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Question 1

Squamous cell carcinoma

Answer 1

• Cavitates (10%) - most commonly out of the other lung cancers
• Hypercalcaemia (due to PTHrP or bone destruction)
• CLUBBING
• HPOA - “onion skin” appearance at end of long bones on XR
• Hyperthyroidism (ectopic TSH)
• Usually presents as obstruction of bronchus leading to infection
• CXR - can’t tell between abscess/cancer. CT will show jagged borders

Question 2

Adenocarcinoma

Answer 2

• Gynaecomastia + HPOA
• Most common type in UK
• Commonly invades mediastinal lymph nodes + pleura, spreads to brain + bones
• Most common in NON-SMOKERS + WOMEN + Far East
• Most likely to cause PLEURAL EFFUSION

Question 3

Small Cell Carcinoma

Answer 3

• Originates from endocrine cells (Kulchitsky cells) and secretes ectopic ACTH
• Ectopic ACTH -> Cushings
• ADH secretion -> SIADH
• Lambert-Eaton syndrome -> Proximal muscle weakness (legs > arms), muscle strength IMPROVES after exercise. Eyes not affected.
• Spreads very early, inoperable at presentation. Generally palliative chemo.

Question 4

TB drug side effects

Answer 4

Rifampicin - Enzyme inducer. hepatitis, orange secretions

Isoniazid - Enzyme inhibitor. Peripheral neuropathy (give pyridoxine Vit B6), Hepatitis, agranulocytosis.

Pyrazinamide - Hyperuricaemia GOUT, hepatitis, arthralgia/myalgia

Ethambutol - Optic neuritis (Check vision prior)