Brainscape's Knowledge GenomeTM

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


See full index

Year 3 > Week Six - Case One > Flashcards

Week Six - Case One Flashcards

1
Q

what are 95% of lung cancer

A

carcinoma of the bronchus

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

what are 2%

A

alveolar tumours

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

when does death normally occur

A

after 30 ‘cell doublings’ of malignant cells

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

what cancers can you get lung secondaries from

A

Breast
Kidney
Uterus
Ovary
Testes
thyroid

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

what is the one year survival rate

A

20%

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

what is the 5 year survival rate

A

5%

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

what is the most common type of cancer worldwide

A

lung cancer

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

how many deaths a year in the UK are due to lung cancer

A

32,000

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

what is the male to female ratio

A

3:1

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

it is the ‘what’ most common death in the UK

A

it is the third most common death in the UK

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

what percentage of lung cancer cases does smoking cause

A

90%

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

what is the worst type of asbestos

A

there are three colours, white blue and brown

blue is the worst - you are only at risk when the asbestos is broken up - as this releases the fibres

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

what is the specific type of cancer asbestos produced

A

mesothelioma

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

what are the other causes of lung cancer

A

Living in an urban, as opposed to a rural area
Passive smoking increases the risk 1.5x
Asbestos
There are three colours of asbestos – white, blue and brown – blue is the worst! You are only at risk when the asbestos is broken up – as this releases the fibres. It usually causes a specific type of tumour – mesothelioma.
Arsenic (in batteries and paints and fertilizer)
Iron oxide
Chromium
Petroleum products
Oil
Coal mining – this link is controversial – it is not actually the coal, it is the haemotite (iron ore) and silica that causes the cancer. Evidence is controversial – some coal mining areas have a higher incidence than the general population, whilst other areas don’t.
Radiation
Radon
Scarring – e.g. post TB

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

what type of tumours tend to be associated with occupational factors

A

adenocarcinomas

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

what are the four types of bronchial carcinoma

A

small cell
adenoma
squamous cell carcinoma
large cell

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

what is the
- aetiology
- development time
- survival
- common location
of small cell carcinoma

A
  • 20-30% of cases
  • development time is 3 years- doubles in 30 days
  • survival rate is around 5%
  • found around the hilum/central of lung
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the
- aetiology
- development time
- common location
of adenoma

A
  • 30% of cases
  • development time is 15 years - doubles in 200 days
  • most often found peripherally - therefore present late because they are less likely to cause obstruction symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the
- aetiology
- development time
of sqamous cell carcinoma

A
  • 35% of all cases
  • 8 years development time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the
- aetiology
- common location
of large cell carcinoma

A
  • 15% of cases
  • presents centrally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

why do tumours arising in the main bronchus tend to present earlier than those arising in the small bronchus

A

because they will cause far greater symptoms at an early stage

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

what percentage of tumours are in the lobar bronchi

A

80%

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

how is squamous cell carcinoma usually present

A

as obstructive lesions of the bronchus leading to infection

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

what can squamous cell carcinoma sometimes do

A

cavitates

this will occur when the central part of the tumour undergoes necorisis

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

what does lung cancer usually cause

A

hypercalcaemia

by bone destruction or production of PTH analogues

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

where do adenocarcinomas arise from

A

mucous cells in the bronchial epithelium

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

where do adenocarcinomas commonly invade

A

the mediastinal lymph nodes and the pleura, and spreads to the brain and bones

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

do adenocarcinomas usually cavitate

A

no

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

what can adenocarcinomas cause

A

excessive mucous secretion

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

what are large cell carcinomas `

A

basically just less well differentiated versions of adenocarcinomas and squamous cell carcinoma

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

what do large cell carcinomas do early on

A

metastatise early and therefore are associated with poor prognosis

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

what are bronchoalveolar cell carcinomas

A

very rare
a variation of adenocarcinoma
account for 1-2% of all lung carcinoma

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

how will bronchoalveolar cell carcinomas present

A

as a single nodule, or many small nodular lesions

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

what do bronchoalveolar cell carcinomas cause are major symptom

A

occasionally they cause production of huge amounts of mucous (which will be coughed up as sputum)
may appear like consolidation on the CXR
Causes ‘bronchorrhoea’ – diarrhoea of the bronchus – produces huge amounts of white sputum!

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

what do small cell carcinomas arise from and what is their nickname

A

arise from endocrine cells (Kulchitsky cells)

oat cell carcinomas

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

what type of cells are Kulchitsky cells

A

APUD cells, and as a result, there tumours will secrete many poly-peptides

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

what will some of these polypeptides do

A

cause auto-feedback to induce further cell growth

they can also cause various presentations such as Addison’s and Cushing’s disease

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

what do small cell carcinomas respond to and what is the prognosis

A

they respond to chemotherapy but prognosis is generally poor

they spread very early, and almost always inoperable at presentation

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

what are the two types of APUD cells

A

Open – secrete products in response to luminal contents, as well as nervous and hormonal stimuli

Closed – have no luminal receptors, and just respond to nervous and hormonal stimuli.

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

what are tumours of the apex of the lung called

A

superior sulcus tumours

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

what can superior sulcus tumours cause

A

severe pain - can affect the lower part of the brachial plexus - C8,T1 and T2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

where will this cause severe pain

A

in the shoulder and down the inner surface of the arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is Pancoast’s tumour

A

They can also spread to the chest wall, damaging the intercostal nerves, or even the brachial plexus and causing severe pain. This is caused by tumours in the apex of the lung (called superior sulcus tumours), and they can affect the lower part of the brachial plexus – C8, T1 and T2 – and this will cause severe pain in the shoulder and down the inner surface of the arm. There is also weakness of the hand. This is known as Pancoast’s tumour.

And the pain this causes is known as pancoast’s syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what can this lead to the loss of

A

the first rib - the tumour eats it up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what is any atypical tumour

A

Pancoast’s tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what may also be involved and if it is - what can it result in

A

the sympathetic ganglion may also be involved

if this is damaged it can result in Horner’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is Horner’s syndrome

A

it results from damage to the sympathetic nervous system. in this particular case, it results from damage to the sympathetic chain at or above the stellate ganglion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

where are these ganglion and therefore what type of tumour would have to cause this

A

these ganglia lie on the outside of the thoracic vertebrae, so it would have to be a central posterior tumour that would cause this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what are the clinical features of Horner’s syndromw

A

Clinical features of Horner’s Syndrome include a drooping eyelid (ptosis) resulting from improper innervation of the superior tarsal muscle, ‘upside-down’ ptosis, miosis (constricted pupil) and dilation lag.

There may also be anhydrosis (decreased sweating) and enophthalmosis (an impression that the eye has sunk in) on the affected side of the face. There may also be dilation of blood vessels on the affected side, resulting in flushing, and a blood shot eye.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what can the primary tumour or lymph nodes do

A

metastasise and spread to the mediastinum and invade or compress the heart, oesophagus, superior vena cava, trachea, and phrenic or left recurrent laryngeal nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what does compression of the SVC cause

A

early morning headache, oedema of the upper limbs, facial congestion and distension of the jugular vein and veins on the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what may be affected with nodal presentation

A

supraclavicular and mediastinal lymph nodes can be affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

where are the normal blood borne mets

A

Blood borne – mets to the liver, bone adrenal glands, skin and brain. Mets in the brain can cause change in personality, epilepsy, or a focal neurological lesion. The deposits in the adrenal glands are rarely symptomatic, but often found on post mortem.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what is the ADH manifestations of bronchial carcinoma

A

inappropriate ADH secretion

this causes hyponatraemia - by denying the patient fluids, you can bring the fluid back to normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what does ectopic ACTH secretion cause

A

Cushing’s syndrome, will produce symptoms similar to those on steriods, and these patients (unlike those on steroids) will be very heavily pigmented

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what is hypercalcaemia in bronchial carcinoma usually due to

A

the secretion of PTH (parathyroid hormone related peptides) This mostly occurs with squamous cell cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what are endocrine disturbances typically associated with

A

small cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is the definition of paraneoplastic syndromes

A

non-endocrine, non-metastatic complication

these can be present several years before the tumour itself presents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what the neurological complications (2-16%)

A

Polyneuropathy – caused by antibodies against the myelin sheath – the damage is irreversible. It can present with virtually any neurological symptom.

Cerebellar degeneration – and other encephalopathies.

Lambert-Eaton Syndrome – essentially myasthenia gravis secondary to lung carcinoma. Other muscular condition may also occur.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what are the vascular and haematological complications

A

Thrombophlebitis migrans
Anaemia – can be microcytic or normocytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what is HPOA

A

hypertrophic pulmonary osteoarthropathy

this occurs in 3% of cases (mostly small cell and adenoma). There will be joint stiffness, and severe pain in the wrists and ankles, sometimes also gynaecomastia. On x-ray there will be proliferative periostitis at the ends of the long bones, which have an ‘onion skin’ appearance. This is also associated with finger clubbing where cancer is the cause. It is thought to be caused by a blood borne factor released by the tumour – when patients have the primary tumour removed the pain goes away!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what is finger clubbing caused by and what is it the result of

A

caused by non-small cell carcinoma

this is thought to be a result of ecptopic hormone production which occurs in approx . 10% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what does carcinoid syndrome present with and how is it diagnosed

A

Carcinoid syndrome – This presents with hepatomegaly, flushing and diahrroea – Diagnosed using 24 hour urine 5-HIAA tests.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what is the frequency of the symptoms present in bronchial carcinoma

A

Cough 41
Chest Pain 22
Cough and pain 15
Coughing blood (haemoptysis) 7
Chest infection <5
Malaise <5
Weight loss <5
Shortness of breath <5
Hoarseness <5
Distant spread <5
No symptoms <5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what do many patients have

A

co-existing COPD

66
Q

what is the type of pain patients feel

A

fullness in the chest - later it may develop to a severe persistent pain

67
Q

what is usually the earlier symptom

A

cough

68
Q

what is common with tumours arising in the central bronchi

A

haemoptysis is common
occasionally these tumours may invade large blood vessels which can cause a massive haemopysis that can be fatal

69
Q

what type of pneumonia is telling of bronchial carcinoma

A

Pneumonia – if this is recurrent at the same site, or is slow to respond to treatment, then this is suggestive of bronchial carcinoma. Tumours the block the bronchi prevent the proper functioning of the mucociliary escalator, and thus bacteria are retained behind the blockage.

70
Q

when is stridor present

A

when there is an obstruction above the main carina

71
Q

what is a monophonic and polyphonic wheeze

A

monophonic wheeze indicates there is only one obstruction - this is an ominous sign as the most probable cause is carcinoma

polyphonic wheeze is more suggestive of many airway blockages

72
Q

what does hoarseness of the voice suggest

A

that there is left laryngeal involvement, particularly if there is also a bovine cough

if this involvement is present, then the tumour is inoperable

73
Q

what are the ten natures of presentations

A

Typically, respiratory symptoms that do not respond to other standard treatments (e.g. cough that doesn’t respond to antibiotics)
Persistent symptoms
Change in nature of chronic ‘smoker’s cough’
History of smoking!
Isolated incidences of haemoptysis
Weight loss
Decreased appetite – as a result of the inflammatory reaction that the tumour induces – particularly TNF that is released
HPOA
Hoarseness of voice – involvement of the vocal chords of left recurrent laryngeal nerves
Pancoasts’ tumour

74
Q

what does a physical examination show

A

usually normal, unless there is a significant bronchial obstruction or the tumour has spread

75
Q

what would absent lung sounds and dullness to percussion at the lung bases suggest

A

phrenic involvement - as this will cause unilateral raising of the diaphragm

76
Q

what type of tumours will be visible on X ray

A

symptomatic tumours

77
Q

when can asymptomatic tumours be seen on X ray

A

when they are greater than 1cm in diameter

78
Q

when will tumours confined to the central airways be visible

A

on bronchoscopy and CT

79
Q

what percentage of lung cancers present with a mass

A

70%
virtually all small cell carcinomas and squamous cells will present as a visible mass

adenocarcinomas tend to occur more around the periphery of the lung than other regions

80
Q

what can bronchial carcinoma appear as

A

Bronchial carcinoma can appear as a round shadow on an x-ray. It typically has a jagged edge, although this may not be distinguishable. It may also appear as a cavity.

81
Q

what does bronchial carinoma spread to the lymphatic channels cause

A

This causes lymphangitis carcinomatosa which will cause dyspnoea and may causing a streaky shadowing on the x-ray. This is usually unilateral. If it is bilateral that it is more likely to be due to lung mets from other primaries, usually one from below the diaphragm, e.g. in the stomach or colon.

82
Q

what is CT useful for q

A

looking for disease in the mediastinum and can also detect masses that are too small to be seen on CXR <1cm diameter

83
Q

what is PET useful for

A

staging

84
Q

what are the points with PET scanning

A

It is also useful for staging – where the f-deoxyglucose PET scan is employed.
No point in doing a PET if you don’t plan to operate! Basically it just tells you if it has spread – thus if it is suitable for surgery.
You would normally do a staging CT first – if this is clear, then you use a PET to look for more distant spread. If it all looks clear, then you can operate.
This is about 90% accurate for mets
On the PET results you look at the SUV value – the higher this is, the more likely the lesion is to be metastatic spread (scale is about 1-9)

85
Q

what is bronchoscopy most useful to obtain

A

cytology and biopsy. Tumours that involve the first 2cm on either main bronchus are inoperable.

86
Q

what may you also see on bronchoscopy

A

Widening of the angle of the carina – this suggests involvement of the mediastinal lymph nodes; either due to metastasis or they may be reactive. You can biopsy them on bronchoscopy by passing a needle through the bronchial wall.

Cytology – this is the study of cells that are no longer in their natural environmental structure – e.g. cell obtained from a bronchial washing. Histology is the study of both the cells, and the natural structure in which they are found.

Only really useful for tumours in an area about 10cm square around the hilum:

87
Q

what is percutaneous aspiration and biopsy - CT guided biopsy

A

This is useful for peripheral lesions that cannot be seen by bronchoscopy. It is done through the chest wall and usually guided by x-ray or CT.

This is able to reach 75% of peripheral lesions that cannot be reached by bronchoscopy.

The chance of pneumothorax is very high (anywhere between 1-25% – thus the patient has to be fit enough to survive one of these if you are going to do this on them. Twice as many patients will require a chest drain as receive a pneumothorax)

Haemoptysis will also occur in about 5% of patients

This is useful if positive, but if negative is pretty useless (i.e. it could just means you missed the part of the lesion you wanted)

88
Q

what are the other investigations for bronchial carcinoma

A

FBC – for detection of anaemia
LFT’s – to check for liver involvement
Biochemistry – hypercalcaemia, hyponatraemia
Increased Ca2+ – this will occur as a result of bone metastasis. May also be a result of secretion of parathyroid hormone.
Decreased sodium – this will occur as a result of adrenal involvement (Addisonianism).

89
Q

what is mediastinoscopy

A

Just put a cut just above the sternal notch and stick a camera down – helps to see in the mediastinum because you can’t see this very well on x-ray – checks for nodes in cases of peripheral tumours
You can get to post tracheal lymph nodes best.
PET has reduced the need for this procedure – it used to be done in all patients – now its only done in cases where they can’t decide if there is spread or not
Presence of any mediastinal disease is a contraindication for surgery
The procedure itself requires general anaesthetic, and thus many patients aren’t fit for it.

90
Q

what is the general prognosis rule for lung cancer

A

20% of the cases will survive to 12 months

6% will survive to 5 years

91
Q

what is non-small cell carcinoma staged using

A

the TNM system

92
Q

look up the TNM staging model

A
93
Q

what are the two classifications of small cell carcinoma

A

limited or extensive

SCC is extremely aggressive and metastasis occurs early

94
Q

what is limited small cell carcinoma

A

confined to one lung/hemithorax

may have spread to lymph nodes on the same side

95
Q

what is extensive small cell carcinoma

A

distant metastasis, may have spread liver, bones, adrenals, brain, skin

96
Q

what is the life expectancy for limited disease

A

on average, is around 3 months from presentation. with chemotherapy, this may be up to one year

97
Q

what is the life expectancy for extensive disease

A

on average around 1 month at presentation. with chemotherapy it can improve to around 8 months.

the 5 year survival is 5%

98
Q

what percentage of SCC and NSC respond to chemotherapy

A

90% of SCC but only 50% of NSC will

99
Q

what is offered treatment wise for TNM State 1 NSC

A

operable – 70% survival at 5 years after surgery. This is quite low for such a small cancer (~2cm)

100
Q

what is the treatment for TNM Stage 2 NSC

A

survival drops to 40% after surgery. This is because there are often tiny metastasis that you cannot see

101
Q

what is the treatment for TNM Stage 2a NSC

A

25% survival – although many surgeons don’t like to operate on these. Adjuvant chemotherapy, given after the operation, improves survival by 5%

102
Q

what is the treatment for TMN Stage 4 NSC

A

only chemotherapy offered. If you give no treatment – they have a 6% chance of being alive after 1 year. With chemotherapy, about 12% will still be alive after 1 year.i

103
Q

in general, how long does chemotherapy expand life span for

A

extends lifespan by two months. however, only about a half of patients respond to chemotherapy

104
Q

what percentage of cancers are suitable for surgery at presentation

A

only about 15-20%

105
Q

what are the currently recommend chemotherapy regimens for small cell carcinoma

A

Cyclophosphamide + doxorubicin + vincristine + etoposide,
or
Cisplatin + radiotherapy if the disease is limited

106
Q

what is the treatment regimen for chemotherapy

A

day one- bolus
day 14 - blood tests

107
Q

what happens during the 3rd week of each cycle

A

you may have blood transfusions and other treatments that help you to recover before the next cycle

108
Q

what classes who chemotherapy is available to

A

the WHO classification for performance status.

only available for those in 0-2 and under the age of 80

109
Q

what is prognosis determined by if there are brain mets

A

survival drops to 1-2 months. prognosis is determined by the brain mets, and no longer by the primary tumour

110
Q

why is surgery not appropriate for those over 6y5

A

as the operative mortality exceeds the survival rate

111
Q

what is a contraindication for radiotherapy

A

poor lung function

112
Q

what percentage of lung cancers are SCC and NSC

A

20% are small cell
80% are non small cell

113
Q

what are the four types of non-small cell lung cancer

A

Adenocarcinoma (around 40% of total lung cancers)

Squamous cell carcinoma (around 20% of total lung cancers)

Large-cell carcinoma (around 10% of total lung cancers)

Other types (around 10% of total lung cancers)

114
Q

what do small cell lung cancer cells contain

A

neurosecretory granules

115
Q

what do these neurosecretory granules release and what does this mean SCC is responsible for

A

release neuroendocrine hormones. may be responsible for various paraneoplastic syndromes

116
Q

what are the presenting features of lung cancer - 7

A

Shortness of breath
Cough
Haemoptysis (coughing up blood)
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy – often supraclavicular nodes are the first to be found on examination

117
Q

the next questions are on the extra pulmonary manifestations of lung cancer

A

Lung cancer is associated with a lot of extrapulmonary manifestations and paraneoplastic syndromes. These are linked to different types and distributions of lung cancer. Exam questions commonly ask you to suggest the underlying cause of a paraneoplastic syndrome. Sometimes they can be the first evidence of lung cancer in an otherwise asymptomatic patient.

118
Q

what do recurrent laryngeal nerve palsy patients present with

A

hoarse voice.

119
Q

what is recurrent laryngeal nerve palsy caused by

A

a tumour pressing on or affecting the recurrent laryngeal nerve as it passes though the mediastinum

120
Q

what is phrenic nerve palsy due to and what does it cause and present with

A

due to nerve compression, causes diaphragm weakness and presents with shortness of breath

121
Q

what is superior vena cava obstruction caused by

A

a direct tumour compression on the superior vena cava.w

122
Q

what does SVC obstruction present with

A

facial swelling, difficulty breathing, and dissented neck and upper chest veins

123
Q

what is Pemberton’s sign

A

where raising the hands over the head causes facial congestion and cyanosis

124
Q

SVC obstruction is a medial emergency

A
125
Q

what is Horner’s syndrome a triad of

A

a triad of partial ptosis, anhideosis, and mitosis

126
Q

what can Horner’s syndrome be caused by

A

Pancoast tumour (found in the pulmonary apex) pressing on the sympathetic ganglion

127
Q

what presents with hyponatremia that is related to lung cancer

A

syndrome of inappropriate ADH can be caused by ectopic ADH secretion by a small cell lung cancer

128
Q

what can Cushing’s be caused by

A

Cushing’s syndrome can be caused by ectopic ACTH secretion by a small-cell lung cancer.

129
Q

what can hypercalcaemia be caused by

A

Hypercalcaemia can be caused by ectopic parathyroid hormone secreted by squamous cell carcinoma.

130
Q

what is limbic encephalitis

A

paraneoplastic syndrome where small-cell lung cancer causes the immune system to make antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas. This causes symptoms such as short-term memory impairment, hallucinations, confusion and seizures. It is associated with anti-Hu antibodies.

131
Q

what is Lambert-Eaton myasthenic syndrome

A

Lambert-Eaton myasthenic syndrome is caused by antibodies against small-cell lung cancer cells. These antibodies also target and damage voltage-gated calcium channels sited on the presynaptic terminals in motor neurones. This leads to weakness, particularly in the proximal muscles. It can also affect the intraocular muscles, causing diplopia (double vision); levator muscles in the eyelid, causing ptosis; and pharyngeal muscles, causing slurred speech and dysphagia (difficulty swallowing). Patients may also experience dry mouth, blurred vision, impotence and dizziness due to autonomic dysfunction.

132
Q

what are the NICE guidelines for suspected cancer

A

recommend offering a chest x-ray carried out within 2 weeks to patients over 40 with:
Clubbing
Lymphadenopathy (supraclavicular or persistent abnormal cervical nodes)
Recurrent or persistent chest infections
Raised platelet count (thrombocytosis)
Chest signs of lung cancer

133
Q

what are the two KEY examination findings that automatically indicate an urgent chest x ray

A

finger clubbing and supraclavicular lymphadenopathy.

these are quick things to check for and can save a patients life

134
Q

who else to NICE also recommend offering a CXR to

A

patients over 40 years old who have:
Two or more unexplained symptoms in patients that have never smoked

One or more unexplained symptoms in patients that have ever smoked or had asbestos exposure

135
Q

what are the unexplained symptoms that NICE list

A

Cough
Shortness of breath
Chest pain
Fatigue
Weight loss
Loss of appetite

136
Q

what is the first line investigation for lung cancer

A

chest x ray

137
Q

what findings on a CXR suggest cancer

A

Hilar enlargement
Peripheral opacity (a visible lesion in the lung field)
Pleural effusion (usually unilateral in cancer)
Collapse

138
Q

what is used in a CT staging scan

A

contrast enhanced scan using injected construct

139
Q

what do PET-CT scans involve

A

PET-CT (positron emission tomography) scans involve injecting a radioactive tracer (usually attached to glucose molecules) and taking images using a combination of a CT scanner and a gamma-ray detector to visualise how metabolically active various tissues are. They help identify metastases by highlighting areas of increased metabolic activity.

140
Q

what is EBUS

A

Bronchoscopy with endobronchial ultrasound (EBUS) involves endoscopy with ultrasound equipment on the end of the scope. This allows detailed assessment of the tumour and ultrasound-guided biopsy.

141
Q

what is offered first line to patients with non-small cell lung cancer with disease isolated to a single area

A

surgery

142
Q

what are the three options for removing a lung tumour

A

Segmentectomy or wedge resection involves removing a segment or wedge of lung (a portion of one lobe)

Lobectomy involves removing the entire lung lobe containing the tumour (the most common method)

Pneumonectomy involves removing an entire lung

143
Q

what does a thoracotomy scar in your OSCEs indicate

A

either a lobectomy, a pneumonectomy, or lung volume reduction surgery for COPD.

144
Q

what does a right-sided mini thoracotomy incision in a cardiology station likely mean

A

minimally invasive mitral valve surgery

145
Q

what does absent breath sounds on an entire side indicate

A

a pneumonectomy

146
Q

what do focal absent breath sounds suggest

A

a lobectomy

147
Q

what were lobectomies and pneumonectomies used to treat in the olden days

A

TB

148
Q

what is the most common subtype of lung cancer in non-smokers and females

A

adenocarcimona

149
Q

why are patients kept in the department for 15 minutes after a contrast injectionn

A

in case of allergic reaction

150
Q

what is the mechanism of action of Lambert-Eaton syndrome

A

autoantibodies that block acetyl-choline being released

the symptom is muscle weakness

151
Q

what is the mechanism of action and symptoms of hypertrophic oestoarthropathy

A

new bone formation in periosteum in the forearms and lower legs

marked clubbing and pain

152
Q

what is the diagnosis of cancer confirmed with

A

biopsy

153
Q

how do most pet scans work

A

by injecting a radio tracer called fluorodeoxyglucose which is similar to naturally occurring glucose

154
Q

what are the possible complications of a CT guided biopsy

A

pneumothorax
haemopytsis

155
Q

what are the molecular markers that can be performed in a liver biopsy

A

EGFR
ROS1
ALK
BRAF
KRAS

156
Q

why is it useful to identify mutations - what dos it allow for

A

allows for targeted drug therapy with tyrosine kinase inhibitors

157
Q

what is another class of drugs used in advanced lung cancer

A

immune checkpoint inhibitors

158
Q

what is the checkpoint protein on T cells

A

PD-1 is a checkpoint protein on T cells, ad binds to PDL-1 on cancer cells which results in the cancer cell evading attack

159
Q

what drug are patients started on if they had a high PDL-1 status

A

pembrolizumab

160
Q

when does immunotherapy related pneumonitis classically happen

A

within the first 3 months after starting therapy and presents with cough, shortness of breath

161
Q

what is immunotherapy related pneumonitis treated with

A

It is treated with steroids, intravenous methylprednisolone in more severe disease, or oral prednisolone in milder disease.

162
Q
A

Year 3 (63 decks)

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