DIT review - Pulmonary 3 Flashcards
What is the main reason to differentiate between small cell and non-small cell lung cancer
Treatment:
Small cell = chemo
Non-small cell = surgery
Describe location and other diseases that can be caused by small cell lung cancer (what substances does the tumor produce)
- “S” = smokers, central, secreting
- Poorly differentiated small cells (high nucleus: cytoplasm ratio)
- Arise from neuroendocrine cells
- Chromogranin A positive
- May produce:
- ADH = SIADH
- ACTH = Cushing’s
- Antibodies against pre-synaptic Ca2+ channels = Lambert-Eaton
Location and histology of squamous cell lung cancer (non-small cell)
- “S” = smokers, central, secreting
- Often presents as a hilar mass
- Keratin pearls and intercellular bridges
What hormone may be produced by squamous cell carcinoma
- May produced PTH = hypercalcemia
Location and populations associated with adenocarcinoma of the lung
- Non-smokers and female smokers
- Located in lung periphery
Describe Bronchioalveolar lung cancer (what it is and histology)
- Subtype of Adenocarcinoma
- X-ray shows hazy infiltrates similar to pneumonia
- Columnar cells grow along pre-existing alveolar septa = apparent “thickening” of alveolar walls
- Excellent prognosis
Describe large cell lung carcnioma
- Smokers
- Located in lung periphery
- Anaplastic and undifferentiated tumor
- Process of elimination – no keratin pearls, intercellular bridges, glands, or mucin
- Poor prognosis (poorly differentiated cells)
Type of cell that comprises carcinoid tumor
- Well-differentiated neuroendocrine cells
- Chromogranin A positive
Common locations of carcinoid tumor
- Lung = Classically presents as a polyp-like mass in the bronchus
- GI tract = only causes carcinoid syndrome if metastasis to liver
Presentation of carcinoid tumor
- Bronchospasm and wheezing
- Flushing
- Diarrhea
- R-sided heart lesions
Complications associated with Pancoast tumor
- Hoarseness = recurrent laryngeal nerve
- Horner syndrome (ptosis, miosis, anhydrosis) = superior cervical ganglion
- SVC syndrome = superior vena cava
- Facial plethora
- Jugular venous distension
- Edema and blue discoloration of arms and face
- Sensorimotor deficit
Risk factors associated with mesothelioma
- Malignancy of pleura
- Associated with asbestos
- No associated with smoking
- Psammoma bodies
Most common places for lung cancer to metastasize to
- Adrenals, brain, bone, liver
Most common locations for lung cancer to have metastasized from
- Breast, colon, prostate, bladder
What is pneumonia?
Inflammation in the alveoli
What will you see on CXR in the 3 types of pnuemonia:
- Lobar
- Bronchopneumonia
- Interstitial
Lobar = consolidation of an entire lobe
Broncho = scattered, patchy consolidation centered around bronchioles
Interstitial = diffuse infiltrate with increaed lung markings
Common pathogens in lobar pneumonia
- Strep pneumoniae, Klebsiella, Legionella
Phases of lobar pneumonia
- Congestion = red-purple; exudate with mostly bacteria
- Red hepatization = red-brown; exudate with bacteria, RBC, WBC, fibrin
- Gray hepatization = gray; exudate with WBC and fibrin; RBCs are degraded
- Resolution = components of exudate are digested
Common pathogens in bronchopneumonia
- Strep pneumoniae, Staph aureus, H. influenzae, Klebseilla
Common pathogens in interstitial pneumonia
- Mycoplasma, Chlamydia, Legionella, viruses (RSV, CMV, influenza, adenovirus)
Treatment for lung abscesses
Clindamycin
What is a pleural effusion
- Fluid between the two pleural layers
- Can lead to restricted lung expansion during inspiration
Describe transudate pleural effusions (content and causes)
- Low protein content
- THINK: Transudate is more transparent
- Due to increased hydrostatic pressure (e.g. CHF or fluid overload) or decreased oncotic pressure (e.g. cirrhosis, nephrotic syndrome)
Describe exudate pleural effusion (content and causes0
- High protein content, cloudy
- Due to malignancy, pneumonia, trauma, connective tissue disease
- Must be drained due to risk of infection
