1. Second Session
1.1. Step (6): Review of Learning Objectives
1.1.1. Mass in the lung:
1.1.1.1. Neoplasia
1.1.1.2. Inflammatory
1.1.1.2.1. Infectious
1.1.1.2.2. Non-infectious
1.1.1.3. Benign lesion
1.1.1.3.1. Hamartoma
1.1.1.4. Difference between malignant and benign lesions
1.1.1.4.1. Malignant: can have corona radiata, irrigular ridge, Above 3 cm
1.1.2. Lung cancer
1.1.2.1. Types
1.1.2.1.1. Adenocarcinoma
1.1.2.1.2. Small cell
1.1.2.1.3. Squamous
1.1.2.1.4. Large cell
1.1.2.2. 10% of heavy smoker develop cancer ( But 80% of those who developed lung cancer used to be tobacco smokers )
1.1.2.3. Risks: smoking, age, asbestos, air pollution
1.1.2.4. Sings and symptoms:
1.1.2.4.1. Cough, wheezing, hemoptysis,
1.1.2.4.2. Systemic: fever, weight loss
1.1.2.4.3. Met: bone pain
1.1.2.4.4. Para-neoplastic syndrome: SIADH( hyponatriemia + euvolmic ) .. ACTH production .. Lambert-eaton syndrome and other neurological syndromes
1.1.2.4.5. Pancost tumor: Ptosis, miosis, anhydrosis, enophthalmos
1.1.2.4.6. SVC obstruction
1.1.2.4.7. Clubbing & PHOA
1.1.2.4.8. Airways obstruction
1.2. Step (7): Gathering Information & Inquiry Plan
1.2.1. History
1.2.2. Physical Examination
1.2.2.1. Vitals:
1.2.2.1.1. BP: 110/65
1.2.2.1.2. pulse: 90 per min
1.2.2.1.3. Wight : 50 Kg .. height: 150 cm
1.2.2.1.4. Not jaundiced
1.2.2.1.5. TEMP: 37.4
1.2.2.2. General appearance: emaciated
1.2.3. Investigation
1.3. Step (8): Diagnostic Decision
1.3.1. Mechanism
1.3.2. Presentation
1.3.3. Supporting Data
1.4. OBJECTIVES
1.4.1. Management and prevention
2. Third Session
2.1. Step (9): Review of Learning Objectives
2.2. Step (10): Management
2.2.1. Non-small cell
2.2.1.1. Stage one & two: surgical
2.2.1.1.1. Exceptions ( Refusal, affecting the bronchi and esophagus, co-morbidity )
2.2.1.2. Stage 3?
2.2.1.2.1. Chemi + radio
2.2.1.3. Stage 4:
2.2.1.3.1. Surigcal intevention ( has to be have a solitary metastatic leison + confined to one area )
2.2.2. Small cell
2.2.2.1. Chemotherapy
2.2.2.1.1. Cisplatin or carboplatine + etoposide
2.2.2.2. Surgical if the tumor is not Met
2.2.2.2.1. Because by the time of the diagnosis the cancer has spread( Only done to get a biopsy )
2.2.2.3. Radiotherapy ( Rarely used )
2.2.3. For the prevention of the nausea and vomiting associated with chemo >> Ondasterone
2.2.4. If brain met is suggested > prophylactic radiation BUT if sure >> radiation and chemo
2.2.5. Prevention
2.2.5.1. Cutting off smoking
2.2.5.2. Awareness of the risk of smoking
2.2.5.3. Asbestos as a risk
2.3. Step (11): Feedback & Resources
3. First Session
3.1. Step (1): Identifying Difficult Words & Cues
3.1.1. Difficult Words
3.1.1.1. Naturopath
3.1.2. Cues
3.1.2.1. 50 M
3.1.2.2. Worsening cough
3.1.2.3. Shortness of breath
3.1.2.4. Pain; left rib, pelvic pain, RUQ
3.1.2.5. MASS IN THE RIGHT LUNG
3.1.2.6. need for further investigation
3.1.2.7. Pain worsening at night
3.1.2.8. Worsen with bending
3.2. Step (2): Problem Formulation
3.2.1. 50 y old Male complaining of RUQ pain, and in the left rib & left pelvic region with shortness of breath and cough. 2 y ago X-ray showed right lung mass lesion.
3.3. Step (3): Hypotheses Generation
3.3.1. Lung cancer
3.3.2. what about the mass in the x-ray?
3.3.3. Liver cancer > Lung ( Met ) to the bone as well
3.3.4. TB
3.3.5. Pelvic trauma
3.3.6. Alcoholic pt; multiple rib fractures
3.4. Step (4): Hypotheses Organization
3.4.1. Neoplastic ( of the lung mass ) & Non-neoplastic
3.5. Step (5): Learning Objectives
3.5.1. 1- To list the DDx of mass in the lung upon X-ray
3.5.2. 2- Lung cancer definition, pathogenesis, risk factors, presentation, investigations and pattern of metastasis