Lung Cancer

Question 1

Which cancer causes hypertrophic pulmonary osteoarthropathy?

Answer 1

Adenocarcionoma where there is primo steal reaction of bones cauasing clubbing and arthritis primary affecting wrists and akles

Question 2

What is the criteria for 2 week referral?

Answer 2

Aged 40+ with unexplained haemoptysis
Chest X-ray findings suspicious for lung cancer

Question 3

When should urgent CXR be performed?

Answer 3

Patient over 40 that has smoked and has either of the symptoms:

Cough
Fatigue
Shortness of breath
Chest pain
Weight loss
Anorexia

Question 4

When should urgent CXR be considered for patient over 40+?

Answer 4

Persistent/recurrent chest infection
Finger clubbing
Supraclavicular or persistent cervical lymphadenopathy
Thrombocytosis
Chest signs consistent with lung cancer (e.g. reduced breath sounds, dullness to percussion)

Question 5

Which cancers cause lobar collapse?

Answer 5

Squamous cell carcinoma because they are located centrally and can also cause bulky hilum.

Question 6

Which cancers are located centrally?

Answer 6

Squamous cell and small cell lung carcinoma
-> require bronchoscopy for analysis

Question 7

Which cancers are located peripherally?

Answer 7

Adenocarcioma and large cell
-> require Percutaneous biopsy for analysis

Question 8

What is first line for small cell lung cancer?

Answer 8

Chemotherapy with palliative intent to prolong life
Lobectomy
-> small cell is more aggressive and ends to be more advanced at a later stage

Question 9

When is immunotherapy typically sued?

Answer 9

Advanced non small cell lung cancer
-> includes medications such as pembrolizumab or atezolizumab

Question 11

How can small tumours be removed?

Answer 11

Wedge resection

Question 12

What is a requirement for all patients undergoing surgery?

Answer 12

Sampling of mediastinal adn hilar lymph nodes and PET-CT scan

Question 13

How does adrenal gland metastasis present?

Answer 13

Flank pain
Adrenal insufficiency

Question 14

Why does Persistent lower respiratory tract infection occur?

Answer 14

Due to obstructing tumour

Question 15

Why does brachial plexus injury occur?

Answer 15

Tumour invasion from pancoast tumour

Question 16

What does the rescue pack for COPD contain?

Answer 16

Amoxicillin antibiotic
Oral corticosteroids

Question 18

What is the management of SVC syndrome?

Answer 18

Urgent administration of dexamethasone to reduce oedema and improve airway potency

Question 19

What investigation is used if history indicates metastases?

Answer 19

Radionuclide bone scan

Question 20

What is first line investigation if lesion is found on CXR?

Answer 20

CT scan to identify and localise the lesion

Question 21

Which investigation is performed after CT scan?

Answer 21

Fibre-optic bronchoscopy which allows for samples to be taken to visualise the bronchial tree

Question 22

What is endobrahcial ultrasound guided aspiration?

Answer 22

Ultrasound is inserted into the lungs and allows lymph node evaluation; less available than fibre optic bronchoscopy

Question 23

What is the cause of leg and arm weakness improving with exertion? l

Answer 23

Lambert Eaton myasthenia syndrome, which bilateral ptosis and double vision it is caused by voltage gated Ca2+ channel antibodies

Question 24

What is lambert-Eaton associated with? s

Answer 24

Small cell lung cancer

Question 25

How does muscle weakness which worsens on Exertion/end of day indicate?

Answer 25

Myasthenia gravis -> eyes are affected first

Question 26

What is hypercalcaemia associated with in lung cancer?

Answer 26

Smqouaos cell carcinoma due to PTH-rp

Question 27

Where does adenocarcinoma arise from?

Answer 27

Mucus cells in bronchial epithelium, found in peripheral airways

Question 28

Which type of lung cancer causes hyperthyroidism?

Answer 28

Squamous cell carcinoma due to ectopic TSH

Question 29

Which imaging is ideal to investigate suspected lung cancer?

Answer 29

CT -> CXR is initial

Question 30

What is sued to establish eligibility for curative treatment for non smalls ell cancer

Answer 30

PET scan

Question 31

What are the contraindications of surgery in non small cell cancer?

Answer 31

stage IIIb or IV (i.e. metastases present) FEV1 < 1.5 litres is considered a general cut-off point* malignant pleural effusion tumour near hilum vocal cord paralysis SVC obstruction

Question 32

When should urgent referral for lng cancer be performed?

Answer 32

people aged 40 and over with any of the following: persistent or recurrent chest infection finger clubbing supraclavicular lymphadenopathy or persistent cervical lymphadenopathy chest signs consistent with lung cancer thrombocytosis

Question 33

Waht is the first line investigation for staging lung cancer prior to biospy?

Answer 33

CT scan which aids in biopsy to determine the size of the tumour intially

Question 34

What is the gold standard to use following biopsy for staging in lung cancer?

Answer 34

PET-CT for assessing metastasis and differentiating between benign and malignant lymph nodes and before surgery. Pet CT is ideally used with a CT scan.

Question 35

What investigation is used to assess response to surgery or chemotherapy?

Answer 35

PET-CT

Question 36

What to use for suspicion of metastasis if PET-CT is not available?

Answer 36

Radionucleide scan