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C. Year 3 MLA Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is the leading cause of death from cancer worldwide in men and women?

1 - stroke
2 - lung cancer
3 - AIDs
4 - liver disease

A

2 - lung cancer

  • 19% of new cancers
  • 35,000 deaths/year in UK
  • 3rd commonest cause of death in UK
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2
Q

What is the incidence of lung cancer?

1 - 40/year
2 - 400/year
3 - 4000/year
4 - 40,000/year

A

4 - 40,000/year

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3
Q

Does the risk of lung cancer increase with age?

A
  • yes
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4
Q

Which of the following is NOT a risk factor for lung disease?

1 - Radiation
2 - Arsenic
3 - Coal tar
4 - Petroleum products
5 - Family History
6 - Diet

A

6 - Diet

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5
Q

What is the general latent period for lung cancer?

1 - 5-10 years
2 - 10-20 years
3 - 20-50 years
4 - 30-40 years

A

4 - 30-40 years

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6
Q

What is the main cause of lung disease, up to 90% of cases?

1 - family history
2 - diet
3 - smoking
4 - exposure of chemical at work

A

3 - smoking

  • linear relationship with smoking and lung cancer
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7
Q

Can passive smoking increase the risk of lung cancer?

A
  • yes
  • but not as much as active smoking
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8
Q

What is the most common occupational risk factor for lung cancer?

1 - asbestos
2 - radiation
3 - smoke inhalation
4 - arsenic

A

1 - asbestos

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9
Q

Asbestos is the most common occupational cause of lung cancer. What is the latency period of asbestos exposure before developing lung cancer?

1 - 5-10 years
2 - 10-20 years
3 - 20-40 years
4 - 30-40 years

A

3 - 20-40 years

  • 7 x increased risk of lung cancer in non-smoker
  • 93 x increased risk of lung cancer in smoker + asbestos exposure
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10
Q

What % of lung cancers are due to genetic mutations?

1 - 0.8%
2 - 8%
3 - 18%
4 - 80%

A

2 - 8%

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11
Q

8% of lung cancers are due to genetic mutations. Which of the following are NOT genes commonly associated with lung cancer?

1 - BRCA1
2 - BRCA2
3 - RD51D
4 - p53

A

4 - p53

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12
Q

Are the following associated with small cell lung cancer or non-small cell lung cancer?

  • Epidermal Growth Factor Receptor (EGFR)
  • Programmed death ligand 1 and receptor (PD-L1)
  • KRAS
  • Anaplastic lymphoma kinase (ALK)
A

non-small cell lung cancer

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13
Q

A 52 year old man presents to his GP with a persistent cough. He works as a builder and has been fairly fit and well in the past. He has developed a cough recently. Which of the following would you NOT generally ask about his cough?

1 - onset
2 - duration
3 - dry/productive
4 - location of cough
5 -how much sputum?

A

4 - location of cough

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14
Q

A 52 year old man presents to his GP with a persistent cough. He works as a builder and has been fairly fit and well in the past. He has developed a cough recently. Which of the following would you NOT generally ask about in associated symptoms?

1 - shortness of breath
2 - mMRC score
3 - chest pain
4 - ankle oedema
5 - wheeze

A

4 - ankle oedema

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15
Q

A 52 year old man presents to his GP with a persistent cough. He works as a builder and has been fairly fit and well in the past. He has developed a cough recently. Which of the following would you NOT generally ask about in associated symptoms?

1 - shortness of breath
2 - mMRC score
3 - chest pain
4 - ankle oedema
5 - wheeze

A

4 - ankle oedema

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16
Q

A 52 year old man presents to his GP with a persistent cough. He works as a builder and has been fairly fit and well in the past. He has developed a cough recently. Which of the following is NOT typically a “Red Flag” symptoms you will ask about?

1 - haemoptysis
2 - weight loss
3 - fevers
4 - night sweats
5 - chest pain

A

5 - chest pain

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17
Q

A 52 year old man presents to his GP with a persistent cough. He works as a builder and has been fairly fit and well in the past. He has developed a cough recently. What risk factors will you NOT generally ask about?

1 - smoking
2 - genetic mutations
3 - asbestos exposure 4 - radiation

A

2 - genetic mutations

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18
Q

What is the most common presentation in a patient with lung cancer?

1 - Persistent cough (> 8 weeks)
2 - Worsening breathlessness
3 - Chest pain
4 - Haemoptysis

A

1 - Persistent cough (> 8 weeks)

Persistent cough (> 8 weeks) (80%)
Worsening breathlessness (60%)
Chest pain (50%)
Haemoptysis (30%)

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19
Q

Horners syndrome can be seen in patients with lung cancer. What is horners syndrome?

1 - problem with sympathetic tone on one side of the face
2 - problem with parasympathetic tone in whole face
3 - problem with sympathetic tone on whole face
4 - problem with parasympathetic tone on one side of the face

A

1 - problem with sympathetic tone on one side of the face

  • tumour can compress sympathetic ganglia
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20
Q

Horners syndrome can be seen in patients with lung cancer and is a problem with sympathetic tone on one side of the face. Which of the following is NOT a symptom of horners syndrome?

1 - ptosis
2 - meiosis
3 - corneal arcus
4 - anhidrosis

A

3 - corneal arcus

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21
Q

In a cancer patient which of the following do we NOT commonly see when examining the patient?

1 - general appearance: cachexia, low BMI (normal 20-25)
2 - increased RR (> 20 bpm)
3 - tachycardia (> 100 bpm)
4 - Clubbing
5 - bradycardia (< 60 bpm)
6 - Hoarse voice

A

5 - bradycardia (< 60 bpm)

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22
Q

In a cancer patient which of the following do we NOT commonly see when examining the patient?

1 - horner’s syndrome (miosis, ptosis, anhidrosis and enophthalmos)
2 - pneumothorax
3 - lymphadenopathy (cervical or supraclavicular)
4 - tracheal deviation
5 - wheeze

A

2 - pneumothorax

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23
Q

A pleural effusion can occur in lung cancer. What is a pleural effusion?

1 - fluid filling space between lungs and chest wall
2 - fluid filled space between lungs and heart
3 - cardiomegaly
4 - carcinoma in pleural space

A

1 - fluid filling space between lungs and chest wall

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24
Q

In a patient with suspected lung cancer, which of the 2 of the following would be done immediately?

1 - CXR
2 - bronchoscopy
3 - Blood tests (FBC, U+Es, LFTs)
4 - PET scan
5 - lung function test

A

1 - CXR

3 - Blood tests (FBC, U+Es, LFTs)

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25
Q

In a patient with suspected lung cancer, we would perform a CXR and blood tests. Which of the following is NOT a standard investigation?

1 - lung drain and culture
2 - bronchoscopy
3 - PET scan
4 - lung function test
5 - CT scan

A

1 - lung drain and culture

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26
Q

When diagnosing lung cancer, is histology samples (tissue) or cytology (better?

A
  • histology samples (tissue)
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27
Q

What is a nodule?

1 - abnormal growth of tissue
2 - cancerous growth of tissue
3 - benign growth of tissue
4 - pus filled cavity

A

1 - abnormal growth of tissue

  • could be cancerous or benign
  • always presume cancer until confirmed otherwise
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28
Q

When we want to quantify the functional impact cancer may have on the lungs, which scoring system do we use?

1 - Wellness score
2 - CURB65 score
3 - WHO Performance Status
4 - GOLD score

A

3 - WHO Performance Status

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29
Q

The WHO Performance Status is used to assess the impact cancer can have on patients function. The scoring has 5 levels, is 0 or 5 the worse score?

A
  • 5
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30
Q

Brain, bone and an MRI of the thorax can often be performed in a patient with lung cancer. Why is this?

A
  • investigate metastasis
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31
Q

Below is a list of benign tumours. Which is not a benign lung tumour?

1 - Hamartoma
2 - Arterio-venous malformations (AVMs)
3 - Carcinoid tumour
4 - Granuloma
5 - Adenocarcinoma
6 - Rheumatoid lung nodules

A

5 - Adenocarcinoma

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32
Q

Nodules that are detected on imaging can become calcified. If they become calcified are they more likely to be malignant or benign?

A
  • benign
  • appear very bright on CT
33
Q

PET scans can be performed to stage cancers. To do this 18 Fluoro-2-deoxy-glucose (FDG) (analogue of glucose) is injected. Why is this?

1 - glucose binds well to malignant cells
2 - malignant cells do not absorb glucose
3 - malignant cells have very high metabolism
4 - glucose can be absorbed by body

A

3 - malignant cells have very high metabolism

34
Q

What is the imaging modality of choice for staging lung cancer?

1 - ultrasound
2 - MRI
3 - CT-PET
4 - X-ray

A

3 - CT-PET

35
Q

Bronchoscopy is a techniques used most commonly for what?

1 - haemoptysis
2 - viewing alveoli
3 - seeing small/distal tumours
4 - good view of large distal tumours

A

1 - haemoptysis

  • commonly used for suspected lung cancer and take biopsy
  • can also use this for cytological lavage
36
Q

There are a number of diagnostic and therapeutic approaches to lung cancer. What is a wedge biopsy?

1 - part of lobe removed
2 - one lobe removed
3 - one lung removed
4 - all of the above

A

1 - part of lobe removed

37
Q

There are a number of diagnostic and therapeutic approaches to lung cancer. What is a lobectomy biopsy?

1 - part of lobe removed
2 - one lobe removed
3 - one lung removed
4 - all of the above

A

2 - one lobe removed

38
Q

There are a number of diagnostic and therapeutic approaches to lung cancer. What is a pneumonectomy?

1 - part of lobe removed
2 - one lobe removed
3 - one lung removed
4 - all of the above

A

3 - one lung removed

39
Q

Patients with suspected lung cancer will receive a full lung function assessment. Why is this important?

1 - important to know if they will survive treatment
2 - important to know if their airways can be optimised prior to treatment
3 - important to understand if the cancer is curative

A

2 - important to know if their airways can be optimised prior to treatment

  • may start them on COPD or asthma medication to help with symptoms
40
Q

If a patient has a suspected lung cancer and we need a biopsy that is central, what biopsy method should we use?

1 - bronchoscopy
2 - open surgery
3 - CT guided biopsy
4 - X-ray guided biopsy

A

3 - CT guided biopsy

41
Q

Patients with suspected lung cancer will always have which 2 of the following cardiac tests as part of their diagnostic and treatment plan?

1 - ECG
2 - CPEX
3 - Echo
4 - troponin measurement

A

1 - ECG
3 - Echo

  • likely to have cardiac disease if they are smokers
42
Q

Carcinogens, such as smoke and asbestos are exposed to the bronchial mucosa and epithelium. This can cause changes in the epithelium cells. Which of the following is cancerous?

1 - metaplasia
2 - dysplasia

A

2 - dysplasia

  • cell becomes abnormal
  • metaplasia means cells change to a different type of cell (squamous to columnar)
43
Q

Bronchial epithelium cells can become metaplasic and then dysplasia and eventually lead to enough abnormal cells called lung cancer. Which of the following is NOT a common site of local invasion from the original mass?

1 - adjacent lung
2 - pericardium
3 - pleura
4 - oesophagus
5 - ribs and muscle

A

4 - oesophagus

44
Q

Bronchial epithelium cells can become metaplasic and then dysplasia and eventually lead to enough abnormal cells called lung cancer. Which of the following is NOT a common site of distal metastasis spreading through lymphatics and blood from the original mass in the lungs?

1 -lymph node
2 - adrenals
3 -liver
5 - bone
6 - brain
7 - gall bladder
8 - skin

A

7 - gall bladder

45
Q

What does bronchogenic mean?

1 - genetics of lung tissue
2 - lung tissue
3 - cancer of the lung tissue
4 - cancer

A

3 - cancer of the lung tissue

  • could involve tissue surrounding or within the lungs
46
Q

There are 2 main types of lung cancer, small cell lung cancer and non small cell lung cancer. Which is most common?

A
  • non small cell lung cancer
  • accounts for 85% of lung cancer and has a better prognosis
47
Q

Where do squamous cell lung cancers arise from?

1 - squamous cells anywhere in the body
2 - squamous cells from the skin
3 - squamous cells of the lungs

A

3 - squamous cells of the lungs

48
Q

Where do Adenocarcinoma cell lung cancers arise from?

1 - mucin produces cells anywhere in the body
2 - squamous cells from the skin
3 - squamous cells of the lungs
4 - mucin producing glandular epithelium

A

4 - mucin producing glandular epithelium

  • adeno relates to glandular tissue
49
Q

There are 3 key types of non small cell carcinomas that we need to be aware of:

  • adenocarcinoma (40%)
  • squamous cell carcinoma (35%)
  • large cell carcinoma (15%)

Which of the following is NOT a characteristic of adenocarcinoma?

1 - arise from mucous cells of the epithelium
2 - less associated with smoking
3 - more peripheral, grow slowly, metastasize late
4 - grow centrally

A

4 - grow centrally

50
Q

There are 3 key types of non small cell carcinomas that we need to be aware of:

  • adenocarcinoma (40%)
  • squamous cell carcinoma (35%)
  • large cell carcinoma (15%)

Which of the following is NOT a characteristic of Squamous Cell Carcinoma?

1 - develops in large central airways
2 - cavitating with necrosis and haemorrhage
3 - less associated with smoking
4 - PTH secreting (hypercalcaemia)

A

3 - less associated with smoking

51
Q

There are 3 key types of non small cell carcinomas that we need to be aware of:

  • adenocarcinoma (40%)
  • squamous cell carcinoma (35%)
  • large cell carcinoma (15%)

Which of the following is NOT a characteristic of large cell carcinomas?

1 - poorly differentiated
2 - highly aggressive
3 - metastasize early
4 - good prognosis

A

4 - good prognosis

52
Q

The X-ray of the chest below shows which type of small cell carcinoma?

1 - adenocarcinoma
2 - squamous cell carcinoma
3 - large cell carcinoma

A

1 - adenocarcinoma

  • located peripherally
53
Q

The X-ray of the chest below shows which type of small cell carcinoma?

1 - adenocarcinoma
2 - squamous cell carcinoma
3 - large cell carcinoma

A

2 - squamous cell carcinoma

  • located centrally and it is cavitating
54
Q

Which type of cell type do small cell lung cancers typically originate from?

1 - glandular cells
2 - alveoli cells
3 - squamous cells
4 - endocrine cell

A

4 - endocrine cell

  • also called Kulchitsky cells, located close to the basement membrane
55
Q

Small cell lung cancers typically originate from endocrine cells, also called Kulchitsky cells. What are these cells able to secrete?

1 - mucin
2 - polypeptide hormones
3 - steroids
4 - histamines

A

2 - polypeptide hormones

  • endocrine meals to secrete things
  • endocrine = hormones
  • exocrine = saliva, sweat, juices etc.
56
Q

Which of the following is NOT a characteristic of small cell lung cancers?

1 - secrete polypeptide hormones
2 - good prognosis
3 - often central tumours
4 - highly aggressive, grow rapidly and metastasizes early

A

2 - good prognosis

57
Q

Why can lung cancer cause pleuritic chest pain and effusion?

1 - increases vasodilation
2 - grows on nerves causing deferred pain
3 - spreads into pleural space
4 - increases cell permeability

A

3 - spreads into pleural space
- the parietal layer has pain receptors
- visceral layer has no pain sensation

58
Q

Why can typically happen to the ribs in lung cancer?

1 - increased Ca2+ content
2 - osteoporotic
3 - degrade and brittle
4 - deform

A

3 - degrade and brittle

  • eroded bones lead to lots of pain
59
Q

What is a pancoast tumour?

1 - tumours resembling pans
2 - tumours growing in the apex of the lungs
3 - tumours involving lymph nodes
4 - virchow’s nodes

A

2 - tumours growing in the apex of the lungs

  • named after doctor
  • can cause severe pain and occlude blood vessels
  • can affect nerves in brachial plexus
60
Q

If a patient presents to ED with a bone fracture, but no history of trauma, what could this be?

1 - lung cancer
2 - osteoarthritis
3 - inflammatory bowel disease
4 - raynauds syndrome

A

1 - lung cancer

  • pathological fracture
  • metastasis causing pain and hypercalcaemia
61
Q

If a patient has lung cancer and it metastasise to the liver, what are typically the 2 things we could see?

1 - raised CRP and jaundice
2 - jaundice and raised LFT
3 - raised LFT and GGT
4 - gall stones and jaundice

A

2 - jaundice and raised LFT

62
Q

If a patient has lung cancer and it metastasise to the skin, how can this typically present?

1 - nodules
2 - erythema
3 - trigger points
4 - hair loss

A

1 - nodules

63
Q

In addition to metastasis in lung cancer, they can also cause paraneoplastic syndrome. What is this?

1 - tumours secrete hormones
2 - tumours degrade tissue para-sternally
3 - tumours secrete neurotransmitters
4 - tumours inhibit the release of hormones

A

1 - tumours secrete hormones

64
Q

In addition to metastasis in lung cancer, they can also cause para-neoplastic syndrome, which is the release of hormones from the tumour. Which of the following is NOT a common para-neoplastic syndrome?

1 - SIADH: hyponatraemia (SCLC)
2 - ACTH: Cushing’s syndrome (SCLC)
3 - PTH: hypercalcaemia (SCC)
4 - hypergonadism

SIADH = syndrome of inappropriate secretion of antidiuretic hormone
ACTH = Adrenocorticotropic hormone
PTH = parathyroid hormone

A

4 - hypergonadism

65
Q

What does the chest X-ray below show?

1 - small cell lung cancer
2 - pleural effusion
3 - non small cell carcinoma
4 - fibrosis

A

2 - pleural effusion

66
Q

What is mesothelioma?

1 - malignant tumour of the mesentery in GIT
2 - malignant tumour of the mesentery in uterus
3 - malignant tumour of the mesothelial tissue surrounding the lungs

A

3 - malignant tumour of the mesothelial tissue surrounding the lungs

  • very poor prognosis
67
Q

Mesothelioma is a malignant tumour of the mesothelial tissue surrounding the lungs. What is the most common cause of this?

1 - alcohol
2 - drugs
3 - asbestos
4 - smoking

A

3 - asbestos

68
Q

Mesothelioma is a malignant tumour of the mesothelial tissue surrounding the lungs typically caused by asbestos, with a latency period of around 30-40 years. Which of the following is NOT a common clinical presentation?

1 - Severe chest pain (chest wall)
2 - Anorexia and weight loss
3 - Horners syndrome
4 - Increasing breathlessness

A

3 - Horners syndrome

69
Q

In a patient with Mesothelioma, which imaging modality is commonly used to discover it?

1 - MRI
2 - CT scan
3 - ultrasound
4 - X-ray

A

4 - X-ray

  • but CT can also be used
  • can cause:
    1 - thickened pleura
    2 - nodularity of pleura
    3 - contraction of hemithorax
    4 - unilateral pleural effusion
70
Q

In a patient with Mesothelioma, we may perform an analysis of the pleural fluid where we may find exudate. When comparing exudate and transudate, which has the following:

  • high protein and LDH
  • low protein and LDH
A
  • exudate = high protein and LDH
  • transudate = low protein and LDH
71
Q

Wha does the CT scan of the lungs show?

1 - small cell lung cancer
2 - pleural effusion
3 - non small cell carcinoma
4 - mesothelioma

A

4 - mesothelioma

72
Q

Which of the following is NOT typically a treatment option for patients with mesothelioma?

1 - Surgery
2 - Chemotherapy
3 - Palliative care
4 - immunotherapy

A

4 - immunotherapy
- patients should also be advised to see compensation as well

73
Q

In patients with non-small cell lung cancer (NSCLC) and SCLC, does chemotherapy cure the cancer?

A
  • no
  • prolongs life, rarely curative
  • often palliative and combined with radiotherapy
74
Q

Which of the following is radiotherapy used for?

1 - radical use: high dose, curative intent (CHART)
2 - Palliative: low dose, symptom control: Pain at tumour site, Bony metastases, Spinal cord compression
3 - Prior to surgery: de-bulking, down-staging tumour
4 - Combined modality: with chemotherapy
5 - Post surgery: improve long term survival
6 - all of the above

A

6 - all of the above
- if the tumour has spread it is rarely curative

75
Q

Which of the following is NOT a typical adverse events of radiotherapy?

1 - pneumonitis
2 - lung fibrosis
3 - gallstones
4 - arrhythmias
5 - heart failure
6 - dysphagia

A

3 - gallstones

76
Q

Is surgery typically used for both small cell and non-small cell lung cancer?

A
  • typically used for non-small cell lung cancer
  • used for small cell lung cancer if caught early
77
Q

All of the following therapies can be used in patients with small cell and non-small cell lung cancer as palliative care, EXCEPT which one?

1 - Radiotherapy
2 - Chemotherapy
3 - Immunotherapy

A

1 - Radiotherapy
- can reduce quality of life and even kill patients if they become infected

78
Q

Lung cancer typically has a poor prognosis, why is this?

1 - patients present late with symptoms
2 - lungs compensate for damaged tissue
3 - patient compensates for SOB
4 - all of the above

A

4 - all of the above

C. Year 3 MLA Respiratory (15 decks)

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