Lung CA

Question 1

MC cause of CA related deaths in US

Answer 1

lung CA

Question 2

MC RF for lung CA

Answer 2

smoking

Question 3

what two RF are synergistic for causing lung CA

Answer 3

smoking and asbestos

Question 4

what is included in non-small lung CA

Answer 4

adenocarcinoma
large cell
squamous cell
lepidic pattern

Question 5

btwn non-small cell and small cell lung CA, which is more aggressive and usually metastatic at time of presentation

Answer 5

small cell lung CA

Question 6

what is normally tx of choice for non-small cell lung CA

Answer 6

surgical resection

Question 7

what is normally tx of choice for small cell lung CA

Answer 7

chemotherapy - bc more aggressive and usually metastatic at presentation

Question 8

USPSTF screening guidelines for lung CA

Answer 8

annual low-dose CT screening for those 50-80 who have no sx of lung CA + a 20 PPY smoking hx who currently smoke or have quit within 15 years

Question 9

when should screening for lung CA be d/c

Answer 9

when a person has not smoked for 15 years or develops a health condition that substantially limits life expectancy or the ability or willingness to undergo curative surgery

Question 10

what is the MC primary lung CA in smokers, women, men, and nonsmokers (50%)

Answer 10

adenocarcinoma of the lung

Question 11

strongest RF for adenocarcinoma of the lung

Answer 11

smoking

Question 12

chest XR for adenocarcinoma of the lung

Answer 12

usually peripherally located

Question 13

CT guided biopsy for adenocarcinoma of the lung

Answer 13

gland formation (glandular appearance) w mucin production

Question 14

second MC of lung CA after adenocarcinoma

Answer 14

squamous cell lung CA

Question 15

characteristics of squamous cell lung CA

Answer 15

typically centrally located - associated w cavitary lesions (central necrosis w cavitation), hypercalcemia, and pancoast syndrome

Question 16

sx of small cell lung CA

Answer 16

paraneoplastic syndromes - superior vena cava syndrome, Lambert eaton syndrome, SIADH (hyponatremia), Cushing syndrome (ectopic ACTH production), Horner syndrome

Question 17

chest XR for small cell lung CA

Answer 17

mass often centrally located

Question 18

what will histology show for small cell lung CA

Answer 18

sheets of small dark blue cells w rosette formation (about 2x the size of resting lymphocytes)

Question 19

MC type of lung CA

Answer 19

non-small cell lung CA

Question 20

which lung CA is less likely to be associated w smoking

Answer 20

adenocarcinoma

Question 21

MC cause of superior vena cava syndrome

Answer 21

small cell lung CA

Question 22

sx superior vena cava syndrome

Answer 22

facial, neck, upper extremity edema
facial plethora
chest pain
respiratory sx
neurologic manifestations
dyspnea (MC presenting sx)

Question 23

PE for superior vena cava syndrome

Answer 23

dilated and prominent neck and chest veins

Question 24

sx lambert-eaton myasthenic syndrome

Answer 24

proximal muscle weakness that improves w repeated muscle use
autonomic sx - dry mouth MC

Question 25

PE for Lambert eaton myasthenic syndrome

Answer 25

hyporeflexia
sluggish pupillary response
no significant muscle atrophy

Question 26

sx superior sulcus (pan coast) tumors

Answer 26

shoulder and arm pain MC initial sx
Horner syndrome - triad of ipsilateral ptosis (drooping of eyelid), miosis, anhidrosis due to involvement of the paravertebral sympathetic chain
weakness atrophy of the muscles of the hand and/or arm
may have ulnar neuropathy

Question 27

MC cause of mesothelioma

Answer 27

chronic asbestos exposure in 80% (industrial worker in 1930s-1940s increases risk)

Question 28

sx malignant mesothelioma

Answer 28

pleuritic chest pain
dyspnea
fever
night sweats
weight loss
hemoptysis

Question 29

chest XR mesothelioma

Answer 29

unilateral pleural thickening and blood pleural effusions

Question 30

solitary pulmonary nodule

Answer 30

single, small (</= 30 mm) usually well-circumscribed lesion that is surrounded entirely by pulmonary parenchyma

lesions measuring > 30 mm are considered masses and have higher malignant potential

Question 31

a nodule showing sizable increase over a period of days is likely

Answer 31

nonmalignant (infectious or inflammatory)

Question 32

a nodule showing sizable increase over a period of months is likely

Answer 32

malignant

Question 33

nodule characteristics that are likely benign

Answer 33

< 6 mm
very fast or no growth on repeat imaging 2 years apart
“popcorn” calcification pattern
solid
multiple pulmonary nodules that are < 5 mm in diameter, juxtaposed to either the visceral pleural or an interlobar fissure

Question 34

nodule characteristics that are likely malignant

Answer 34

> 8 mm (50% risk if > 20 mm)
rapid doubling time (within 100 days)
spiculated
subsolid
upper lobe
multiple pulmonary nodules that are >/= 1 cm in diameter

Question 35

patient characteristics that are likely benign (nodule)

Answer 35

lifelong nonsmoking
< 35 yo
no hx of malignancy

Question 36

patient characteristics that are likely malignant (nodule)

Answer 36

smoking hx
occupational exposure (asbestos)
>/= 35 yo
prior dx of CA

Question 37

CT scan indications for pulmonary nodule

Answer 37

no prior films for comparison
nodule has increased in size for more than 2 years
findings suggestive or CA or CA related findings
no nodule on previous chest radiograph

Question 38

Indications for PET scan pulmonary nodule

Answer 38

Nodules >/= 1 cm
if positive, do biopsy

Question 39

indications for chest imaging 3 mos (pulmnary nodule)

Answer 39

nodules that are benign based on CT findings