Download MBBS Pulmonary Medicine Presentations 1 Approach To A Case of Lung Neoplasm Lecture Notes

--- Content provided by​ FirstRanker.com ---

TUMOURS

CASE SCENARIO

vA 55 YEAR OLD MALE PRESENTS IN OPD WITH NON RESOLVING RIGHT SIDE

--- Content provided by FirstRanker.com ---

CHEST PAIN WITH ASSOCIATED BREATHLESSNESS ON EXERTION. HE HAS THE

ABOVE SYMPTOMS SINCE LAST 6 MONTHS

--- Content provided by⁠ FirstRanker.com ---

vHE ALSO COMPLAINS OF FEVER MODERATE GRADE WITH CHILLS SINCE PAST

7 DAYS

vON FURTHER QUERY HE REVEALS HAVING ONE EPISODE OF BOUTS OF

--- Content provided by​ FirstRanker.com ---

BLOOD STREAKED SPUTUM AROUND 1 YEAR BACK, WHICH RESOLVED ON

SOME LOCAL MEDICATIONS AND PATIENT DID NOT CONSULT FOR THAT ANY

--- Content provided by‍ FirstRanker.com ---

FURTHER


FURTHER .....

--- Content provided by⁠ FirstRanker.com ---

vOCCUPATION: FARMER

vHE HAS NO OTHER COMORBIDITIES, DENIES HAVING TAKEN ATT IN THE

PAST AND CONTACT HISTORY

--- Content provided by FirstRanker.com ---

vFAMILY HISTORY IS NON CONTRIBUTORY

vSMOKING: 10 CIGARETTE/ DAY SINCE 30 YEARS
? PACK YEARS: ?

--- Content provided by​ FirstRanker.com ---

? SMOKING INDEX: ?
EXAMINATION

GENERAL

--- Content provided by​ FirstRanker.com ---

SYSTEMIC

?PALLOR: PRESENT

RESPIRATORY

--- Content provided by​ FirstRanker.com ---

?ICTERUS: ABSENT

DIMINISHED RIGHT SIDE BREATH

--- Content provided by‍ FirstRanker.com ---

SOUNDS ON AUSCULTATION WITH

?CYNOSIS: ABSENT

STONY DULLNESS ON PERCUSSION

--- Content provided by​ FirstRanker.com ---

?LYMPHADENOPATHY: LEFT

CVS

--- Content provided by​ FirstRanker.com ---

SUPRACLAVICULAR 1cm

NORMAL

?CLUBBING: PRESENT

--- Content provided by‌ FirstRanker.com ---

ABDOMEN

?PEDAL EDEMA: ABSENT

--- Content provided by‌ FirstRanker.com ---

TENDERNESS IN RIGHT

HYPOCHONDRIAC REGION

CNS

--- Content provided by​ FirstRanker.com ---

NORMAL

INVESTIGATIONS

vROUTINE BLOOD TESTS: CBC, LFT, KFT

--- Content provided by‌ FirstRanker.com ---

vCHEST RADIOGRAPH [PA]
vECG
vUSG ABDOMEN

--- Content provided by⁠ FirstRanker.com ---

CXR (PA)

WHAT DO WE SEE ?

MEDIASTINAL SHIFT ?

--- Content provided by FirstRanker.com ---

RIGHT HILUM ?

RIGHT PLEURAL SPACE ?

--- Content provided by‌ FirstRanker.com ---

DIFFERENTIAL DIAGNOSIS?

1. RIGHT SIDED PLEURAL EFFUSION
2. RIGHT LUNG COLLAPSE
WHAT NEXT?

--- Content provided by FirstRanker.com ---

SE
A

PLEURAL SPACE

--- Content provided by⁠ FirstRanker.com ---

ISE

LUNG

--- Content provided by⁠ FirstRanker.com ---

E

D

PARENCHYMA AND

--- Content provided by‍ FirstRanker.com ---

AIRWAYS


T

--- Content provided by‌ FirstRanker.com ---

H
H

MEDIASTINUM

--- Content provided by FirstRanker.com ---

RC
A

OTHER SITES

--- Content provided by FirstRanker.com ---

PARANEOPLASTIC

SE

SYNDROMES

--- Content provided by‍ FirstRanker.com ---

INVESTIGATIONS?

?USG THORAX

--- Content provided by‍ FirstRanker.com ---

?THORACOCENTESIS

FLUID FOR CYTOLOGY

DIAGNOSTIC/ THERAEUTIC

--- Content provided by‍ FirstRanker.com ---

AND CELL BLOCK

?CT THORAX

--- Content provided by‌ FirstRanker.com ---

TISSUE FOR HPE AND IHC/

MUTATION ANALYSIS

?BRONCHOSCOPY

--- Content provided by‌ FirstRanker.com ---

CONVENTIONAL/ EBUS GUIDED TBNA/ RADIAL PROBE TBNA


USG THORAX

--- Content provided by FirstRanker.com ---

THORACOCENTESIS

PLEURAL FLUID:
LOOK AT:
1. COLOR

--- Content provided by⁠ FirstRanker.com ---

2. TURBIDITY
3. REFILLING
SEND FOR:
1. CYTOLOGY MALIGNANT CELLS
2. CELL COUNT AND DIFFERENTIALS

--- Content provided by FirstRanker.com ---

3. LDH
4. ADA/ ZN SMEAR
5. BIOCHEMISTRY: PROTEINS AND SUGAR

--- Content provided by‍ FirstRanker.com ---

CT THORAX

CT THORAX CONTD.

--- Content provided by​ FirstRanker.com ---

BRONCHOSCOPY

BRONCHOSCOPY

CONVENTIONAL

--- Content provided by‍ FirstRanker.com ---

EBUS GUIDED TBNA

RADIAL EBUS

--- Content provided by FirstRanker.com ---

[ENDOBRONCHIAL/

[CENTRAL AND

TBLB/ CRYOBIOPSY]

--- Content provided by FirstRanker.com ---

MEDIASTINAL]

[PERIPHERAL]

--- Content provided by FirstRanker.com ---

WORKUP

METASTASIS

SEARCH

--- Content provided by FirstRanker.com ---

ABDOMEN

CNS

--- Content provided by‌ FirstRanker.com ---

THYROID

BONE

FEMALES

--- Content provided by⁠ FirstRanker.com ---

GENITAL

ORGANS

--- Content provided by FirstRanker.com ---

MALES

PROSTATE
TNM GRADING

--- Content provided by​ FirstRanker.com ---

STAGING


WHAT NEXT?

--- Content provided by FirstRanker.com ---

HISTOPATHOLOGY AND ROLE OF

MUTATION ANALYSIS

IMUNOHISTOCHEMISTRY

--- Content provided by⁠ FirstRanker.com ---

EGFR, ALK1, ROS 1, KRAS, PDL 1 ANTIBODY

ADENOCARCINOMA: TTF 1, NAPSIN A

--- Content provided by​ FirstRanker.com ---

{SENSITIVITY=80%}

WHY?

SQUAMOUS: p40 {MOST SENSITIVE

--- Content provided by‍ FirstRanker.com ---

CERTAIN THERAPEUTIC IMPLICATIONS,

AND SPECIFIC}

--- Content provided by FirstRanker.com ---

LIKE

OTHERS= p 63 AND ck 5/6

? PEMETREXED IS EFFECTIVE FOR

--- Content provided by​ FirstRanker.com ---

ADVANCED ADENOCARCINOMA

BEST COMBO= TTF1 AND p40/ p63

--- Content provided by FirstRanker.com ---

?BEVAIZUMAB IS CONTRAINDICATED IN

SQUAMOUS CELL CARCINOMA

?NIVOLUMAB EFFECTIVE FOR

--- Content provided by​ FirstRanker.com ---

ADVANCED SQUAMOUS CELL

CARCINOMA

--- Content provided by​ FirstRanker.com ---

MANAGEMENT: GENERAL CONDITION

--- Content provided by‌ FirstRanker.com ---

TYPES OF LUNG CANCER WHO 2015 CLASSIFICATION

EPITHELIAL

METASTATIC

--- Content provided by‍ FirstRanker.com ---

MESENCHYMAL

ECTOPIC

--- Content provided by⁠ FirstRanker.com ---

LYMPHOHISTOCYTIC


MEDIASTINAL TUMOURS

--- Content provided by⁠ FirstRanker.com ---

--- Content provided by​ FirstRanker.com ---

ETIOLOGY AND RISK FACTORS
SIGNS AND SYMPTOMS

vOCCASIONALLY INCIDENTAL FINDING

--- Content provided by​ FirstRanker.com ---

vSYMPTOMS DEPEND UPON LOCATION OF TUMOR IN LUNG

vSIGN AND SYMPTOMS ALSO DEPEND UPON SIZE, DEGREE OF

OBSTRUCTION AND METASTASIS

--- Content provided by⁠ FirstRanker.com ---

SIGNS AND SYMPTOMS (CONTD.)

THERE ARE 4 TYPES OF SIGNS AND SYMPTOMS OF LUNG CANCER:
1) LOCALIZED ? INVOLVING THE LUNG.

--- Content provided by​ FirstRanker.com ---

2) GENERALIZED ? INVOLVES OTHER AREAS THROUGHOUT THE

BODY IF THE CANCER HAS SPREAD.

--- Content provided by‍ FirstRanker.com ---

3) PARANEOPLASTIC SYNDROMES

4) THORACIC ONCOLOGY MEDICAL EMERGENCIES
LOCALIZED SIGNS AND SYMPTOMS

--- Content provided by⁠ FirstRanker.com ---

1. COUGH
2. BREATHING PROBLEMS, SOB, STRIDOR
3. CHANGE IN PHLEGM
4. LUNG INFECTION, HEMOPTYSIS
5. HOARSENESS, HICCUPS

--- Content provided by FirstRanker.com ---

6. WEIGHT LOSS
7. CHEST PAIN AND TIGHTNESS
8. PANCOAST'S SYNDROME
9. HORNER'S SYNDROME
10. PLEURAL EFFUSION

--- Content provided by​ FirstRanker.com ---

11. SUPERIOR VENA CAVA SYNDROME
12. FATIGUE

GENERALIZED SIGNS AND SYMPTOMS

--- Content provided by​ FirstRanker.com ---

1. BONE PAIN
2. HEADACHES, MENTAL STATUS CHANGES OR NEUROLOGIC

FINDINGS

--- Content provided by FirstRanker.com ---

3. ABDOMINAL PAIN, ELEVATED LIVER FUNCTION TESTS,

ENLARGED LIVER, GASTROINTESTINAL DISTURBANCES

(ANOREXIA, CACHEXIA), JAUNDICE, HEPATOMEGALY

--- Content provided by‍ FirstRanker.com ---

4. WEIGHT LOSS
5. ENDOCRINAL , METABOLIC AND VASCULAR CHANGES
THORACIC ONCOLOGY MEDICAL EMERGENCIES

--- Content provided by⁠ FirstRanker.com ---

1. SUPERIOR VENA CAVA OBSTRUCTION
2. TUMOR AND PULMONARY EMBOLISM
3. TUMOR LYSIS SYNDROME
4. HYPERCALCEMIA
5. PERICARDIAL TAMPONADE

--- Content provided by‌ FirstRanker.com ---

6. MASSIVE PLEURAL EFFUSION

THANK YOU