Lung Cancer

Question 1

Define hypertrophic osteoarthropathy

Answer 1

Combines clubbing and periostitis of the small hand joints - can occur secondary to lung cancer

Question 2

Myasthenia gravis can be associated with what type of malignancy?

Answer 2

Thymus tumour

Question 3

What is the most common malignancy to be associated with Lambert-Eaton syndrome?

Answer 3

Small cell lung cancer

Question 4

What is Lambert-Eaton syndrome?

Answer 4

Rare autoimmune condition characterised by muscle weakness of the the limbs as a result of impaired [re-synpatic release fo ACh. Also known as LEMS - Lambert-Eaton myasthenic syndrome

Question 5

Small cell lung cancer is classically associated with what type of hormone condition?

Answer 5

SIADH

Question 6

What does SPIKES stand for in the context of breaking bad news?

Answer 6

S - Situation
P - Patient perception
I - Invitation to continue with the explanation
K - Knowledge in small chunks
E -Empathy for the shock/ other emotions
S -Strategy, what you and the patient are going to do

Question 7

What are the 4 most common forms of cancer seen in the UK population?

Answer 7

1. Breast
2. Lung
3. Colorectal
4. Prostate

Question 8

Suggest 5 potential causes of bronchial carcinoma

Answer 8

1. Smoking
2. Ionising radiation
3. Asbestos
4. Fibrosing alveolitis
5. Industrial chemicals

Question 9

What is the most common form of primary lung cancer?

Answer 9

Small cell lung cancer

Question 10

Give 2 clinical signs associated with SVC obstruction

Answer 10

1. Facial/ hand swelling that is worse in the morning

2. Headache

Question 11

What is the treatment of choice for small cell lung cancer?

Answer 11

Chemotherapy

Question 12

Suggest 5 potential differential diagnoses for bronchial carcinoma

Answer 12

1. TB
2. Pneumonia
3. Lung metastases from another primary malignancy
4. Benign lung tumour
5. Wegener’s granulomatosis

Question 13

Define Wegener’s granulomatosis

Answer 13

Rare inflammatory disease that affects a variety of tissue types including the blood vessels, lungs and kidneys

Question 14

What are the 3 subcategories of TNM staging

Answer 14

T - Grade of primary tumour
N - Regional lymph nodes
M - Distant metastases

Question 15

Give 5 indications that would make a bronchial carcinoma inoperable

Answer 15

1. Distant metastases
2. Mediastinal spread
3. Poor pulmonary function
4. Frequent angina/ heart failure
5. Psychological failure

Question 16

What is the mainstay treatment for non-small cell lung cancer

Answer 16

Surgery and radiotherapy

Question 17

Name the chemotherapy agent that can be used in the treatment of EGFR mutation positive cells

Answer 17

Gefitinib

Question 18

Name the 2 most common nerves to be affect by the mass affect of a bronchial carcinoma

Answer 18

1. Recurrent laryngeal nerve - leading to Horner’s syndrome

2. Phrenic nerve

Question 19

Briefly outline the action of parathyroid hormone on the kidney

Answer 19

Upregulates the reabsorption of calcium from the kidney tubules

Question 20

PTrP is most commonly associated with which 4 cancer types?

Answer 20

1. Breast
2. Squamous cell lung cancer
3. Cholangiocarcinoma
4. Multiple myeloma

Question 21

Name the procedure used to collect a sample of fluid in the assessment of a pleural effusion

Answer 21

Thoracentesis

Question 22

A bloody pleural effusion sample may indicate one of which 4 conditions?

Answer 22

1. Malignancy
2. Asbestosis
3. Pulmonary infarction
4. Postcardiac injury syndrome

Question 23

A white coloured pleural effusion sample may indicate what underlying pathology? (2)

Answer 23

1. Chylothorax

2. Cholesterol effusion

Question 24

A black pleural effusion sample may indicate what underlying pathology?

Answer 24

Aspergillus

Question 25

Yellow-green pleural effusion sample may indicate what underlying pathology?

Answer 25

Rheumatoid pleurisy

Question 26

Dark green pleural effusion sample may indicate what underlying pathology?

Answer 26

Bilothorax

Question 27

'Anchovy paste like' pleural effusion sample is indicative of which underlying pathology?

Answer 27

Amebic liver abscess

Question 28

Pus in the pleural effusion sample is indicative of which underlying pathology?

Answer 28

Empyema

Question 29

What are the 3 main causes of a transudate pleural effusion?

Answer 29

1. Chronic heart failure 2. Cirrhosis 3. Nephrosis

Question 30

Recall the 3 components of Light's criteria

Answer 30

1. Pleural fluid protein/ serum protein >0.5 2. Pleural fluid LDH/ serum LDH >0.6 3. Pleural fluid LDH > 2/3 upper limit of normal serum LDH

Question 31

If a pleural effusion has protein >7-8g/dL which 2 differential diagnoses should be considered?

Answer 31

1. Waldenstrom's macroglobulinemia | 2. Mutiple myeloma

Question 32

When analysing a pleural effusion sample, and LDH > 1000 points towards which 3 differentials?

Answer 32

1. Empyema 2. Rheumatoid pleurisy 3. Malignancy

Question 33

Pleural fluid glucose <60 mg/dL points towards which 5 differential diagnoses?

Answer 33

1. Rheumatoid pleurisy 2. Parapneumonic effusion or empyema 3. Malignant effusion 4. Lupus pleuritis 5. Oesophageal rupture