Lung cancer and more

Question 1

Pulm nodule workup?

Answer 1

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

Question 2

Lung cancer that is cavitary?

Answer 2

Squamous and direct extension

Question 3

Adenocarciumo

Answer 3

Asbestos has high hyalurodinase (means wants to move)

Question 4

Squamous cell paraneoplastic?

Answer 4

PTH related peptide
Hypercalcemia

Dermatomyositsi (in all lung cancer)

Question 5

Superior vena cava syndroma?

Answer 5

Head swelling, CNS symptoms and headache and vision changes

Need endogenous stunting, then radition therapy

COMES WITH CANCER

Question 6

What are non small cell lung cancers?

Tx

Answer 6

Squamous, adenocarcinoma and large cell cancer

CAN RESECT them and add chemoradiation

Question 7

Idiopathic pulmonary fibrosis history?

Lavage shows what?

Tx?

Answer 7

Progressive intolerance
Dyspnea, crackles, JVD, tachypnea, Clubbing

Lavage shows neutrophils

It is a restrictive lung disease

Question 8

CT on lung fibrosis?

Answer 8

Honeycomb (or ground glass)

Question 9

Lung fibrosis serum markers?

Answer 9

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

LUNG BIOPSY needed for dx and staging

Question 10

Tx of idiopathic pulmonary fibrosis?

Answer 10

Pirfenidone (prevents collagen synth)

Nintedanib blocks fibrogenic growth factors

glucocorticoid exacerbation

PULMONARY NOTgood (Pirfect Nintendos)

LUNG TRANSPLANT (5 year survival)

Question 11

Sarcoid lab? KNOW!

Answer 11

Increase ACE (angiotensin converting enzyme)

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

more WBC, sed rate, alk phos

Question 12

Sarcoid treatment?

Unique finding of sarcoid?

Answer 12

STEROIDs, usually self limiting

ANERGY (no reaction to skin test like PPD)

Question 13

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

Answer 13

Sarcoid. Steroids!

Question 14

Asbestosis complications?

Answer 14

bronchogenic carcinoma, mesothelioma

Question 15

What exposure increases risk of TB or progressive fibrosis?

Answer 15

Silicosis (sand mining)

Question 16

Does coal increase risk of cancer?

Answer 16

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

Question 17

Berylliosis?

Answer 17

Increased risk of cancer

Question 18

Goodpasture syndrome?

Answer 18

antiglomerular basement membranes

Hemoptysis,d yspnea, recent infection

ANTI GBM

Proteinura and granular cast

Crescentric glomerulonephritis

IgG along glomerular capillaries

Question 19

Tx of good pasture?

Answer 19

Plasmapheresis, glucocorticoids and immunosppressive

Question 20

Granulomatosis with polyangitis has nasal saddle.

Tx?

Answer 20

C disease! Cyclophosphamide and corticosteroids

Question 21

heart issues with each of the following?

Chromosome 22q11
Trisomy 21
Congen rubella
Turner
Marfan

Answer 21

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

Question 22

PE 4 star topic!

H and P?

Answer 22

Tachypnea and tachycardia

Altered mental status. Boring physical exam

think of cause for it

Question 23

acid base in PE?

Answer 23

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

Question 24

PE findings on EKG?

KNOW

Answer 24

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

Question 25

Dx for PE?

Answer 25

CT with contrast

Question 26

PE tx?

Answer 26

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)

Question 27

Pulm HTN is 2 or 3 star

Cauess?

Answer 27

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

Question 28

Dx of pulm htn?

Answer 28

Echo is sufficient.

Question 29

Tx of idiopathic pulm htn

Answer 29

Vasodilators

Prostoglandins
Endothelia antagonists (__sentans)
Cyclic GMP inhibitors: sildenafil
Nifedipine

Diuretics can help reduce congestion

Question 30

Pulmonary edema and wedge pressure less than 18 is what?

Answer 30

ARDS (if higher, think cariogenic cause)

Question 31

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

Answer 31

VQ

Question 32

Tx of pulm htn is best with what?

Answer 32

Prostagladins Pro at Pulm htn

other vasodilators
Sentans (endothelin blockers)
Phosph inhib
Dihydropyridine