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what are the different types of non small cell lung cancer?
- sqaumous cell lung carcinoma
- adenocarcinoma
- large cell carcinoma
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which are more common, small or non small cell lung cancer?
non small cell lung cancer
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what are the respiratory causes of clubbing?
- tumours: bronchial cancer, mesothelioma, ,large cell lung cancer
- interstitial lung disease
- fibrosing alveolitis
- TB
- supparative lung disease: abscess, empyema, cystic fibrosis, bronchiectasis
- AV fistula
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what are the cardiac causes of clubbing?
- congenital cyanotic heart disease
- subacute bacterial endocarditis
- atrial myxoma
- any disease featuring chronic hypoxia
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what are the GI & HPB causes of clubbing?
- IBD: esp Crohns
- Cirrhosis: esp PBC
- lymphoma
- Malabsorption - eg coeliac
- polyposis
- oesophageal cancer
- laxative abuse
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what is cirrhosis?
- irreversible liver damage
- loss of normal hepatic architecture
- fibrosis
- nodular regeneration
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what are the 3 most common causes of cirrhosis?
- chronic alcohol abuse
- HBV infection
- HCV infection
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name 4 risk factors for lung cancer
- smoking
- asbestos
- arsenic
- radioation - radon gas
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name 4 main symptoms of lung cancer
- cough
- haemoptysis
- dyspnoea
- chest pain
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give 6 general signs found in a pt with lung cancer
- cachexia
- clubbing
- anaemia
- HPOA (hypertrophic pulmonary osteoarthropathy) wrist pain due to periostis of long bones
- supraclavicular LN
- axillary LN
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where do lung cancers metastasise to? and what signs and symptoms does this make?
- brain: confusion, fits, focal CNS signs, cerebellar syndrome
- bone: pain, anaemia, increased calcium
- liver: hepatomegaly
- adrenals: Addison's
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what are the chest signs of lung cancers? 4 options
- none
- consolidation
- collapse
- pleural effusion
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what are the local complications of lung cancer?
- NERVE: recurrent laryngeal nerve palsy, phrenic nerve palsy
- VESSELS: SVC obstruction causing oedema
- HORNERS SYNDROME: pancoast's tumour at apex of lung, can grow into sympathetic ganglion, brachiocephalic vein, subclav artery
- BONE: rib erosion
- HEART: pericarditis (central chest pain to back, better when lean forward, pericardial friction rub, saddle ST elevation, AF
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what are the metastatic complications of lung cancer?
- BONE: bone pain, anaemia, inc calcium
- liver: hepatomeg
- adrenals: Addison's
- Brain: focal neurology or general confusion, fits..
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What are the endocrine complications of lung cancer?
- ectopic hormone secretion:
- causing SIADH (high ADH, low Na)
- Cushings: small cell lung cancer secrete ACTH
- hypercalcaemia: as PTH released by SQUAMOUS cell tumours
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what are the non metastatic neuro complications?
- confusion
- fit
- cerebellar syndrome
- proximal myopathy
- neuropathy
- polymyositis
- Eaton-Lambert syndrome: autoimmune disorder affecting VG calcium channels on presynaptic memb of NMJ so no ACh release and so no muscle contraction, muscle weakness
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other paraneoplastic syndromes of lung cancer
- dermatomyositis
- acanthosis nigricans
- HPOA, wrist pain
- clubbing
- thrombophlebitis migrans
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what are the different investigations used to diagnose lung cancer?
- CYTOLOGY: sputum and pleural fluid at least 20ml
- CXR: peripheral, circular opacity; hilar enlargement, consolidation, collapse, pleural effusion, bony secondaries
- FNA OR BIOPSY: superficial LN and periph lesions
- BRONCHOSCOPY: histology and assess if operable
- CT: stage
- PET scan: help staging
- Radionuclide bone scan if suspect mets
- Lung function tests
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what is the treatment for non small cell tumours if a) low stage, b) poor resp reserve, c) advanced disease
- a) low stage: excision for peripheral tumours with no mets
- b) if resp reserve poor: curative radiotherapy
- c) advanced: chemo and radio
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what is the treatment for small cell tumours and why is it different?
- small cell tumuors are disseminated at presentation
- treat: chemo and or radio
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what are the different options for palliative treatment of lung cancer?
- Radiotherapy: if bronchial or SVC obstruction, haemoptysis, bone pain, cerebral mets
- SVC obstruction: SVC stent + radiotherapy + dexamethasone
- Endobronchial therapy: tracheal stenting, cryotherapy, laser, brachytherapy
- symptomatic pleural effusion: pleural drainage or pleurodesis
- Pain: analgesia
- steroids
- Antiemetics
- Cough: cough linctus (codeine)
- Bronchodilators
- anti depressant
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Other than small cell and non small cell lung tumours, name 3 others:
- bronchial adenoma: most are carcinoid
- hamartoma
- mesothelioma: tumour of mesothelial cells in the pleura related to asbestos exposure. may have v.long latent period between exposure and tumour development
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