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Stage 4: CSIM 2 > Week 9: Lung cancer > Flashcards

Week 9: Lung cancer Flashcards

1
Q

Why is smoking highly associated with bladder cancer

A

Inhaled carcinogens are processed by liver then passed out in urine

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2
Q

In a pt with lung cancer, what does a hoarse voice indicate

A

Invasion of recurrent laryngeal N

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3
Q

What does Pancoast’s syndrome consist of

A
  1. Horner’s syndrome
  2. Chest wall pain
  3. T1 dermatome pain
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4
Q

What does Horner’s syndrome consist of

A
  1. Miosis (pupil constriction)
  2. Anhydrosis
  3. Partial ptosis
  4. Enophthalmos
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5
Q

What is Lambert-Eaton syndrome?

  • pathophysiology
  • symptoms
A

Ab against presynaptic calcium channels –> damaged nerves unable to produce sufficient Ach –> Muscle weakness

Muscle weakness is improved by exercise

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6
Q

Squamous cell lung cancer often invades the T1 nerve root.

How would you differentiate symptoms of this from a Median + Ulnar N palsy?

A

T1 nerve root invasion:
Sensory deficit in forearm

Median + Ulnar N palsy:
Sensory deficit in hand

Both have the same motor symptoms

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7
Q

2 week wait referral criteria for lung cancer

A
  1. CXR signs that suggest cancer

2. Age >40yo + unexplained haemoptysis

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8
Q

Types of lung cancer

A
  1. Adenocarcinoma in situ
  2. Small cell
  3. Squamous cell
  4. Large cell
  5. Mesothelioma
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9
Q

Causes of Horner’s syndrome

A
  1. Apical tumour
  2. Aortic dissection (eg in Marfan’s)
  3. Carotid body tumour
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10
Q

From where does adenocarcinoma in situ arise

A

Bronchial mucosal glands

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11
Q

From where does SCLC arise

A

Small cells in larger airways

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12
Q

From where does squamous cell lung cancer arise

A

Epithelial cells from central bronchi to terminal alveoli (so lesion may be seen centrally or peripherally)

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13
Q

From where does large cell lung cancer arise

A

Epithelial cells from central bronchi to terminal alveoli (lesion tends to be seen peripherally)

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14
Q

From where does mesothelioma arise

A

Surface serosal cells of pleura, peritoneal, pericardial cavities

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15
Q

CXR shows a central mass. Which lung cancers might it be?

A

Small cell

Squamous cell

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16
Q

CXR shows a peripheral mass. Which lung cancers might it be?

A

Squamous cell

Large cell

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17
Q

CXR shows diffuse nodules. Which lung cancers might it be?

A

Adenocarcinoma in situ

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18
Q

CXR shows cavitation. Which lungs cancer might t be?

A

Squamous cell

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19
Q

Most common lung cancer

A

Adenocarcinoma in situ

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20
Q

Which lung cancers are more aggressive?

A
  1. Small cell
  2. Large cell
  3. Mesothelioma
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21
Q

Which lung cancers cannot be cured surgically?

A
  1. Small cell

2. Mesothelioma

22
Q

Which type of lung cancer is particularly associated with clubbing

A

Squamous cell

23
Q

Which 2 types of lung cancer are more associated with skin mets

A
  1. Small cell

2. Squamous cell

24
Q

Which type of lung cancer is particularly associated with hypercalcaemia?
Pathophysiology of this

A

Squamous cell.

Due to PTHrP production

25
Q

Management of hypercalcaemia

A
  1. IV fluid

2. IV bisphophonates

26
Q

Which type of lung cancer is particularly associated with SIADH

A

Small cell

27
Q

Management of SIADH

A

Fluid restriction

Democlocycline

28
Q

Which type of lung cancer is particularly associted with Cushing’s?
Pathophysiology of this

A

Small cell

Due to ectopic ACTH production

29
Q

Where do lung cancers tend to mets to

A
  1. Liver
  2. Adrenal
  3. Bone
  4. Brain
30
Q

Diagnostic investigation for lung cancer

A

Biopsy

31
Q

Staging investigation for lung cancer

A

PET-CT

32
Q

Describe the order in which investigations are done in lung cancer

A
  1. CXR, Bloods (FBC, UnEs, LDH, serum calcium)
  2. CT chest abdo pelvis
  3. Biopsy
  4. PET-CT
  5. Investigation for mets (eg CT head, bone scan)
33
Q

What sign is pathognomic of SVCO

A

Non-pulsatile JVP

34
Q

Signs of SVCO

A
  1. Facial oedema
  2. Headache (due to cerebral oedema)
  3. Dyspnoea, chest pain, cough (due to venous distention of chest)
  4. Non-pulsatile JVP

Signs worsened by bending forward

35
Q

Causes of SVCO

A
  1. Compression/ invasion of the tumour

2. Thrombosis

36
Q

CXR findings in SVCO

A

Widening of superior mediastinum

superior mediastinum starts at top of ribs and ends at T4/T5

37
Q

Acute management of SVCO

A
  1. Sit upright

2. Dexamethosone

38
Q

Permanent treatment of SVCO

A
  1. Stent
  2. Radiotherapy
  3. Thrombolysis (if caused by thrombus)
39
Q

2 causes of hypercalcaemia in cancer

A
  1. PTHrP
    (100x more potent than PTH)
  2. Bony mets
40
Q

Which cancers (all organs) are more associated with hypercalcaemia

A
  1. Squamous cell lung cancer
  2. Breast cancer (due to bony mets)
  3. Renal cancer
  4. Head and neck, oesophageal cancer
41
Q

Signs of hypercalcaemia

A
  1. Rapid onset nausea
  2. Polyuria, polydipsia, dehydration
  3. Cardiac arrhythmias
  4. Confusion
42
Q

Definition of neutropenic sepsis

A
  1. Fever
    >38 on single reading or >37.5 on 2 readings over 1h
  2. Neutrophils <1.0 x10^9/L
  3. Unexplained hypotension/ tachycardia
43
Q

Treatments which cause neutropenic sepsis

A
  1. Chemotherapy (main cause)

2. Radiotherapy

44
Q

What investigations to do in neutropenic sepsis

A

Blood cultures, swabs, MSU, CXR

Note: examine all over but do NOT do PV/PR

45
Q

Empirical a/b to give in neutropenic sepsis

A

Tazocin/ gentamycin

46
Q

What level of platelets must you ensure to keep above when treating neutropenic sepsis

A

Platelets >20 x10^9/L

47
Q

What drug is preferably avoided in neutropenic sepsis

A

Paracetamol

48
Q

Most common endocrine neoplastic syndrome

A

SIADH

49
Q

Skin manifestations indicate stage what NSCLC and SCLC?

A

Stage 4

50
Q

Which cancer is associated with ectopic ACTH production?

Signs of this

A

SCLC

  • Cushing’s
  • Addison’s

Stage 4: CSIM 2 (47 decks)

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