Which one of the following is a contraindication to surgical resection in lung cancer?
Correct Answer D: Contraindications to lung cancer surgery include SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis.
Paralysis of a vocal cord implies extracapsular spread to mediastinal nodes and is an indication of inoperability.
Lung cancer: non-small cell management:
Surgery contraindications:
* However if FEV1 < 1.5 for lobectomy or < 2.0 for pneumonectomy then some authorities advocate further lung function tests as operations may still go ahead based on the results.
A 52-year-old man with a history of alcohol dependence is admitted with fever and feeling generally unwell. An admission chest x-ray shows consolidation in the right upper lobe with early cavitation.
What is the most likely causative organism?
Correct Answer D: Pneumonia in an alcoholic - Klebsiella.
Pneumonia:
Community acquired pneumonia (CAP) may be caused by the following infectious agents:
Klebsiella pneumoniae is classically in alcoholics.
Streptococcus pneumoniae (pneumococcus) is the most common cause of community-acquired pneumonia.
Characteristic features of pneumococcal pneumonia:
Management:
A 74-year-old woman with thyroid cancer is admitted due to shortness of breath.
What is the best investigation to assess for possible compression of the upper airways?
Correct Answer E: Flow volume loop is the investigation of choice for upper airway compression.
Flow volume loop: A normal flow volume loop is often described as a 'triangle on top of a semi circle'
Flow volume loops are the most suitable way of assessing compression of the upper airway.
You review a 26-year-old woman. She has a history of asthma and is prescribed salbutamol 100mcg 2 puffs prn, beclometasone dipropionate 400mcg bd and salmeterol 50mcg bd. Last week she found out she was pregnant and stopped the beclometasone and salmeterol inhalers as she was concerned about potential harm to the pregnancy.
What is the most appropriate action?
Correct Answer E: Both the BNF and British Thoracic Society guidelines stress the need for good control of asthma during pregnancy. The BNF advises that 'inhaled drugs, theophylline and prednisolone can be taken as normal during pregnancy and breast-feeding'.
Asthma: stepwise management in adults:
The management of stable asthma is now well established with a step-wise approach:
*beclometasone dipropionate or equivalent
Additional notes: Leukotriene receptor antagonists:
Fluticasone is more lipophilic and has a longer duration of action than beclometasone Hydrofluoroalkane is now replacing chlorofluorocarbon as the propellant of choice. Only half the usually dose is needed with hydrofluoroalkane due to the smaller size of the particles.
Long acting B2-agonists acts as bronchodilators but also inhibit mediator release from mast cells. Recent metaanalysis showed adding salmeterol improved symptoms compared to doubling the inhaled steroid dose.
Which one of the following causes of lung fibrosis predominately affect the upper zones?
Correct Answer E:
Lung fibrosis: It is important in the exam to be able to differentiate between conditions causing predominately upper or lower zone fibrosis. It should be noted that the more common causes (cryptogenic fibrosing alveolitis, drugs) tend to affect the lower zones.
Fibrosis predominately affecting the upper zones:
Fibrosis predominately affecting the lower zones:
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