PBL Quiz - Block 13 Week 1!

No

100

What is bronchitis?

Inflammation of the bronchi

200

What are the common driver mutations for small cell carcinoma?

TP53 and RB1 - inactivated in 100% of tumours!

300

Mutation of which gene is said to be a hallmark of small cell lung cancer?

RB1

400

Name 2 local effects of a lung carcinoma (in the lungs) - explain how for each one

1. Pneumonia/abscess/lobar collapse - Tumour airway obstruction may cause tissue distal to the obstruction to become infected
2. Lipid pneumonia - Secretions accumulate distal to the blockage (including lipid rich surfactant) can cause lipid pneumonia as airspaces are filled up with cells so no gas exchange
3. Pleural effusion - Tumour spread to the pleura
4. Hoarseness - Tumour invades the recurrent laryngeal nerve

500

Examples of platinum based drugs used for lung cancer treatment? MoA and side effects?

MoA: Cause cross-linking of DNA which inhibits DNA repair and/or synthesis in cancer cells

Side effects: neurotoxicity, causing peripheral neuropathies including POLYNEUROPATHY

Maybe

100

Bronchitis is more commonly bacteria-caused, true or false?

False - It is usually viral

200

Signs and symptoms of bronchitis?

1. Coughing
2. Sputum production
3. Fever
4. Sore throat

300

ABCDE mnemonic for breaking bad news

Advanced preparation

Building a relationship

Communicate well

Deal with patient reactions

Encourage and validate emotions

400

Name 3 bacteria that can cause acute bronchitis

•Haemophilus influenzae

•Streptococcus pneumonia

•Staphylococcus aureus

•Mycoplasma pneumoniae

500

Use and MoA of paclitaxel

Used for NSCLC in patients unsuitable for curative treatment

MoA: ANTI-MICROTUBULE agent: inhibits spindle function by preventing disassembly, so it blocks mitosis and activates the mitotic checkpoint to trigger apoptosis or reversion of the G-phase of the cell cycle without division occuring!

Never

100

Name the 2 main histological types of epithelial tumours

•non-small cell carcinomas (87%)

- adenocarcinoma (> 40%)

- squamous cell carcinoma (20%)

- large cell carcinoma (2%)

-other (carcinoid, sarcoma, combination of      patterns)

•small cell carcinoma (13%)

200

What are the main causes of lung cancer?

1. Smoking (90%)
2. Occupational exposure to carcinogens such as radon, arsenic, asbestos, chromates, nickel (9-15%)
3. Environmental radon (10%)
4. Outdoor and indoor air pollution (1-2%)
5. Underlying chronic lung disease: pulmonary fibrosis, COPD, tb
6. FHx

300

What is the choice of treatment for a carcinoma of the lung dependent on?

Histological subtype

Tumour stage at presentation

400

Which of the adenocarcinoma common driver mutations is most commonly seen in smokers and which is more common in non-smokers?

Smokers - KRAS mutation (BRAF mutation too)

Non-smokers - EGFR mutation (ALK & ROS1 translocation common too)

500

Name 2 local effects of a lung carcinoma (extra to the lungs) - explain why for each

1. Dysphagia - oesophageal invasion by tumour
2. Diaphragm paralysis - phrenic nerve invasion by tumour
3. Rib destruction - chest wall invasion by tumour
4. Superior Vena Cava (SVC) syndrome - SVC compression by tumour
5. Horner syndrome - Sympathetic ganglia invasion by tumour at apex lung (Pancoast tumour)
6. Pericarditis - pericardial involvement
7. Pancoast tumour - brachial plexus invasion leads to hand muscle weakness and axillar & shoulder pain

Definitely not

100

Name some common symptoms of lung carcinoma

1. Cough (75%)
2. Weight loss (40%) ADVANCED SIGN
3. Chest pain (40%) ADVANCED SIGN
4. Dyspnoea (20%)

200

Treatments for lung cancer 

1. Surgery/resection
2. Radiation therapy
3. Chemotherapy
4. Targeted therapy

300

Name 3 common viruses that can cause acute bronchitis

1. Rhinovirus
2. Adenovirus
3. Influenza A and B
4. Parainfluenza virus

400

Name some systemic effects of lung carcinoma

1. Metastatic spread: bone, brain, liver, skin, adrenal glands
2. Paraneoplastic syndromes (S&S due to a tumour) secondary to ectopic production of hormones by the lung cancer cells
3. Lambert-Eaton myaethnic syndrome - auto-antibodies against neuronal calcium channels
4. Peripheral neuropathy
5. Dermatological abnormalities
6. Haematological abnormalities
7. Hypertrophic pulmonary osteoarthropathy with clubbing

500

Examples of paraneoplastic syndromes secondary to ectopic production of hormones by the lung cancer cells

1. ADH - hyponatraemia (commonly in SCLC)
2. ACTH - Cushing syndrome
3. Parahormone - hypercalcaemia (commonly in squamous cell carcinoma)
4. Calcitonin - hypocalcaemia
5. Gonadotrophins - gynaecomastia
6. Serotonin and bradykinin - carcinoid syndrome

Undeniably fun questions about radon and asbestos and breaking bad news

100

Name the SPIKES mnemonic inside 15 seconds

SPIKES

 Setting up

 Perception

 Invitation

 Knowledge

 Emotions

 Strategy and summary

200

Where does radon naturally occur?

soils and rocks

300

Up to how long can the latent period be between exposure to asbestos and detection of tumour in Malignant mesothelioma?

50 years

400

Where is the highest level of radon in the UK?

Cornwall

500

Since what year has asbestos use prohibited in Europe

2005