Chronic pneumonias/ Lung cancer

Question 1

Chronic pneumonias share all of the following common features EXCEPT:

a. lung inflammation for weeks to months
b. intracellular pathogens of macrophages
c. histology of granulomas
d. lower lung involvement
e. constitutional symptoms of fatigue, weight loss, fever, cough, dyspnea

Answer 1

d is false - UPPER lung involvement is seen

Question 2

Treatment for latent TB

Answer 2

9 months of INH

Question 3

Treatment for active TB

Answer 3

INH, RMP, PZA, EMB for 2 months,

then INH + RMP for 4 months

Question 4

Ddx of localized pulmonary infiltrate with adjacent hilar adenopathy (aka back of potatoes) includes 4

Answer 4

1. lung Ca
2. Mycobacterial disease
3. Fungi
4. Sarcoidosis

Question 5

True/False: Disseminated histoplasmosis is best diagnosed by serology

Answer 5

False! - urine antigen

Question 6

True/False: Acute and chronic pulmonary histoplasmosis is best diagnosed by serology

Answer 6

True

Question 7

What are the 2 biggest challenges worldwide with TB?

Answer 7

1. multi drug resistance

2. co-infection with HIV

Question 8

Diagnosis of latent TB

Answer 8

TST skin test + neg CXR
or
INFy release assay blood test (more specific) + neg CZR

Question 9

Diagnosis of active TB

Answer 9

Sputum acid fast stain x3 
Culture and susceptibilities (3-6 wks) 
CXR 
Or, Nucleic acid amplification 
*do NOT get skin test (false neg)

Question 10

The highest rate of progression of TB per year occurs in what situation?

Answer 10

10% EACH year in concurrent HIV infection

vs. 5% anytime after 2 years or 5% within 2 years

Question 11

More common lung cancer: small cell or non small cell?

Answer 11

non small cell (80-85%)

of which, adenocarcinoma is most common

Question 12

What is the most important component of lung cancer predicting treatment and survival?

Answer 12

BIOLOGY! > histology > stage

–think about targeted therapies (GF receptors)/ immunotherapy (ex. anti PD1 Ab)

Question 13

Which of the following pairs of stages: treatment is FALSE?

a. Stage I: surgery
b. Stage II: chemotherapy
c. Stage IIIa: neoadjuvant chemo/ RT +/- surgery
d. Stage IIIb/ IV: palliative (chemo, RT, hospice)

Answer 13

b is false - Stage II is treated by surgical resection (and potentially added chemo/ RT)

Question 14

Who should be screened for lung CA using low dose chest CT?

Answer 14

Age 55-75, smokers w/ 30 pack yr history, ex smokers that have quit within 15 years
-most end up being benign, but does reduce death

Question 15

metastasis defines stage __ lung CA

Answer 15

IV (including exudate pleural effusion) - terminal

Question 16

True/ False - Small cell lung cancer is treated with resection with adjuvant chemoradiation

Answer 16

False - LITTLE role for surgery, treated with chemorad

also, high incidence of hormone/protein production

Question 17

What is done if a nodule is found in lung CA screening?

Answer 17

1. FIRST - observation (w/ interval imaging) - look for growth, shape (spiculated), density (calcification), location (upper lobe), size
2. PET scan
3. Biopsy