Lung cancer management
Which of the following treatments is indicated for localized non-small cell lung cancer (NSCLC) in a patient with good performance status?
A) Palliative care alone
B) Systemic chemotherapy
C) Surgical resection
D) Whole-brain radiotherapy
E) Best supportive care
Answer: C) Surgical resection
Explanation: Surgical resection is the treatment of choice for localized NSCLC in patients with good performance status, as it offers the best chance for a cure. Other treatments, such as chemotherapy or radiotherapy, may be used as adjuvant therapies depending on the case.
At what age do most smokers typically begin smoking?
A) Before age 12
B) Between ages 12 and 18
C) Between ages 18 and 25
D) Between ages 25 and 30
Answer: B) Between ages 12 and 18
Explanation:
Most smokers start smoking during adolescence, typically between the ages of 12 and 18. Early initiation is influenced by factors such as peer pressure, family members who smoke, and socioeconomic status.
A 57 year old Asian female is diagnosed with lung cancer after she developed a new, persistent cough. She has no past medical history, has never smoked and works as an accountant. A biopsy is taken to make a histological diagnosis.
What is the most likely type of lung cancer in this patient?
What investigation is mandatory for a patient with haemoptysis?
1 Chest x-ray
2 CT
3 ABG
4 ECG
1 Chest x-ray
In the assessment of a solitary pulmonary nodule, which of the following is the most definitive method to determine if the nodule is malignant?
A. PET scan
B. Chest X-ray
C. Bronchoscopy
D. Fine-needle aspiration biopsy
E. Sputum cytology
Answer: D. Fine-needle aspiration biopsy
Biopsies are the gold-standard investigation for pulmonary nodules
Which of the following side effects is most commonly associated with long-term opioid use in palliative care patients with lung cancer?
A) Hepatotoxicity
B) Nephrotoxicity
C) Constipation
D) Hypertension
E) Hyperglycaemia
Answer: C) Constipation
Explanation: Constipation is a common side effect of long-term opioid use due to the drug’s action on the gastrointestinal system. Managing this side effect is crucial to maintain patient comfort and quality of life.
How many young people (11-15) have tried smoking in the UK?
A) 50,000
B) 100,000
C) 200,000
D) 400,000
Answer: D) 400,000
Explanation:
According to Action on Smoking and Health (ASH) about 400,000 11-15 year olds have tried smoking at some point and 100,000 smoke now
A 67 year old male smoker has haemoptysis and 5kg of weight loss over the last 3 months. On examination, a loud monophonic wheeze is heard over the medial aspect of the right middle zone. His renal profile shows hyponatraemia.
What is the most likely diagnosis?
A patient presents with a 3 week history of bloody sputum. They have lost some weight recently and feel generally unwell. What is the most important diagnosis to investigate?
1 TB
2 Pneumococcal pneumonia
3 Lung cancer
4 GORD
3 Lung cancer
A 55-year-old smoker presents with an incidental finding of a 2 cm solitary pulmonary nodule (SPN) on a chest X-ray. Which of the following is the most likely diagnosis?
A. Tuberculosis
B. Hamartoma
C. Metastatic cancer
D. Primary lung cancer
E. Granuloma
D. Primary lung cancer
A 68-year-old man with metastatic non-small cell lung cancer is experiencing severe pain due to bone metastases. What is the most appropriate treatment to manage his pain?
A) Non-steroidal anti-inflammatory drugs (NSAIDs)
B) Opioid analgesics
C) Acetaminophen
D) Antibiotics
E) Radiation therapy to the bone lesions
Answer: B) Opioid analgesics
Explanation: Opioid analgesics are the most appropriate treatment for severe pain, especially in the context of cancer-related bone metastases. They provide effective pain relief, which is essential for improving the patient’s quality of life.
How many people smoke in the UK?
A) 3%
B) 7%
C) 13%
D) 17%
Answer: C) 13%
Explanation:
12.9% of people smoke in the UK which is equal to 1 in 8. This is compared with 22.3% globally.
A 65 year old patient with a long term smoking history presents to the General Practice complaining of a persistent cough over the past four months and night sweats.
She has purple stretch marks along her abdomen, and has gained weight. She has been attending cognitive behavioural therapy after experiencing anhedonia and low mood. She is referred to the local hospital. The results of the most recent investigation an endobronchial ultrasound transbronchial needle aspiration shows cells with dense neurosecretory granules.
What is the most likely underlying diagnosis?
A 77-year-old man on the stroke ward was initiated on antibiotics seven days ago for an aspiration pneumonia. His clinical condition initially improved, however, over the last two days he has deteriorated with spiking fevers and production of copious amounts of foul-smelling sputum. This morning he expectorated a large volume of blood. A chest X-ray is taken and shows right lower lobe consolidation with central cavitation with an air-fluid level. Which of the following is the most likely cause of this patient's haemoptysis?
1 Tuberculosis
2 Aspergilloma
3 Squamous cell lung cancer
4 Lung abscess
4 Lung abscess
Which of the following is not a common cause of a solitary pulmonary nodule?
A. Hamartoma
B. Granuloma
C. Lung abscess
D. Bronchogenic carcinoma
E. Pleural effusion
E. Pleural effusion
A 70-year-old woman with stage IV small cell lung cancer (SCLC) has been receiving palliative chemotherapy. She now presents with significant dyspnea and poor oxygen saturation. Which of the following is the most appropriate immediate management option?
A) Increase the dose of her current chemotherapy
B) Start oxygen therapy and consider opioids for dyspnoea
C) Refer for surgical resection
D) Begin radiotherapy to the primary tumour site
E) Prescribe a high-dose corticosteroid
Answer: B) Start oxygen therapy and consider opioids for dyspnoea
Explanation: For immediate relief of dyspnoea in advanced lung cancer, oxygen therapy can help improve oxygen saturation. Opioids are also effective in reducing the sensation of breathlessness, improving patient comfort.
What is the estimated total cost to society of smoking in England?
A) £84 Million a year
B) £129 Million a year
C) £332 Million a year
D)£13 Billion a year
The total cost to society in England is estimated to be around £12.9 billion a year including lost productivity because of premature deaths and sick leave (£4 billion), smoking breaks (£5 billion), social care of older smokers (1.1 billion) and fires caused by smoking (£391 million).
A 65-year-old male presents with a 6-month history of progressive muscle weakness, particularly in his legs, which improves with repeated activity. He also reports dry mouth and difficulty swallowing. His past medical history is significant for a 40-pack-year smoking history. On physical examination, he has diminished deep tendon reflexes that improve after muscle activation. Chest X-ray reveals a right hilar mass. Which of the following is the most likely diagnosis?
A. Myasthenia Gravis
B. Lambert-Eaton Myasthenic Syndrome
C. Amyotrophic Lateral Sclerosis
D. Guillain-Barré Syndrome
E. Polymyositis
Answer: B. Lambert-Eaton Myasthenic Syndrome
A 58-year-old man presents to the emergency department with a 2-week history of cough, fever, and night sweats. He has now developed hemoptysis, coughing up approximately 100 mL of blood over the past 24 hours. He has a 30-pack-year smoking history and worked as a construction worker. On physical examination, he has decreased breath sounds in the right upper lobe. Chest X-ray reveals a cavitary lesion in the right upper lung field. What is the most likely diagnosis?
A. Tuberculosis
B. Bronchogenic carcinoma
C. Pulmonary embolism
D. Lung abscess
E. Goodpasture syndrome
Answer: A. Tuberculosis
A 62-year-old woman presents to the clinic with a 3-month history of persistent dry cough and mild shortness of breath on exertion. She reports that these symptoms have gradually worsened over the past few weeks. She denies any fever, night sweats, or weight loss. Her past medical history is significant for rheumatoid arthritis (RA), which has been well-controlled with methotrexate and low-dose prednisone for the past 10 years, although she reports that recently joint pain has been more bothersome.
Given her symptoms and history, a chest X-ray is ordered, which reveals multiple small, round opacities in both lungs. A follow-up high-resolution CT scan of the chest confirms the presence of multiple nodules, ranging in size from 0.5 cm to 1.5 cm, with some showing cavitation.
What is the most likely diagnosis for the pulmonary nodules in this patient?
Rheumatoid nodules