Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

(Emily) semester 2 > week 4 in person lectures > Flashcards

week 4 in person lectures Flashcards

1
Q

lung cancer kills more than breast and prostate cancer combines

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

other factors aside from tobacco/smoking that causes lung cancers?

A

asbestos, environmental radon e.g. from granite, air pollution and urban environment

other occupational exposure, other radiation, pulmonary fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which two carcinogenic chemicals in tobacco smoke are the most toxic

A

polyclyclic aromatic hydrocarbons
n-nitrosamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Effect of carcinogenic chemicals?

A

Epithelial effects
there is a multi-hit theory of carcinogenesis, genomic damage, in a numbers game

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the two major tissue pathways of lung carcinogenesis?

A

invasive adenocarcinoma and invasive squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how does invasive adenocarcinoma occur

A

atypical adenomatous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

’’ ‘’ of squamous

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

oncogene addiction

A

a signular molecukar abnormlaity, is the primary driver to the evolution of the cancer
adeno

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is oncogene addiction more likely to occur in invasive adenocarcinoma or squamous cell/small cell

A

adenocarcinoma???

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
A

squamous cell/small cell
everything to do with tobacco, less so with the other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Are the oncogenic drivers suitable for targeting by drugs?

A

most are, but only like 4 approved in UK. Most not approved by NHS Scotland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In particular for squamous cell carcinoma, are the oncogenic drivers suitable for targeting by drugs?

A

not really

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Metastases to the lung are uncommon

A

false

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

4 main histological types of lung cancer:

A

squamous cell
adenocarcinoma
small cell carcinoma
large cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Binary distinction between small cell carcinoma and otherwise?

A

There is NSCLC vs small cell carcinoma SCLC

However NSCLC, it’s important to distinguish between squamous cell and adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Primary lung cancers are often asymptomatic

A

yes, they grow clinically silent for many years- symptoms present late in natural history

‘Symptomatic lung cancer is fatal lung cancer’
Most cured is incidentally found lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

squamous cell carcinoma frequently cavitate, so it may look like:

A

a hole in the lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

bronchial tumors bleed, yes or no

A

yes hence coughing up blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

local effects of lung cancer?

A

bronchial obstruction (collapse)
endogenous lipoid pneumonia
infection/abscess
bronchiectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

lung infection more common when blockage of bronchus

A

yh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Local effect of lung cancer on pleura?

A

inflammatory, and from pleura to chest wall/mediastinum (malignant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Radiological change to pleura may not be due to malignancy, but just inflammation

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Would a surgeon ever take some rib?

A

in certain conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Direct invasion of nerves due to lung cancer, name the 4 symptoms:

A

diaphragmatic paralysis
hoarse, bovine cough
pancoast T1 damage
horner’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

damage to phrenic nerve due to cancer leads to what

A

diaphragmatic paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

damage to l recurrent laryngeal nerve due to cancer leads to what

A

hoarse, bovine cough SO IMPORTANT TO RECOGNIZE BOVINE COUGH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

don’t sweat on one side of their face=

A

horners. Potentially due to lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

damage to recurrent plexus (perhaps due to lung cancer metastasis) is what

A

pancoast T1 damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

damage to cervical sympathetic nerves is called what syndrome

A

horner’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Small cell secrete hormones like

A

ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Squamous cell secrete hormones like

A

P.H see lecture slide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Small cell carcinoma is the worst, true or false

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Can oncogenic drivers be targeted for therapy?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

In squamous cell, there is little or no effective molecular therapy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Immunotherapy: recogmises PD1/PD-L1 interaction, allows cancer cells to flourish. It’s an immune checkpoint in NSCLC. True or false

A

true. It’s a therapeutic target

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

immune checkpoints are adopted by tumours to avoid immune destruction. so we need what

A

immune checkpoint inhibitors are gaining increased use in lung and other cancer therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What do we see on a full blood count?

A

neutrophils, macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What causes the pus in COPD?

A

acute inflammatory cell (neutrophil polymorph) causes pus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

haemoptysis- what’s the first disease you think of, for an elderly smoker

A

lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Elderly smoker with many pack years cough up blood. What do you do next?

A

CT for bone
CXR
MRI for the soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When tumours outgrow blood supply, what happens?

A

necrosis
blood vessels burst
leading to blood in sputum

also can cough up necrotic tissue, and blood from cavity

42
Q

What causes cavitation?

A
43
Q

Main complications of a cavity

A

also can cough up necrotic tissue, and blood from cavity
get bacteria or fungi in cavity and this causes infection

44
Q

What’s dysphagia?

A

difficulty swallowing

45
Q

Why might someone have difficulty swallowing?

A

Is oesophagus narrowed?
Or problem with larynx? Pharynx? Stomach?

46
Q

Difficulty swallowing, think oesophagus is narrowed, what do we do next

A

barium swallow, could see mass

47
Q

Treatment for flashcard 45?

A

too old for surgery, so have radiotherapy

48
Q

Tumour shrinks, vomits=

A

aspiration

49
Q

Endoscopy, ulcertaion

A
50
Q

place stent oesophagus down so she can swallow

A
51
Q

still vomits, then develops final illness:
fever, cough with cream-coloured sputum, breathlessness (dysnoea)

A

check sputum, positive culture. Then chest x ray, patchy white areas in the lung fields

diagnosis: pneumonia, possibly secondary to aspiration of food

52
Q

Why fever?

A

We’re not actually sure why. Bacteria like 37. But the physiology behind a fever is cytokines (produced by wbc like neutrophils , macrophages)
You feel cold, so that you get hot. Temp regulation goes up.

53
Q

What colour is sputum normally?

A

translucent

54
Q

If someone gets pneumonia, why do they get pneumonia?

A

Possibly upper respiratory tract infection, e.g. covid
Possibly aspiration- and it’s the larynx that stop stuff getting in the lungs
Flu, usually non-severe
You can have predisposition to bacterial infection by aspirating anything
Anyone with pre-existing lung disease
IV drug users

55
Q

Anything that affects cough reflex, therefore higher incidence of aspiration

A
56
Q

Treatment of pneumonia,

A

antibiotics, keep comfortable

57
Q

Green sputum, that’s dead bacteria, if sputum goes clear again, that’s a good sign

A
58
Q

Simple case of aspiration: anyone with blockage of oesophagus can aspirate food into larynx, and then lungs

A
59
Q

pneumonia could have lead to septicemic shock

A
60
Q

Why slice the tongue during an autopsy

A

epilectics bite their tongue

61
Q

Why black lungs

A

pollution

62
Q

purpose of stent

A

stop food from ulcerating the mucosa

63
Q

There is a decreasing prevalence in non-smokers for lung cancer

A

false, increasing- pollution?

64
Q

Who get’s more lung cancer, women or men

A

women

65
Q

Ten symptoms of lung cancer

A

chronic coughing
coughing up blood
wheezing sound (particularly new)
chest and bone pain
chest infections
difficulty swallowing
hoarse voice (recurrent laryngeal nerve)
sob
unexplained weight loss
nail clubbing

66
Q

What do I mean by ‘paraneoplastic’ symptoms

A

Of the liver, due to cancer you’re secreting hormones

67
Q

If coughing for how long, get a CXR?

A

three weeks

68
Q

5 initial investigations due to GP

A

CXR, FBC, Renal, liver functions, and calcium, clotting screen, spirometry

69
Q

Sometimes lung cancer can present as anemia, true or false

A

true

70
Q

practice looking at x-ray’s, and your technique

A
71
Q

EBUS

A

taking sample

72
Q

Bronchoscopy and EBUS are the most common investigations

A

true

73
Q

what type of lung cancer is most common

A

Both adenocarcinoma and squamous cell carcinoma

74
Q

If not radical treatment, it must be what

A

palliative (just improve quality of life)

radical is with curable intent

75
Q

PET scan is initial or further staging

A

for further staging

0-4 (4 is basically chair/bed bound)
3= ‘up and about’ < 50%

76
Q

Explain prognosis, and conditions of prognosis?

A

yes
be very honest

77
Q

Is chemotherapy radical or palliative?

A

both

78
Q

confirm cancer after imaging how

A

have tissue confirmation of malignancy

79
Q

what’s reflex testing

A

crack on and get results whether we need the results or not, for efficiency and time sensitivity

80
Q

If metastatic disease, with a large tumour burden, what type of treatment?

A

incurable disease, consider palliative treatments

81
Q

PE and hyponatraemia as complications of cancer are poor prognostic markers?

A

true

hyponatraemia = high calcium

82
Q

If PS3, largely housebound, frail, what treatment:

A

unsuitable for systemic anti cancer treatment
too frail to withstand toxicities of treatment

let them know they’re not just discarded, for the scrapyard. Consider explaining why qol

83
Q

Why might you consider an indwelling pleural catheter for palliation of breathlessness?

A

for ‘symptom directed care’/ palliative for quality of life

84
Q

Anticoagulate plus haemoptysis, concern?

A

Could increase- it’s a risk vs benefit judgement call. Anticoagulate was for the pulmonary embolism- which might contribute to breathlessness. So they were tryna ease sob. But capacity to reverse decision if need be.

85
Q

What to do next:
78F
general malasise
looks ‘well’ and ‘fit’, PS1
Palpable L supraclavicular lymph node
Ex-smoker of 22 years, used to be 20 a day

A

Take CXR
Take FNA from that lymph node to see if there is evidence of malignancy

86
Q

22 years ex smoker, has lung cancer, what type of cancer most likely?

A

adenocarcinoma

so the odds that there is an oncogenic carcinoma is high, vs if she was a life long smoker, where the odds would be low

87
Q

Patient with adenocarcinoma is fit, what treatment and what next

A

Potentially suitable for aggressive concurrent chem/rad, if no metastasis

Take PET scan to confirm
Also EBUS, and molecular analysis of EGFR mutation

88
Q

What’s the drawback of a PET scan?

A

Inflam vs malignancy

89
Q

Incurable disease, but has EGFR mutation?

A

consider palliative treatments
EGFR mutation- wouldn’t respond well to chemo. So suitable for systemic anti-cancer therapy, taken orally.

Response to these meds potentially up to 3 years of a normal qol
TKI targeted therapy

90
Q

57M joiner, haemoptysis, mild dysponea, smoker 36 pack years, family history of lung cancer, had been in hospital for rib/trauma issue where cavity was incidental finding

A

take bronchoscopy

91
Q

Squamous cell carcinoma locally aggressive, fit and well, what next

A

take PET scan

Surgery likely to give best chance of cure, may require adjuvant treatment

had completed left lower lobe lobectomy

92
Q

Shoulder pain and background of cancer, why is that worrying

A

potential of recurrent disease

93
Q

chemo and sepsis

A

don’t bode well together

edit card: why not

94
Q

What treatment might be super helpful for pain

A

radiotherapy

95
Q

82F
very fit
never smoked
mild sob on exertion
incidental finding of hiatus hernia, and lung nodule on CT
prev breast cancer, mastectomy

what next

A

Take CT, is this lung or breast?

So take PET scan

96
Q

Early-stage adenocarcinoma, consider what

A

radical treatment,
debate surgical resection vs radiotherapy

patient should have first refusal over this matter, as surgery really is best option

97
Q

small cell lung cancer has a propensity to spread where

A

the brain

and obviously brain metastasis would change the treatment intent

98
Q

smoking and radiotherapy:

A

radiotherapy relies on free radicals, so the more oxygen the better

99
Q

CT scan, every 6 months for about 5 years: for a check-up following an all-clear from lung cancer, does this sound about right?

A

yes

100
Q

Chemo doesn’t cross blood brain barrier, true or false

A

True

101
Q

Does lung cancer screening exist

A

Not YET

(Emily) semester 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions