lung malignancy, mediastinal disorders, pulmonary nodules

Question 1

what are the characteristics of a solitary pulmonary nodule

Answer 1

• <3cm
• isolated round opacity

most are benign

Question 2

what would radiology show for a solitary pulmonary nodule

Answer 2

• CXR: popcorn calcification
• CT areas of altering fat/calcifications

Question 3

what are the 4 types of lung cancers

say whether they present centrally or peripherally

Answer 3

• Small Cell Carcinoma - presents centrally
• Squamous Cell Carcinoma - presents centrally
• Adenocarcinoma - present peripherally
• Large Cell Cancer - anywhere but often more peripheral

Question 4

what portion of the lung is more likely to be malignant

Answer 4

upper lobe

Question 5

what features make a solitary pulmonary nodule more likely to be malignant

Answer 5

• in the upper lobes
• subsolid (ground glass = bad)
• ill defined, lobular, or spiculated. (NOT smooth)
• growth on serial imaging
• stippled or eccentric pattern

Question 6

what is the screening reccomendation for lung cancer

Answer 6

• 50-80 years old in good health
• currently smokes or quit in the past 15 years
• at least 20 pack year history
• access to treatment

screening should be an annual low dose CT scan

Question 7

what are the symptoms associated with pancoast tumor

Answer 7

• shoulder pain (brachial plexus)
• horners syndrome
• atrophy of hand muscles

Question 7

what is a pancoast tumor

Answer 7

tumor in the apex of the lung causing compression of surrounding structures

Question 8

what population is at risk for a false negative PET scan

Answer 8

diabetic, because PET scan measures glucose metabolism

Question 9

what biopsy modality is reccomended for peripherally located lung tumors

Answer 9

transthoracic percutaneous fine-needle aspiration with CT guidance

Question 10

what biopsy modality is preferred for centrally located lung tumors

Answer 10

endobronchial US bronchoscopy

Question 11

what are the 4 classifications of lung cancer

Answer 11

1. small cell lung cancer
2. squamous cell carcinoma
3. adenocarcinoma
4. large cell carcinoma

2-4 are all “non small cell lung cancer”

Question 12

what are the characteristics of small cell lung cancer

Answer 12

• rare in non-smokers
• bronchi (centrally located)
• presents as large hilar mass w bulky mediastinal LAD

Question 13

what is the MC form of lung cancer in NON smokers

Answer 13

adenocarcinoma

but this is still more common in smokers than non smokers

Question 14

what is the treatment of lung cancer

Answer 14

stage 1: surgery +/- radiation
stage 2 and 3: surgery + chemo +/-radiation
stage 4: chemo +/- palliative radiation and surgery

Question 15

what is a bronchial carcinoid tumor

Answer 15

rare cancer developes in bronchi and rarely metastasizes

MC before age 60. no link to smoking.

Question 16

what is the clinical presentation of bronchial carcinoid tumor

Answer 16

• hemoptysis
• wheezing
• recurrent pneumonia
• carcinoid syndrome (flushing, diarrhea, wheezing, hypotension)

carcinoid syndrome is rare but i know itll be on there

Question 17

what is the diagnostic for bronchial carcinoid tumors

Answer 17

bronchoscopy showing pink/purple tumor that bleeds significantly on biopsy

Question 18

what is the treatment for bronchial carcinoid tumors

Answer 18

surgical excision
to avoid tumor bleeding and airway obstruction