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Medicine

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Respiratory

Question
14 out of 27
 

Ramesh 40 yrs male patient presenting with polyuria, pain abdomen, nausea, vomiting, altered sensorium was found to have bronchogenic carcinoma. The electrolyte

abnormality seen in him would be: (AIIMS May 2013)



A Hyponatremia

B Hyperkalemia

C Hypocalcaemia

D Hypercalcemia

Ans. D

Hypercalcaemia

It is more commonly occurs in squamous cell lung cancer, and is due to PTH like polypeptide secreted by squamous cell cancer. Hypercalcemia leads to polyuria because of nephrogenic diabetes cause by hypercalcemia. Hyponatremia occurs more commonly in small cell due to SIADH but polyuria is not a feature of SIADH.

Characteristic of Small cell carcinoma lung (SCLC)

1). SCLC makes up about 15 percent of all lung cancers. The majority of lung cancers, 75 to 85 percent, are called non-small cell lung cancers.

2). Usually present as central masses

3). Cigarette smoking is an important risk factor and association of smoking with small cell carcinoma lung is high.

4). Associated with release of ACTH, ADH, calcitonin, ANF and Gastrin releasing peptide and thus may manifest with hypokalemia (ectopic ACTH).

5). Highly malignant tumors with least five year survival rates.

6). Highly metastatic lesions with widespread disease at time of diagnosis.

7). Management is primarily with chemotherapy with or without radiotherapy

8). 90% regression with chemotherapy

9). Objective shrinkage in 80% to 90% patients with radiotherapy.

10). Surgery is unlikely to be curative because disease is usually widespread at presentation.

Extra edge:

Hormones produced by SCC

Paraneoplastic syndrome

ACTH

SIADH/ ANP

Calcitonin

Gonadotropins

Cushing's syndrome

Hyponatremia

Hypocalcemia

Gynaecomastia

Note: Small cell carcinoma causes hypocalcemia because of calcitonin. Hypercalcemia occurs in SQUAMOUS cell cancer

Seuerity of Small Cell Lung Cancer:

A simple two-stage system is used. In this system, limited-stage disease (seen in about 30% of all patients with SCLC) is defined as disease confined to one hemithorax and regional lymph nodes (including mediastinal, contralateral hilar, and usually ipsilateral supraclavicular nodes), while extensive-stage disease (seen in about 70% of patients) is defined as disease exceeding those boundaries.

Respiratory Flashcard List

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