Lung cancer types vary by location. Squamous cell carcinoma is most common in the UK while adenocarcinoma is most common in the USA. Squamous cell carcinoma is typically central and can cause clubbing, hypercalcemia, and hypertrophic pulmonary osteoarthropathy. Adenocarcinoma is typically peripheral and may cause gynecomastia. Small cell lung cancer is very aggressive and often metastasizes early. It can cause paraneoplastic syndromes like SIADH, Cushing's syndrome, and Lambert-Eaton syndrome. Diagnosis involves imaging, biopsy, and tumor markers. Treatment depends on cancer type and stage but may include surgery, chemotherapy, and radiation therapy.
Lung cancer is a type of cancer that begins in the lungs. Your lungs are two spongy organs in your chest that take in oxygen when you inhale and release carbon dioxide when you exhale. Lung cancer is the leading cause of cancer deaths in the United States, among both men and women
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Lung cancer is a type of cancer that begins in the lungs. Your lungs are two spongy organs in your chest that take in oxygen when you inhale and release carbon dioxide when you exhale. Lung cancer is the leading cause of cancer deaths in the United States, among both men and women
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
4. Lung cancer Types
The most common type of lung cancer
In the UK Squamous cell cancer
In the USA Adenocarcinoma
5.
6. Lung cancer : Non-Small Cell Carcinoma
• There are three main subtypes of non-small cell lung cancer:
1. Squamous cell cancer 2. Adenocarcinoma 3. Large cell lung carcinoma
Squamous cell cancer
Typically central (Squamous= Sentral)
Associated with:
• Parathyroid hormone-related protein (PTHrP) secretion hypercalcaemia
• Strongly associated with Finger clubbing
• Hypertrophic pulmonary osteoarthropathy (HPOA)
The presence of clubbing and tender wrists without synovitis makes pulmonary
osteoarthropathy the most likely diagnosis.
It is usually associated with underlying carcinoma of the lung.
Associated with bronchogenic carcinoma in 90% of cases.
The most sensitive diagnostic investigation is isotope bone scan: increase in the uptake in long
bones, around periarticular surfaces, and also mandible and scapulae
Regression of the pain has been reported with successful resection of the tumor and after vagotomy
• Hyperthyroidism due to Ectopic TSH
7. Most squamous-cell carcinomas present as obstructive lesions, which can manifest as
Infection.
Life threatening haemoptysis
is a medical emergency that requires prompt action.
Pulmonary angiography will identify the blood supply to the tumor and embolization of this vessel(s) will
immediately stem the bleeding.
Histology
will show clusters of lightly stained cells, often associated with groups of partially
keratinized, acidophilic cell clusters.
Pleomorphic cells in cluster with keratin pearls and intercellular bridges
8. Adenocarcinoma
• most common type of lung cancer in non-smokers, although the majority of patients who
develop lung adenocarcinoma are smokers
• Typically located on the lung periphery Normal bronchoscopy.
• May associate with Gynecomastia.
• PET/CT scan offers the best imaging modality to determine LN involvement in bronchial
adenocarcinoma
Histology will show:
• Malignant cells more often arranged in small clusters with an obvious lumen
and duct-like structures.
• Mucin-containing tumor cells with glandular differentiation
9. Bronchioloalveolar cell carcinoma
Bronchioloalveolar cell carcinoma
• It is an adenocarcinoma.
• accounts for around 5% of all primary lung carcinomas.
• 1% of all bronchial carcinomas.
• Growth along the alveolar walls without actually destroying them.
• The classic massive clear frothy sputum (bronchorrhoea) can be up to one liter a
day.
• Other symptoms are dyspnea, weight loss and chest pain.
• Almost a half of patients are diagnosed on routine CXR, usually demonstrating a
peripheral lesion.
• The tumor spreads using the alveolar walls as a frame and the alveoli are often
filled with mucin.
• In those whose tumor is not resect able, prognosis is poor.
10. Management of non-small cell lung cancer
Surgery
• only 20% suitable for surgery
• Stage I (cT1N0 and cT2N0) and stage II (cT1N1, cT2N1 and cT3N0) tumors
should be considered operable.
• Stage IIIA (cT3N1 and cT1-3N2) tumors have a low chance of being cured by
surgery alone, but it can be used in combination with chemotherapy.
• Stage IIIB and IV tumors considered inoperable.
mediastinoscopy performed prior to surgery as CT does not always show mediastinal
lymph node involvement
The functional criteria for pneumonectomy are:
• Forced expiratory volume in 1 second (FEV-1) of >1.5 litres
• FEV-1 > 50% of the observed forced vital capacity, and
• Normal partial pressure of arterial CO2 (Paco2) with the patient at rest
• Prognosis after surgery is about 50-67% at 5 years with stage 1disease
Curative and palliative radiotherapy
11. Contraindications for surgery include:
• Patient refusal
• Asses general health (age 70+rs IHD,MI recent 6wks,increased PCO2
• FEV1 < 1.5 liters is considered a general cut-off point
• If the tumor necessitates a pneumonectomy, the post-bronchodilator FEV should be more than 2 liters.
• Metastases.
• stage III b or IV (i.e. metastases present)
• tumor near hilum
• vocal cord paralysis (implies extracapsular spread to mediastinal L.N)
• SVC obstruction
• Malignant pleural effusion
• Most pleural effusions associated with lung carcinoma are due to the tumor (and results in classification as a
T4 tumor).
• Spread to involve the C8, T1 and T2 nerve roots occurs by rib erosion by tumor to involve the lower roots of
the brachial plexus and is known as a Pancoast tumor.
• This causes severe pain in the shoulder and down the inner aspect of the
arm on the affected side and is a contraindication to surgery
12. Pancoast tumor
• Neoplasm apex of the lung that typically invades the chest wall and brachial plexus causing a Horner's
syndrome (ptosis and constriction of the pupil).
compresses the sympathetic fibers (from T1 and T2) as they travel upwards to
superior cervical ganglion and then to the dilator pupillae as the long ciliary
nerve.
• The tumor causes pain in the C8 and T1 distribution and Horner's syndrome.
pain in the shoulder and the medial surface of the arm.
Patients may initially present to rheumatologists or orthopedic surgeons.
• It may cause small muscle wasting of the hands and erosion of the first rib
the investigation of choice CT of chest
CT is essential to locate the tumor and the extent of rib, vertebral and muscle
involvement.
Chest x-ray may be normal
• Tumors are most commonly squamous cell and are usually inoperable on
presentation
13. Staging lung carcinoma
• It is important to remember the criteria for staging carcinoma of the lung. TNM staging
takes into account;
The size and position of the tumor (T)
Whether the cancer cells have spread into the lymph nodes (N)
Whether the tumor has spread anywhere else in the body - secondary cancer or
metastases (M)
• Computed tomographic (CT) scanning is recommended as a staging procedure. Where
available, PET scanning may be superior
• CT can be performed with or without contrast enhancement, but Contrast enhancement
makes it easier for inexperienced observers to interpret the CT.
• Overall, preoperative CT staging has been shown to overstage or understage when
compared with operative findings in 40% of patients. So biopsy is also needed.
14. TNM System
The International Association for the Study of Lung Cancer (IASLC) developed a SEVENTH EDITION
OF THE TNM SYSTEM in 2010 replaced earlier editions: as fellow
Primary tumor — (T)
T0 – No evidence of primary tumor.
Tis – Carcinoma in situ.
T1 – Tumor that is ≤3 cm
T1a: Tumor is ≤2 cm
T1b: Tumor is >2 cm, but ≤3 cm
T2 – Tumor that is >3 cm but ≤7 cm
T2a: Tumor is >3 cm, but ≤5 cm
T2b: Tumor is >5 cm, but ≤7 cm
T3 – Tumor that is >7 cm ; invades the chest wall (including superior sulcus tumors),
diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium
T4 – Tumor of any size that invades the mediastinum, heart, great vessels, trachea,
recurrent laryngeal nerve, esophagus, vertebral body, or carina; or separate tumor
nodule(s) located in a different lobe of the ipsilateral lung.
15. Regional lymph nodes — (N)
• N0 – No regional lymph node involvement.
• N1 – Involvement of ipsilateral intrapulmonary, peri bronchial, or hilar lymph
nodes.
• N2 – Involvement of ipsilateral mediastinal or sub carinal lymph nodes.
• N3 – Involvement of contralateral mediastinal or hilar lymph nodes.
Metastasis — (M)
• M0 – No distant metastasis
• M1a – Malignant pleural effusion, pericardial effusion, pleural nodules, or metastatic
nodules in the contralateral lung
• M1b – Distant (extra-thoracic) metastasis
_____________________________
16.
17. Carcinoid lung
Overview
• Carcinoid tumors are neuroendocrine
• Originate from Kulchitsky (K) cells in the lung
• Slow growing
• Smoking is NOT a risk factor
Incidence: Lung carcinoid accounts
• 1% of lung tumors
• 10% of carcinoid tumors.
• typical age = 40-50 years
• The incidence is equal between men and women
18. FEATURES
• Often asymptomatic
• Long history of cough,
• Recurrent hemoptysis
• Recurrent infections
Carcinoid tumors (80-90%) develops in a bronchus cause bronchial obstruction Lower
respiratory tract infection.
• Carcinoid syndrome (rare)
• Associated conditions with carcinoid tumor in the lung
Carcinoid syndrome (rare)
• Depends on associated liver metastases
• Occurs in less than 10% of patients with carcinoid tumors, but occurs
most commonly in GIT tumors.
• Can secrete a number of vasoactive compounds (including serotonin and
bradykinin), which result in:
bronchospasm, diarrhea, skin flushing, right sided valvular heart lesions
ACTH secretion and subsequent Cushing's syndrome.
Ectopic growth hormone-releasing hormone [GHRH] and subsequent acromegaly
Multiple endocrine neoplasia (MEN) type 1 where pancreatic neuroendocrine
19. Investigation
CXR
• Often centrally located and not seen on CXR.
• Usually occur in the major bronchi, 85% can be seen Bronchoscopically.
• Most often located in the main bronchi, and occur most frequency in the right
middle lobe.
• A carcinoid tumor in the left lower lobe bronchus could cause distal collapse of
the left lower lobe.
Bronchoscopy
• identifies up to 80% of carcinoid tumors in the main bronchi.
• seen as a highly vascular 'cherry-like' tumor ('cherry red ball')Biopsy is usually followed with brisk
bleeding and should be done via rigid bronchoscopy.
• The histological picture of granular eosinophilic staining of the cytoplasm, is highly suggestive of a
carcinoid tumor.
• Histologically, these tumors consist of compact nests of epithelial cells surrounded by neat, delicate
connective tissue capsules.
20. • Plasma chromograffin A is an effective screening test for carcinoid as it is
very
sensitive, but it is not specific.
• 24 hour urinary excretion of 5-hydroxyindoleacetic acid is more specific for
the
diagnosis, but false positives and negatives are present.
• Scintigraphic imaging with labelled somatostatin increases the ability to
diagnose a carcinoid tumor, but biopsy is required to confirm.
Management
• Surgical resection
• A person with an isolated pulmonary carcinoid should be referred for
tumor resection,
• Somatostatin analogues can be used where there is no possibility
Prognosis
• If no metastases then 90% survival at 5 years
21. Small cell Lung CA
• Also known as "oat-cell carcinoma“ usually central
• arise from APUD* cells an acronym for
• Amine - high amine content
• Precursor Uptake - high uptake of amine precursors
• Decarboxylase - high content of the enzyme decarboxylase
• Most aggressive cancer which typically presents with a short history and 80–90% will have metastases at the time of presentation.
Features
• Ectopic ADH hyponatremia (SIADH )occurs in 5–10% of cases
• Ectopic ACTH Cushing's syndrome
• Due to the short natural history of this type of cancer, Cushing syndrome in small cell ca does not manifest classically by buffalo hump, striae
or central obesity.
• Its presence is suspected by arterial hypertension, hyperglycemia,
hypokalemia, alkalosis and muscle weakness.
• ACTH secretion can cause bilateral adrenal hyperplasia,
• The high levels of cortisol can lead to hypokalemic alkalosis
• In case of chronic heavy smoker with chest infection +hyperglycaemia + Ļow K + increase HCO3? Suspect SCLC with ectopic ACTH secretion.
But if with Low Na and increased K think of Adrenal metastasis MRI adrenals
• Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenia like syndrome
• Neuron-specific enolase (NSE) is a tumor marker indicative of small cell carcinoma
• Associated with L-myc amplification.
• Histologically, Small cell carcinoma has clusters of small, basophilic cells and
22. Management
Usually metastatic disease by time of diagnosis and surgery done only for de bulking
Stage
Early stage (T1-
2a,N0,M0)
Surgery
Early stage (T1-
2a,N0,M0)-
Limited disease
(T1-4,N0-3,M0)
4-6 cycles cisplatin based
chemotherapy, carboplatin if poor
renal function/poor performance
status +/- radiotherapy
Extensive disease
(T1-4, N0-3,
M1a/b)
6 cycles platinum based
combination chemotherapy +
thoracic
radiotherapy if good response
Prognosis
Very poor and survival beyond two 2 years is exceptional
Adverse prognostic factors in small cell lung cancer:
• Serum Na < 132 mmol/l
• Weight loss > 10%
• WHO performance status > 2
• Alkaline phosphatase > 1.5 times upper limit of normal
• LDH > 1.5 times upper limit of normal
• Extensive disease (occurring outside one hemi-thorax and ipsilateral supraclavicular fossa
nodes).
______________________
23. ___
Bronchial Carcinoma
• 20-30% of cases with bronchial carcinoma are of small (oat) cell type from endocrine Kcells (Kulchitsky) cells
• Primary bronchial cancer the tumour edge may have a fluffy or spiked
appearance.
• Paraneoplastic manifestations:
SIADH (5 - 10%)
ACTH (5 %)
ANP
• The most appropriate tool to confirm the diagnosis of bronchial carcinoma is
Bronchoscopy ± Trans bronchial biopsy (NOT CT-guided FNA biopsy).
• CT-guided FNA would be useful; however, there is a high risk of pneumothorax
in patients with FEV1 < 1.
________________________________________________
24. Lung cancer: paraneoplastic features
• Paraneoplastic syndromes are a result of antibody generation from or against malignant cells attacking
normal tissue.
• Both non-small cell and small cell lung cancers are associated with Paraneoplastic syndromes, although they
are more common with the small cell due to its neuroendocrine cell origin.
Squamous cell
• Parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcemia
• Occurs in about 15%
• Best treated with intravenous fluids and bisphosphonates
• Clubbing
• Hypertrophic pulmonary osteoarthropathy (HPOA)
(HPOA) is a proliferative peri-ostisis typically involves the long bones.
It is often painful.
• Hyperthyroidism due to ectopic TSH
Adenocarcinoma
• Gynecomastia
• Bronchial carcinoma can presents with ataxia and bilateral Gynecomastia
• It can be painful and may be associated with testicular atrophy.
• Ataxia can occur as a result of a paraneoplastic cerebellar degeneration associated
with the malignancy
25. Small cell
• ADH : Symptomatic hyponatremia due to SIADH is treated with demeclocycline which induces nephrogenic diabetes insipidus leading to
excretion of excess water.
• ACTH : not typical, hypertension, hyperglycemia, hypokalemia, alkalosis and muscle weakness are more common than buffalo hump etc.
May manifest by Cushingoid facieses and hyperpigmentation of the skin
• Lambert-Eaton syndrome
70% occur in small cell carcinoma
is a pre-synaptic disorder of auto-antibody IgG directed against the pre-synaptic voltage gated calcium
channel (VGCC) leading to impaired acetylcholine release.
Characterized by:
• Proximal muscle weakness (the cranial nerves and respiratory muscles are usually spared)
• Depressed or absent tendon reflexes and
• Autonomic features (for example, dry mouth, impotence, etc.).
Weakness and fatigability can be improved with guanidine hydrochloride
Unlike myasthenia gravis exercise is associated with increasing muscle strength and there is a negative
response to Tensilon.
Electromyography is useful in confirming the diagnosis where repeated nerve stimulations cause a
progressive increase in the size of the muscle action potential.
Cerebellar ataxia:
Paraneoplastic syndromes are a result of antibody generation from or against malignant cells attacking normal tissue.
Example: anti neuronal antibodies (anti-Hu, anti-Yo, anti-Ri ) directed against the Purkinje cells of the cerebellum
leading to the cerebellar syndrome (truncal ataxia).
To diagnose this : Anti-Purkinje cell antibody levels.