week 4

Question 1

what are tyrosine kinase inhibitors (TKIs)

Answer 1

these drugs target tumours carrying specific mutations in adenocarcinoma (a non-small-cell lung cancer)

Question 2

how is radiotherapy to the brain given

Answer 2

radiotherapy to the brain is given prophylactically (“prophylactic” treatment is anything that is given to prevent something) as it is known that SCLC frequently spreads to the brain.

Question 3

what has the protein content of 3g/dl

Answer 3

this describes the protein content of an exudative effusion, which is caused by inflammation.

Question 4

what can liver failure cause

Answer 4

transudative pleural effusion
liver failure alters the protein composition of blood, and therefore alters the balance in oncotic pressure that maintains constant volume in the pleural cavity. This is therefore a process of fluid accumulation due to a change in filtration rather than inflammation, so causes a transudative effusion.

Question 5

what is PTH a feature of

Answer 5

sqaumous cell lung cancer

Question 6

what is stage IV

Answer 6

designates the development of distant metastases

Question 7

what percentage of smokers will develop lung cancer

Answer 7

10%

Question 8

what is radical treatment

Answer 8

any treatment given with the intent to cure the cancer

Question 9

what leeds to voice hoarseness

Answer 9

recurrent laryngeal nerve damage

Question 10

what will happen to the air filled cavity produced after a pneumonectomy

Answer 10

it will eventually fill with fluid

Question 11

what type of lung cancer is faster growing

Answer 11

SCLC - it has a doubling time of 29 days

whereas NSCLC has a doubling time of 129 days

Question 12

what type of pleural effusion does heart failure cause

Answer 12

left ventricular failure causes pulmonary vascular congestion, which forces more fluid into the pleural space. It is therefore a transudative process that causes the pleural effusion seen in heart failure.

Question 13

what type of pleural effusion does rheumatoid arthritis cause

Answer 13

exudative, Rheumatoid arthritis is a multi-system inflammatory disease, and the fluid accumulates due to inflammatory changes.

Question 14

what is prevelance of smoking cigarettes correlated to

Answer 14

economic deprivation, adults in the most deprived postcodes are three times more likely to smoke than adults in the least deprived postcodes.

Question 15

what would happen to the position of the mediastinum in lung collapse

Answer 15

it would shift towards the abnormal side, collapse involves loss of volume, so it creates a pulling force on the mediastinum, causing it to deviate towards the side of the collapsed lung.

Question 16

where do most pleural tumours arise from

Answer 16

most pleural tumours are metastatic deposits from cancer elsewhere – often lung or breast cancers.

Question 17

what is the pressure of pleural fluid

Answer 17

pleural fluid has a slight negative pressure, with the lowest pressure being at the apex. This negative pressure helps keep the surfaces of the lung, pleura and thoracic cavity adherent and facilitates breathing.

Question 18

what are Ectopic ACTH secretion and SIADH effects of

Answer 18

endocrine effects of small cell lung cancer.
ACTH = adrenocorticotropic hormone

SIADH = Syndrome of Inappropriate Antidiuretic Hormone secretion

Question 19

what are paraneoplastic syndromes

Answer 19

hormonal or chemical changes that occur in the body due to lung cancer, often as a result of the secretion of hormones by the primary tumour itself, or through immune system stimulation.

Question 20

where is a sqaumous cell carcinoma of the lung more likely to arise

Answer 20

squamous cell epithelium lines the larger central airways, and so this tumour type tends to arise centrally.

Question 21

does smoking increase the risk of bladder cancer

Answer 21

smoking does not just increase risk of lung cancer. Bladder cancer risk is increased three-fold by smoking (and the relative risks of many other cancers are also increased).

Question 22

what symptoms of lung cancer can radiotherpy be used to treat

Answer 22

bony pain (from metastases) and haemoptysis can be improved by palliative radiotherapy.

Question 23

where is adenocarcinoma of the lung more likely to arise

Answer 23

bronchioalveolar epithelial stem cells transform and undergo atypical adenomatous hyperplasia, developing into adenocarcinoma in situ and then invasive adenocarcinoma of the lung. This epithelium is found in small airways, so this cancer is more likely to arise peripherally.

Question 24

what does putting sterile talcom powder in the pleural cavity do

Answer 24

provokes an inflammatory reaction, which causes the visceral and parietal pleura to fuse, preventing recurrence of pleural effusion.

Question 25

why are T4 lung tumours not surgically resectable

Answer 25

T4 tumours are locally advanced – i.e. invading into surrounding structures such as the aorta or the trachea, and so generally are not suitable for surgical resection.

Question 26

what is horners syndrome a sign of

Answer 26

an apical lung tumour, and results from compression of the sympathetic trunk. Patients with Horner’s syndrome have a constricted pupil (miosis), a drooping eyelid (partial ptosis), and decreased sweating (anhidrosis) on the affected side.

Question 27

how many carcinogens do cigarettes contain

Answer 27

over 60 known

Question 28

regarding lights criteria how would u know if effusion is exudative

Answer 28

If the pleural fluid protein concentration is more than half the serum protein concentration

Question 29

what is a pulmonary mass classed as in a chest xray

Answer 29

an opacity over 3cm

Question 30

by what percent does giving chemo and radio concurrently increase survival rates

Answer 30

5%

Question 31

what are side effects of radiotherapy

Answer 31

pulmonary fibrosis, oesophagitis, ulceration and burning to skin and pericarditis.

Question 32

can PET/CT show the metabolic activity of a lesion

Answer 32

PET imaging involves injection of a radio-labelled glucose analogue. High uptake of glucose (i.e. a high metabolic activity) will therefore show up on the scan as a bright spot, and this may identify metastatic deposits (as cancers typically have high metabolic activity due to their rapid growth).

Question 33

how long after asbestos exposure does it take foe mesothelioma to develop

Answer 33

20-40 years

Question 34

what is adjuvant treatment and when is it given

Answer 34

Adjuvant treatment is chemotherapy or radiotherapy that is given after surgery to resect a lung cancer.

Question 35

what imaging modality allows site of drainage in pleural effusion to be marked

Answer 35

ultrasound imaging allows the fluid to be visualised and quantified with the patient in a seated position, and a marking can be made on the skin to show a safe site for needle insertion and fluid drainage. This cannot be done from a CXR because it is a 2D image, and a CT scan is performed in a supine position, so fluid would move as soon as the patient sits up!

Question 36

what type of lung cancer has a faster response to treatment

Answer 36

Small cell lung cancer tends to have a faster response to treatment than non-small-cell lung cancer. because these cancers grow quickly and are highly metabolically active, they are also vulnerable to treatment and respond quickly.

Question 37

where does lung cancer commonly metastasize to

Answer 37

adrenal gland

Question 38

what type of cancer is the highest mortality worldwide

Answer 38

lung cancer

Question 39

can lung cancer which had spread to mediastinal lymph nodes be resected

Answer 39

no

Question 40

does risk of heart attack decrease when u quit smoking

Answer 40

15 years after stopping smoking, heart attack risk returns to that of a never-smoker. An encouraging reason to stop smoking!

Question 41

can a pneumothorax resolve without treatment

Answer 41

yes, small pneumothoraces in well patients can simply be monitored, as the air will eventually be absorbed by the pleura.

Question 42

can lung cancer cause bronchiectasis

Answer 42

yes, small airway obstruction by a lung tumour can cause the abnormal dilatation of airways known as bronchiectasis.

Question 42

can lung cancer cause bronchiectasis

Answer 42

yes, small airway obstruction by a lung tumour can cause the abnormal dilatation of airways known as bronchiectasis.

Question 43

what must the estimated post operative FEV1 value be to be considered for resective surgery

Answer 43

at least 1L, less than this will likely cause severe breathlessness

Question 44

who do primary pneumothoraces occur in

Answer 44

people with no pre-existing lung disease

Question 45

can lung cancer be staged from a chest xray

Answer 45

people with no pre-existing lung disease

Question 46

is it more likely for a patients cancer to be upstaged or downstaged

Answer 46

up to 15% of patients will have their cancer UPstaged. This is because PET/CT can detect small foci of high metabolic activity (likely metastases) that may have been missed on CT imaging.

Question 47

what is lights criteria for exudative effusion

Answer 47

Pleural fluid protein/Serum protein >0.5

Pleural fluid LDH/Serum LDH >0.6

Pleural fluid LDH >2/3 the upper limit of the lab reference range for serum LDH

Question 48

what can be used instead of surgery

Answer 48

Very high dose radiotherapy can be used instead of surgery in some patients with lung cancer, to remove tumours by ablation. it involves a short coarse of very high dose radiation