W11 Friday PM A Case of Haemoptysis and SOB

Question 1

COPD: signs on physical exam (6)

Answer 1

hyperinflation: barrel chest, hyper-resonance, decreased breath sounds

Cyanosis

Prolonged expiration

Wheeze

Question 2

Normal RR?

Answer 2

12-16

Question 3

In the Australian adult population, clubbing is probably 3 respiratory diagnoses–> what are these?

Answer 3

Suppurative lung disease (NOT COPD–> bronchiectasis, empyema, TB)

Interstitial lung disease (idiopathic or asbestosis)

Bronchogenic cancer (NSCLC)

Question 4

What is the 5 year survival for NSCLC? Why?

Answer 4

15%, because lots of lung cancers present late. (even though 5 year survival of stage 1 cancer is 60-80%)

Question 5

What is the most important ddx for MID back pain in an elderly patient with lung cancer? (2)

Answer 5

bony mets

osteoporotic crush fracture.

Question 6

Worsening cough, recent haemoptysis and long standing SOB in a smoker: Ddx (6)

Answer 6

lung cancer, PE, COPD with exacerbation, bronchiectasis (can have acute exacerbations where chronic colonisation flared up), pneumonia, heart failure

Question 7

How does a PET scan work?

What structures are PET scan positive?

Answer 7

Radioactive glucose (not real glucose, deoxyglucose, gets taken up, starts to get metabolised and the gets stuck

Highly metabolic structures eg tumours

inflammation

Question 8

Lung cancer risk factors (6)

Answer 8

smoking is the most common risk factor. Other factors= radiation therapy, second hand smoke, asbestos, metals, pulmonary fibrosis.

Question 9

What are the factors that need to be taken into account in the context of lung cancer treatment? (8)

Answer 9

Genetic/ histopathological type of cancer, stage of the tumour, site of the tumour, co-morbidities, patients wishes, performance status, lung function, co-morbidities