CSI

Question 1

ECOG

fully active able to carry on pre disease performance

Answer 1

grade 0

Question 2

ECOG grade 1

Answer 2

restricted in physical activity but ambulatory and able to carry out work in light/ sedentary nature

eg office work/ house work

Question 3

ambulatory and capable of self care but unable to carry out any work activities
50% of waking hours up and about

Answer 3

stage 2 ecog

Question 4

stage 3 ecog

Answer 4

capable of only limited selfcare, confined to bed/chair more than 50% of waking hours

Question 5

stage 4 ecog

Answer 5

completely disabled cannot carry on any self care

totally confined to bed/chair

Question 6

stage 5ecog

Answer 6

dead

Question 7

signs of lung cancer?
examination findings?

what paraneoplastic signs?

Answer 7

consolidation, collapse
supraclavicular and axillary lymph node enlargement
pleural effusions: stony dull percussion note and decreased vocal resonance and breath sounds

cushing syndrome and siadh and lambert eaton - small cell
bony mets/ pth related peptide secretion

Question 8

management of SCLC

limited disease

Answer 8

cisplatin
etoposide
chest irradiation

Question 9

extensive disease?

Mx

Answer 9

chemo
cisplatin / etoposide
radiotherapy can be aplliative to reduce effects of metastatic disease

Question 10

complications of SCLC?

Answer 10

pneumonia

SVC compression

Question 11

common metastatses?

Answer 11

brain 
breast
liver
adrenals 
skin

Question 12

endocrien complications?

Answer 12

Ectopic ACTH (1%): Cushing’s syndrome; ectopic ADH production (7–10%):
SIADH; hypercalcaemia (bony metastases or PTH-related peptide secretion).

Question 13

Investigations?

other

Answer 13

Lung function tests
fbc
u&e
ca2+
alkphos 
lft

Question 14

Ix
diagnosis
Staging

Answer 14

Diagnosis:
flexible bronchoscopy
Endobronchiol ultrasounded guided transbronchiol needle aspiration

> 3cm so not a central lesion

Sputum cytology, bronchoscopy with brushings and biopsy or percutaneous biopsy, thoracoscopy.
Staging: CT of chest, abdomen, head. Isotope bone scan.

Question 15

features of sclc
adh release?
acth?
muscle fatiguebility

Answer 15

hyponatraemia
cushings syndrome
acth levels can cause bilateral adrenal hyperplasia > high levels of cortisol > hypokalaemic alkalosis

lambert eaton syndrome

Question 16

which patients are considered for surgery?

Answer 16

t1-2a
N0
M0

Question 17

SVC obstruction

Answer 17

swelling of face/neck and arms
conjunctival and periorbital oedema

headaches worse in morning
visual disturbances
pulseless JVP distension

mx: radical chemo/radiotherapy

Question 18

why does SCLC present with addisons and cushing

Answer 18

Arise from endocrine cells (Kulchitsky cells). These are APUD cells, and as a result, these tumours will secrete many poly-peptides mainly ACTH.
They can also cause various presentations such as Addison’s and Cushing’s disease.

Question 19

what ct scan?

Answer 19

contrast enhanced

should also include adrenals and liver

Question 20

how is limited stage disease determined?

Answer 20

t1-4
n0-3
m0

Question 21

Mx limited disease SCLC

Answer 21

4 to 6 cycles of cisplatin-based combination chemotherapy.

Consider substituting carboplatin in people with impaired renal function, poor performance status (WHO 2 or more) or significant comorbidity.

Question 22

when can surgery be considered?

Answer 22

SCLC t1-2a
n0
mo

Question 23

t1a

Answer 23

tumour measuring 3cm without invasion in the main bronchus

t1a <1cm

Question 24

t1b

t1c

Answer 24

t1b 1-2cm

t1c 2-3cm

Question 25

t2

Answer 25

3-5cm bronchus associated with atelactasis

Question 26

t3?

Answer 26

5-7cm invades chest wall parietal pericardium phrenic nerve

Question 27

t4?

Answer 27

>7 associates with another lobe ipsilateral lobe carina

Question 28

n1

Answer 28

- N1: involvement of ipsilateral intrapulmonary, peribronchial, or hilar lymph nodes

Question 29

n2

Answer 29

N2: involvement of ipsilateral mediastinal or subcarinal lymph nodes

Question 30

n3

Answer 30

- N3: involvement of contralateral mediastinal or hilar nodes, or scalene or supraclavicular nodes on either side

Question 31

what is a central lesion

Answer 31

Central lesions are those located within 3 cm of the proximal bronchial tree, heart, great vessels, trachea, or other mediastinal structures

Question 32

when do you offer flexible bronchoscopy?

Answer 32

central lesion onCT

Question 33

for paratracheal and peri-bronchial intra-parenchymal lung lesions.

Answer 33

endobronchial ultrasound-guided transbronchial needle aspiration (EBUSTBNA

Question 34

small round or spindle-shaped cells with scanty cytoplasm, illdefined borders, and finely granular nuclear chromatin (salt-and-pepper pattern)

Answer 34

sclc

Question 35

most common lung cancer?

Answer 35

adenocarcinoma nsclc Glandular differentiation with mucin-containing elements. o Most express thyroid transcription factor-1 and napsin A.

Question 36

Characterised by the production of keratin, which may take the form of squamous pearls or cells with very eosinophilic cytoplasm

Answer 36

squamous cell carcinoma pthrp hyperparathyroidism but pth is low

Question 37

when do you offer EBUS TBNA?

Answer 37

paratracheal | peribronchial intra parenchymal lung lesions

Question 38

central lesions are located within 3cm of where?

Answer 38

``` bronchial tree heart great vessels trachea mediastinal structures ```

Question 39

m1a

Answer 39

nodules contralateral lobe pleura pericardium / effusions in pleural cavity /pericardium

Question 40

m1b

Answer 40

single extrathoracic mets

Question 41

m1c

Answer 41

multiple extra thoracic mets in 1> organs

Question 42

t4 is invades which structures

Answer 42

``` ƒ carina ƒ diaphragm ƒ great vessels ƒ heart ƒ mediastinum ƒ oesophagus ƒ recurrent laryngeal nerve ƒ trachea ƒ vertebral body ```

Question 43

thorascore

Answer 43

``` 55< male asa physical status 2< who 3< dyspnea 3< diagnosis comorbid 3 ```

Question 44

glandular differentiation with mucin containing elements

Answer 44

adenocarcinoma

Question 45

expresses thyroid transcription factor 1 and napsin A

Answer 45

adenocarcinoma

Question 46

charecteristic protein markers of squamous cell?

Answer 46

p63 | p40

Question 47

Cells have large nuclei, prominent nucleoli, and a moderate amount of cytoplasm.

Answer 47

large cell carcinoma

Question 48

category 2 dyspnea

Answer 48

moderate degree walks slower

Question 49

moderately severe degree | 3

Answer 49

Moderatly severe degree of dyspnea (has to stop because of breathlessness when walking at own pace on the level)

Question 50

stage 4 dyspnea

Answer 50

category 4, Severe degree of dyspnea (stops for breath after walking about 100 yards or after a few minutes on the level)

Question 51

won't leave the house too breathless when dressing etc

Answer 51

stgae 5