L04: Respiratory Malignancies

Question 1

What is the angle of Louis

Answer 1

Point which is:
Bifurcation of trachea
Start of aortic arch
Azygous vein enters SVC

Question 2

What lines the lungs

Answer 2

Parietal and visceral pleura

Question 3

At which rib does the pleura meet

Answer 3

2nd rib

Question 4

Between which rib does the heart lie

Answer 4

3-6 ribs on right of sternum

Question 5

How many lobes are there on the left lobe

Answer 5

2

Question 6

What are the lobes of the left lobe called

Answer 6

Upper

Lower

Question 7

How many lobes does the right lobe have

Answer 7

3

Question 8

What are the lobes of the right lobe called

Answer 8

Upper
Middle
Lower

Question 9

What are the clinical features of lung cancer

Answer 9

Smoker
Haemoptysis 
Weight loss 
Dyspnoea
Cough 
Chest pain 
Hoarse voice

Question 10

What is haemoptysis

Answer 10

Coughing up blood

Question 11

What is dyspnoea

Answer 11

Breathlessness

Question 12

What are the common causes of lung cancer

Answer 12

Smoking
Asbestos
Radiation

Question 13

Which job is more likely to involve asbestos

Answer 13

Plumbing

Construction etc

Question 14

What is the mechanism of asbestos causing lung cancer

Answer 14

1) asbestos binds to epithelial growth factor receptor
2) this sets up a cascade reaction for proliferation of cells

Or
1) asbestos leads to proteases for the break down of cells

Or
1) asbestos leads to DNA damage that is transcribed

Question 15

If we suspect lung cancer what diagnosis method should take place

Answer 15

Chest x-ray

Question 16

To confirm likely lung cancer what diagnostic method is undertaken

Answer 16

CT chest scan

Question 17

If a patient is confirmed to have lung cancer what diagnostic method is used to used to find the type of cancer

Answer 17

Bronchoscopy

Biopsy

Question 18

Which diagnostic method is used to diagnose the stage of cancer

Answer 18

PET

Neck USS

Question 19

To see where the tumour is what method is used

Answer 19

CT scan

Question 20

What are the types of lung cancer

Answer 20

Non small cell lung cancer
Small cell
Carcinoid

Question 21

Within non small cell lung cancer what are the other subgroups of cancer

Answer 21

Squamous
Adenocarcinoma
Undifferentiated or mixed

Question 22

What is the division of the left and right bronchi called

Answer 22

Carina

Question 23

What is a complication of bronchoscopy

Answer 23

Bleeding from the tumour

Infection

Question 24

What are the types of samples we can take with bronchoscopy

Answer 24

Brushing
Washing
Biopsy

Question 25

What are the other wats to get tissue

Answer 25

EBUS | Cervical mediastinoscopy

Question 26

Where is small cell lung cancer derived from

Answer 26

Neuro endocrine tissue

Question 27

How do differentiate between different cell lung cancers

Answer 27

We use specific tumour markers

Question 28

Why do we use tumour markers

Answer 28

Cells express tumours which we can target for it to show positive on a film

Question 29

What does a PET scan enable us to see

Answer 29

If the tumour has spread elsewhere

Question 30

What nodes do we have along the trachea

Answer 30

Lymph nodes

Question 31

How do we stage non small cell lung cancer

Answer 31

We use TNM classification which is: Tumour Node Metastases

Question 32

How do we treat non small cell lung cancer

Answer 32

Surgery Radiotherapy Chemotherapy

Question 33

What is the treatment for small cell lung cancer

Answer 33

Chemotherapy

Question 34

How does metastases spread

Answer 34

Via lymphatic or blood

Question 35

What is common place of metastases

Answer 35

Pleura Brain Bone

Question 36

What do we use to treat brain metastases

Answer 36

Radiotherapy

Question 37

What are the local complications of lung cancer

Answer 37

Superior vena cava obstruction Horners syndrome Recurrent laryngeal nerve palsy Pleural effusion

Question 38

What are the features of superior vena cava obstruction

Answer 38

Fixed and raised jugular venous pressure Lips cyanosis Collaterals

Question 39

What are the features of horners syndrome

Answer 39

Partial ptosis Enopthalmus Meiosis

Question 40

What is partial ptosis

Answer 40

Half drooping eye lid

Question 41

What is enopthalmus

Answer 41

Sinking of the eye

Question 42

What is meiosis

Answer 42

Shrinkage of pupil

Question 43

What is pleural effusion

Answer 43

Fluid in the pleural space

Question 44

What are the clinical features of a pleural effusion

Answer 44

``` Dyspnoea Pain Reduced expansion Dull percussion Reduced vocal resonance ```

Question 45

What are the 3 main mechanism of pleural effusion

Answer 45

Leave into the pleural space Or Produced by pathology in the pleural space Or Pleural fluid is not been removed due to the lymphatics not working

Question 46

What are the 2 classes of pleural effusion

Answer 46

Transudates | Exudates

Question 47

What are the causes of exudate pleural effusion

Answer 47

``` MR BALDY SPIT M- mesothelioma/asbestos R- rheumatoid arthritis B- bronchial cancer A- abscess L- lymphoma D-dressers syndrome Y- yellow nail syndrome S- SLE P- pneumonia I- infarction T- TB ```

Question 48

How do you manage pleural effusions

Answer 48

Tap fluid Aspirate Drain

Question 49

What is mesothelioma

Answer 49

Cancer of pleura

Question 50

What is the cause of mesothelioma

Answer 50

Asbestos

Question 51

What is the treatment for mesothelioma

Answer 51

Chemotherapy Radiotherapy Surgery Immunotherapy