for curative treatment

Question 40

which lung cancer can cause gynaecomastia?

Answer 40

adeno (TT)

Question 41

which lung cancer associated with small cell lung cancer?

Answer 41

lambert eaton syndrome

Question 42

the two lung cancers seen exclusively in smokers?

Answer 42

scc and small cell

Question 43

adenocarcinoma, where is it seen in the lungs?

Answer 43

peripherally (arden)

Question 44

squamous cell (strap) where is it seen?

Answer 44

centrally

Question 45

which one secretes ACTH? which hormone does this cancer also secrete?

Answer 45

small cell lung cancer
A C T H
also secretes ADH

Question 46

which do you get high calcium in?

Answer 46

squamous cell (due to PTH)