Lung cancer

Q) A 73 year male,  old heavy smoker presents with haemoptysis. On examination he is cachectic and shows evidence of clubbing. Imaging shows a main bronchial tumour with massive mediastinal lymphadenopathy together with widespread visceral metastases. Which of the following variant is likely in him? ( Theme from mock test 12- 24) 

a)  Adenocarcinoma
B.  Small cell lung cancer
C. Large cell lung cancer
D. Squamous cell carcinoma

Ans  b

 Small cell lung cancer
Small cell carcinoma is associated with disseminated disease at presentation in the majority of cases. Most cases occur in the main airways and paraneoplastic features are common

Adenocarcinomas are the most common tumour type present in never smokers. They are usually located at the periphery.

Squamous cell carcinomas are reported to be more slow growing and are typically centrally located

Thyroid storm

Q) 40 year old lady was on anti thyroid medications which she stopped for 2 weeks. She presented in emergency with high grade fever and hypotension. ( Thyroid Storm) .What is not a part of further management?

a) Oxygen

b) Beta blockers

c) Radio active Iodine

d) Lugol's idodine

Thyroid MCqs

Ans  c

This is Thyroid storm. radio active iodine is a predisposing factor and not part of management 

Predisposing factors for thyroid storm are 

  1. Cessation of anti thyroid medications
  2. Infection
  3. Thyroid or non thyroid surgery in untreated thyrotoxicosis
  4. Trauma in patients with untreated thyrotoxicosis.
  5. Amiodarone
  6. Iodinated contrast agents
  7. RAI therapy

Management is 

  1. Beta blockers
  2. Oxygen and hemodynamic support
  3. IV Lugol iodine
  4. PTU
  5. Corticosteroids

The symptoms of thyroid storm are more intense and severe than typical hyperthyroidism symptoms. They can include severe fever, rapid and irregular heartbeat (tachycardia), elevated blood pressure, restlessness, confusion, agitation, tremors, excessive sweating, nausea, vomiting, diarrhea, dehydration, and in severe cases, even delirium, seizures, and coma.

Schwartz page 1638

Amylase and Lipase in Acute pancreatitis

Q) Which of the following is false regarding amylase and lipase in acute pancreatitis?
a) Amylase more than 3 times above normal indicates acute pancreatitis
b) Normal serum amylase does not rule out acute pancreatitis
c) Serum lipase is more specific than serum amylase
d) Serum amylase is more sensitive than serum lipase

MCQs on Pancreatitis 

Q) Why does amylase and lipase increase in pancreatitis?

A) They are released from the acinar cells of pancreas during injury

Q) When does serum amylase rise in acute pancreatitis?

A) Within the first 12 hours

Lung Tumors

Q) 50-year-old male with 1 x1 cm mass in the Peripheral part of the right lung was resected with clear margins. histopathology was suggestive of Adenocarcinoma and there was no lymph nodes positive what will be the further management
A. Observe
B. Adjuvant RT
C. Adjuvant CT
D. EGFR testing