Lung cancer and more Flashcards by Jeff Rossow

Pulm nodule workup?

Prior CXR to compare, if new or changed do CT for location and size

Benign: less than 35 years old, less than 2 cm, uniform, no lymphadenopathy

F/U in 3-6 months

Cancer risk: smoker, 45 or older, irregular, bigger than 2 cm, new or progressing

FDG-PET, biopsy, resection depednign on likelihood of malignancy

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Lung cancer that is cavitary?

Squamous and direct extension

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Adenocarciumo

Asbestos has high hyalurodinase (means wants to move)

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Squamous cell paraneoplastic?

PTH related peptide
Hypercalcemia

Dermatomyositsi (in all lung cancer)

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Superior vena cava syndroma?

Head swelling, CNS symptoms and headache and vision changes

Need endogenous stunting, then radition therapy

COMES WITH CANCER

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What are non small cell lung cancers?

Squamous, adenocarcinoma and large cell cancer

CAN RESECT them and add chemoradiation

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Idiopathic pulmonary fibrosis history?

Lavage shows what?

Tx?

Progressive intolerance
Dyspnea, crackles, JVD, tachypnea, Clubbing

Lavage shows neutrophils

It is a restrictive lung disease

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CT on lung fibrosis?

Honeycomb (or ground glass)

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Lung fibrosis serum markers?

SP-A SP-B MCP-1 and KL-6

LUNG BIOPSY needed for dx and staging

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Tx of idiopathic pulmonary fibrosis?

Pirfenidone (prevents collagen synth)

Nintedanib blocks fibrogenic growth factors

glucocorticoid exacerbation

PULMONARY NOTgood (Pirfect Nintendos)

LUNG TRANSPLANT (5 year survival)

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Sarcoid lab? KNOW!

Increase ACE (angiotensin converting enzyme)

Hyper calcium (b/c macrophage making more vit d)

more WBC, sed rate, alk phos

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Sarcoid treatment?

Unique finding of sarcoid?

STEROIDs, usually self limiting

ANERGY (no reaction to skin test like PPD)

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Arhtritis, chest pain, erythema nodulous, lymphadenopathy, vision loss, nerve palsy?

Sarcoid. Steroids!

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Asbestosis complications?

bronchogenic carcinoma, mesothelioma

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What exposure increases risk of TB or progressive fibrosis?

Silicosis (sand mining)

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Does coal increase risk of cancer?

NO, just progressive fibrosis (which is terrible!) Need Pirfendion or nintenib (perfect nintendos)

Berylliosis?

Increased risk of cancer

Goodpasture syndrome?

antiglomerular basement membranes

Hemoptysis,d yspnea, recent infection

ANTI GBM

Proteinura and granular cast

Crescentric glomerulonephritis

IgG along glomerular capillaries

Tx of good pasture?

Plasmapheresis, glucocorticoids and immunosppressive

Granulomatosis with polyangitis has nasal saddle.

Tx?

C disease! Cyclophosphamide and corticosteroids

heart issues with each of the following?

Chromosome 22q11
Trisomy 21
Congen rubella
Turner
Marfan

22q11: truncus and tet
21 is endocardial defects, tet, PDA
Rubella: PDA
Turner is Coarct
Marfan is aortic regurg

PE 4 star topic!

H and P?

Tachypnea and tachycardia

Altered mental status. Boring physical exam

think of cause for it

acid base in PE?

resp alkalosis b/c lots of breathing, but low O2!!

PE findings on EKG?

KNOW

S1Q3T3 (wide S in lead 1, q and inverted T in 3)

Dx for PE?

CT with contrast

PE tx?

O2, fluids or pressors LMWH initially then warfarin for 3 to 6 months IVC filter if contraindication to chronic anticoag (high fall risk) THROMBOLYTICS if unstable (usually don't need it, because dead already if so severe)

Pulm HTN is 2 or 3 star Cauess?

PE, vale disease, L to R shunt, COPD (most common cause), Idiopathic pulm htn

Dx of pulm htn?

Echo is sufficient.

Tx of idiopathic pulm htn

Vasodilators Prostoglandins Endothelia antagonists (__sentans) Cyclic GMP inhibitors: sildenafil Nifedipine Diuretics can help reduce congestion

Pulmonary edema and wedge pressure less than 18 is what?

ARDS (if higher, think cariogenic cause)

Cant do CT angio if history of renal failure or on metformin but you suspect PE, what do you do?

Tx of pulm htn is best with what?

Prostagladins Pro at Pulm htn other vasodilators Sentans (endothelin blockers) Phosph inhib Dihydropyridine