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clinical medicine II exam 2 > Lung CA > Flashcards

Lung CA Flashcards

1
Q

95% of all lung cancers can be broken down into what two types

A
  • small cell lung CA (SCLC)
  • non-small cell lung CA (NSCLC)
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2
Q

describe a Coin lesion

A
  • < 3 cm
  • isolated
  • smooth
  • dense central calcification
  • Benign
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3
Q

when is a solitary pulmonary nodule considered a mass

A

> 3 cm in size

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4
Q

what is the problem with a solitary pulmonary nodule > 3 cm (mass)

A

greater chance of being malignant

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5
Q

list some causes of benign solitary pulmonary nodule

A
  • infectious: TB; cocci
  • pulm abscess
  • Hamartoma
  • Vasculitic lesion
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6
Q

risk factors of lung CA

A
  • smoking
  • exposures: asbestos, radiation
  • genetic predisposition
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7
Q

endobronchial tumor can present as what on physical exam

A

fixed or localized wheeze

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8
Q

solitary pulmonary nodule that presents with lymphadenopathy usually affects which nodes

A
  • supraclavicular
  • scalene nodes
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9
Q

what parameters should you look at when assessing a solitary pulmonary nodule on xray

A
  1. Stability
    • review old films; minimal growth in 2 yrs -> benign
  2. calcification
    • no calcification = elevated risk of CA
  3. shape
    • poorly defined, irregular = elevated risk of CA
  4. size
  • **refer if lesion is not stable, not calcified, not rounded, or > 3 cm
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10
Q

non-small cell types can be broken down into what 3 catagories

A
  1. adenocarcinoma
  2. squamous cell carcinoma
  3. large cell carcinoma
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11
Q

Which two types of lung CA are centrally located

A
  1. small cell lung CA
  2. NSCLC- Squamous cell carcinoma
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12
Q

Which two types of lung are the most aggressive

A
  1. small cell lung CA
  2. NSCLC- Large cell Carcinoma
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13
Q

which type of lung CA

  • arises from mucous glands
  • occurs in lung periphery
  • most prevalent lung CA in both sexes
A

Adenocarcinoma

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14
Q

squamous cell carcinoma may be able to be detected by

A

sputum cytology

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15
Q

Which type of lung CA

  • occurs centrally
  • more likely to cause hemoptysis
  • likely to metastasize to regional lymph nodes
  • can cavitate
A

squamous cell carcinoma

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16
Q

What is the most common symptom of primary lesion

A

cough

  • most frequently occurs with squamous and small cell
17
Q

hemoptysis is most associated with which lung CA

A

squamous cell

18
Q

what is the most common cause of hemoptysis

A

Bronchitis

19
Q

Lung CA can have intrathoracic spread and present as what conditions

A
  1. pleural effusion
  2. pericardial effusion
  3. hoarsness (compression of recurrent laryngeal nerve; most common with Lt sided tumors)
20
Q

What is superior vena cava syndrome

A
  • due to compression or direct invasion (centrally located CA)
  • symptoms
    • HA
    • dyspnea
    • facial or upper extremity swelling
    • plethora
    • dilated neck veins
    • prominent venous pattern on chest
21
Q

What is Pancoast syndrome

A
  • tumor involving superior sulcus compresses brachial plexes and cervical sympathetic nerves
22
Q

what does Pancoast syndrome present with

A
  • Horner’s syndrome
    • Miosis
    • Anhidrosis (lack of sweating)
    • Ptosis (lid droop)
  • atrophy of hand muscles
23
Q

Which paraneoplastic syndrome is most associated with Adenocarcinoma

A
  • carcinogenic thrombophlebitis (Traousseau’s syndrome)
  • hypercoagulability
24
Q

Which paraneoplastic syndrome is most associated with NSCLC Squamous

A
  • PTH-like substance
    • hypercalcemia
25
Q

Which paraneoplastic syndrome is most associated with NSCLC Large cell

A
  • excess HCG production
    • gynecomastia, mikly nipple discharge
26
Q

Which paraneoplastic syndromes are most associated with SCLC (small cell)

A
  • SIADH -> hyponatremia
  • Cushing’s syndrome: ectopic ACTH
  • Eaton-Lambert syndrome: mucle weakness due to defective release of acetylcholine
27
Q

What are the most common sites of distant metastases for lung CA

A
  1. Liver
  2. Bone (elevated alk phos)
  3. Adrenal glands
  4. Brain (noted in 20-30% of patients with SCLC)
28
Q

Small cell lung carcinomas can be diagnosed as one of what two stages

A
  • Limited disease
    • tumor limited to ipsilateral hemithorax
  • Extensive disease
    • tumor extends beyond hemithorax, included pleural effusions
29
Q

Non- small cell lung carcinomas can be diagnosed using TNM system. describe it

A
  • T: Primary tumor
  • N: nodal involvement
  • M: distant metastases
30
Q

How is tissue sample obtained to diagnose lung CA

A
  1. sputum culture: best for central lesion
  2. bronchoscopy with biopsy
  3. fine needle aspriation (CT guided)
31
Q

List stages for NSCLC

A
  1. stage 1: localized CA
  2. stage 2: spread to lymph nodes
  3. stage 3: spread into chest wall
  4. stage 4: spread to another part of body (ex: liver)
32
Q

PFTs are done prior to lung biospy, what is the strongest indicator of post-op complications

A

FEV1 < 60%

33
Q

treatment of stage 1 and stage 2 NSCLC

A
  1. stage 1
    • 75% 5 yr survival
    • surgical resection
  2. stage 2
    • 40% 5 yr survival
    • surgical resection + chemo
34
Q

Low dose helical CT should be used for screening instead of CXR for those at high risk. who falls into this category

A
  • ages 55-74 with 30 pack year history
    • or quit within 15 years
    • or 20 pack year history with one additional risk factor (other than second hand smoke exposure)
35
Q

primary adverse reaction to wellbutrin: used for smoking cessation

A

seizures

36
Q

which type of lung CA is this

  • rapid doubling time
  • centrally
  • hilar and mediastinal lymphadenopathy
  • assoc with
    • SVC syndrome
    • paraneoplastic syndrome
      • SIADH
      • Cushings
      • Eaton-lambert
A

small cell lung ca

clinical medicine II exam 2 (7 decks)

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