Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y1 Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

General features of cancer

A

malignant growth, uncontrolled replication, local invasion, metastases, non-metastatic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Another name for non-metastatic effects?

A

paraneoplastic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are non-metastatic effects?

A

rare, non-metastatic manifestations of malignancy mediated by hormones, cytokines or antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Prognosis of lung cancer?

A

90% incurable at the time of lung cancer diagnosis

50% dead after 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Potential reasons for poor lung cancer prognosis

A

Poor health at the time of diagnosis prevents treatment
Co-morbidities
Tends not to cause symptoms until advanced or metastatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Potential Red Flags for Lung Cancer (8)

A 
cough for 3 weeks or more
haemoptysis
breathless for no reason
recurrent or unresolved chest infections
unexplained weight loss 
chest or shoulder pain
unexplained tiredness or lack of energy
hoarse voice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Differential diagnosis of haemoptysis

A

TB, Pneumonia, Aspergillus, Lung Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Haemoptysis presents in around 70% of patients with lung cancer - true or false?

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Patients presenting with haemoptysis should be _______ and sent for _____

A

referred, CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Any ___ patient with pneumonia has a repeated xray after ______. If this is not resolved then the patient should be referred to CT.

A

50+, 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

On an xray, the affected lung may…

A

lose volume and appear smaller

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Stridor (in context of lung cancer)

A

swelling in the airway due to tumour pressing on bronchioles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Common sites of local invasion in lung cancer (6)

A 
recurrent laryngeal nerve
pericardium
oesophagus
brachial plexus
pleural cavity
SVC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the result of a tumour pressing on the recurrent laryngeal nerve?

A

hoarse voice

may cause the vocal cord not to move

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the issues surrounding pericardial invasion by a tumour?

A 
breathlessness
atrial fibrillation
pericardial effusion
dysrhythmias - tamponade 
poor cardiac output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tumour invasion of the oesophagus causes…

A

dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pancoast tumour

A

apical lung cancer invading the brachial plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Symptoms of pancoasts tumour

A

pain, muscle wasting, sensory loss, weakness - occurring gradually in ipsilateral arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Invasion of the pleural cavity causes…

A

pleural effusion - could contain answer if this is first presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Presentation of pleural effusion on examination

A

dull percussion
low - no breath sounds
white xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Presentation of SVC obstruction due to lung cancer?

A

distension of jugular vein
pressure headaches and blurry vision
superficial veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How might SVC obstruction be relieved in lung cancer?

A

stent or chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Chest wall invasion can cause…

A

erosion of ribs, nerves and arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

type of pain associated with chest wall invasion?

A

neuropathic burning sensation,
worsened by movement
localised
often described as worse at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

The patient is at risk of _______ _______ if the tumour starts to invade the pulmonary artery. This type of tumour may erode through the artery and the ________ to cause a sudden death due to massive _______.

A

Pulmonary embolis
bronchus
haemoptysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Common sites of metastases in lung cancer (6)

A 
liver
brain
bone
adrenal
skin
Lung
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Features of cerebral metastases in lung cancer

A 
Gradual onset of: 
Weakness
visual disturbance
headaches 
fits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Features of headaches due to metastases?

A

worse in the morning
worse with sneezing
not photophobic
due to increase in ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Treatment for cerebral metastases?

A

high dose corticosteroids i.e. dexamethasone (ICP)
radiotherapy (tumour)
chemotherapy (tumour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Particularly abnormal in Liver Metastases?

A

Alkaline Phosphatase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Clinical presentation of bone metastases?

A

non-specific ache away from joint
unusual pain
fracture during trivial mechanical stress
localised pain worse at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Metastases in the adrenal glands ______ cause symptoms but are indicators of ________ disease

A

don’t

advanced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

A CT is unable to determine if a growth on the adrenal gland is a benign adenoma or cancer. In lung cancer patients, why is it important to determine whether it is?

A

It is important to establish whether they can undergo further treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Non-metastatic signs of lung cancer (7)

A 
finger clubbing
hypertrophic pulmonary osteoarthropathy
weight loss
thrombophlebitis
hypercalcaemia
hyponatraemia
weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Other causes of finger clubbing (not lung cancer)

A

liver disease - hep C
congenital cyanotic heart disease
bacterial endocarditis
bronchiectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is hypertrophic pulmonary osteoarthropathy?

A

inflammation and expansion of the outer layer of bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Presentation of hypertrophic pulmonary osteoarthropathy?

A

pain and tenderness of long bones due to elevation of the periosteum away from the bone surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Weight loss is very non-specific. What histories are required to understand weightloss in the context of lung cancer?

A

GI
Resp.
Bones
Age

39
Q

What is thrombophlebitis?

A

inflammation of the veins - very common

40
Q

What is the cause of thrombophlebitis?

A

increased coagulability of blood

41
Q

What is hyponatreamia and how does it present?

A

low sodium causing confusion

42
Q

Weakness is presented as Eaton Lambert Symdrome. This mimics…

A

myaethenia gravis which resolves if primary tumour is resected

43
Q

I have a history of a cough, you ask…

A 
How long has this occured?
Do you produce sputum?
What colour is the sputum?
Do you always have a cough?
Is there anything else associated with the cough?
44
Q

Patients rarely volunteer information about…

A

haemoptysis

45
Q

I come to you having coughed up some blood, what do you ask?

A

How much blood was it?
Has this happened before?
What colour is it, fresh red or dark red?

46
Q

You are taking a history and I reveal I am a cigarette smoker, what questions might you ask?

A

How long have you smoked?
How many a day?
Am I thinking of stopping?
If you have stopped, how long and how many did you smoke?

47
Q

Differential diagnosis for breathlessness?

A

PE, Pleural effusion, pericardial invasion, COPD, infection, lung cancer

48
Q

On examination in a patient you might be concerned about lung cancer, what are you look, listening and feeling for?

A 
finger clubbing
cough
bloated face
lymphadenopathy
dull percussion
enlarged liver
breathlessness
weightloss
hoarse voice
tracheal deviation
stridor
49
Q

What investigations are common when investigating a potential lung cancer?

A 
FBC 
Spirometry - FEV1
CXR
CT of thorax
PET scan
Bronchoscopy
Endobronchial Ultrasound
50
Q

What do you not test for when looking for lung cancer?

A

sputum cytology

51
Q

Which FBCs and bloods do you need in lung cancer suspect?

A

FBC
Na, K, Ca, Alk Phos
LFTs
Coagulation screen

52
Q

What areas do you expect to light up in a PET scan?

A

Bladder and brain

highish in liver and spleen

53
Q

Differential diagnosis in a smoker with haemoptysis and abnormal CXR

A 
Lung cancer
TB
Vasculitis
PE
Secondary cancer
Lymphoma
Bronchiectasis
54
Q

What needs to be considered with CT guided biopsy?

A

if lung is healthy enough to withstand 10% chance of pneumothorax

55
Q

Options for obtaining a tissue diagnosis?

A 
bronchoscopy
CT guided biopsy
Lymph node aspirate
aspiration of pleural fluid
EBUS
Thoracoscopy
56
Q

Benign neoplasm in the lung

A

hamartoma

57
Q

Why are metastases in lung cancer very common?

A

the lungs get all the blood so it is easy for the cells to get around the body

58
Q

What are common clinical presentations of patients experiencing the local effects of lung cancer?

A

obstruction of the airway (pneumonia)
invasion of the chest wall (pain)
Ulceration (haemopytsis)

59
Q

4 common types of lung cancer

A

adenocarcinoma
squamous carcinoma
small cell carcinoma
large cell carcinoma

60
Q

TNM staging is used for lung cancer…what does this stand for?

A

Tumour
Nodes
Metastases

61
Q

What role does immunohistochemistry have to play in identifying cancer?

A

can identify specific expression of tumour suppression factors or oncogenes for targeting via drugs

62
Q

What is mutated in the marjority of adenocarcinomas particularly in non-smokers and asian populations?

A

EGFR

63
Q

What is Lambert-Eaton Syndrome?

A

Paraneoplastic syndrome - weakness that mimics myaesthenia gravis but resolves if primary tumour is resected.

64
Q

How much fluid does the pleura normally contain?

A

4ml

65
Q

How much pleural fluid is needed to be visualised on an x-ray?

A

200ml

66
Q

What type of pleural effusions should cause concern?

A

large unilateral effusions

67
Q

Investigates for a pleural effusion might be?

A 
PA CXR
Pleural Aspirate
Biochemistry
Cytology
Culture
?CT chest
68
Q

If you are unusure if the opacity is fluid on the CXR what can you do?

A

repeat CXR while patient is on their side, the fluid will move and create a straight line at the top

69
Q

What might you suspect with straw-coloured effusion?

A

heart failure or hypoalbunaemia

70
Q

What might you suspect with blood in the effusion?

A

malignancy, trauma, infection, infarction

71
Q

What might you suspect with a milky or turbid effusion?

A

empyema, chylothorax

72
Q

Transudates are…

A

protein <30g/L

73
Q

Exudates are…

A

protein >30g/L

74
Q

Transudates are associated with…(5)

A 
HF
Liver Cirrhosis
Hypoalbuminaemia
Atelectasis
Peritoneal dialysis
75
Q

Exudates are associated with…(4)

A

Malignancy
Infection incl. TB
Pulmonary infarct
Asbestos

76
Q

A pH of less than 7.3 suggests…

A

pleural inflammation i.e. malignancy or RA

77
Q

A pH of less than 7.2 must…

A

be draind

78
Q

Where would glucose be expected to be low in an effusion?

A

Infection, RhA, Malignancy, oesophageal rupture, SLE

79
Q

What two types of non-malignant cell type may be present in an effusion?

A

lymphocytes - TB, malignancy

Neutrophils - acute onset

80
Q

apart from asbestos workers, who may also get mesothelioma?

A

people associated with those who worked with asbestos

81
Q

how long does mesothelioma take to develop?

A

30-40 years post exposure

82
Q

Symptoms that may present with mesothelioma (6)

A

breathlessness; chest pain; weight loss; fever; sweating; cough

83
Q

Investigations in mesothelioma?

A

Imaging
Pleural fluid aspiration
Biopsy

84
Q

Treatment options include:

A

Pleurodese effusions; radiotherapy; chemotherapy; surgery; palliative care

85
Q

What might be done to relieve pleural effusions as a result of mesothelioma?

A

Talc slurry

Long term pleural catheters

86
Q

Complications in the use of talc slurry (6)

A

pleuritic pain; fever; pneumonia; resp. failure; talc pneumonitis; secondary empyema

87
Q

Complications of long-term pleural catheters (3)

A

incorrect placement; bleeding; infection

88
Q

Which cancers particularly metastasise to the pleura?

A

lung; breast; upper GI; lymphoma; melanoma; ovarian

89
Q

Median survival for mesothelioma

A

3-12 months

90
Q

What score is used for predicting survival in mesothelioma?

A

LENT

91
Q

L in LENT…

A

LDH in pleural fluid
<1500 = 0
>1500 = 1

92
Q

E in LENT…

A 
ECOG PS - functioning in daily life 
0=0
1=1
2=2
3-4=3
93
Q

N in LENT

A

Neutrophil to lymphocyte ratio
<9 = 0
>9 = 1

94
Q

T in LENT

A 
Tumour type 
Lowest Risk (0); meso, haematological
Medium risk (1); breast, gynae, renal
HIgh risk (2); lung, other types

Y1 Respiratory (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions