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αναπνευστικο f > Lung—physical findings-Pleural effusions-pneumothorakas-pneumonia- apostima pneumona-mesothilioma-pancoast- Superior vena cava syndrome - karkinoi > Flashcards

Lung—physical findings-Pleural effusions-pneumothorakas-pneumonia- apostima pneumona-mesothilioma-pancoast- Superior vena cava syndrome - karkinoi Flashcards

1
Q

A patient has dyspnea, decreased right breath sounds, dullness to percussion, and decreased tactile fremitus. What is the likely diagnosis?

A

Pleural effusion

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2
Q

A patient has crackles on the right with dullness to percussion and no tactile fremitus. Would there be tracheal deviation?

A

Yes, as there will be deviation away from the side of the lesion if the effusion is large (this is a pleural effusion on the right)

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3
Q

A patient has decreased breath sounds on the right, dullness to percussion, and tracheal deviation to the right. What does he have?

A

Atelectasis (bronchial obstruction) on the right

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4
Q

What are the physical exam findings in a patient with atelectasis (bronchial obstruction)?

A

Decreased breath sounds, dullness to percussion, decreased fremitus, tracheal deviation toward the side of the lesion

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5
Q

A patient has dyspnea, hyperresonance, decreased breath sounds on the left, and tactile fremitus. Is there tracheal deviation?

A

There is no tracheal deviation (this patient has a simple pneumothorax)

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6
Q

A man has dyspnea, absent right breath sounds, hyperresonance, and tracheal deviation to the left. How will fremitus be affected?

A

Fremitus will decrease (this patient has a tension pneumothorax)

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7
Q

A patient has fever, dyspnea, right bronchial breath sounds, dullness to percussion, and increased tactile fremitus. Likely diagnosis?

A

Lobar pneumonia

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8
Q

A patient has shortness of breath, severe HF, bronchial breath sounds, dullness to percussion at bases, and increased fremitus. Diagnosis?

A

Pulmonary edema

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9
Q

A patient has fever, bronchial breath sounds, dullness to percussion, and increased fremitus. Is there tracheal deviation?

A

No tracheal deviation, as with pulmonary edema and simple pneumothorax (this patient has lobar pneumonia)

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10
Q

Pleural effusion and tension pneumothorax have tracheal deviation ____ (away from/toward) the side of the lesion.

A

Away from

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11
Q

Atelectasis (from bronchial obstruction) has tracheal deviation ____ (away from/toward) the side of the lesion.

A

Toward

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12
Q

In terms of pleural effusions, transudates have ____ (less/more) protein than exudates.

A

Less

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13
Q

Name the three types of pleural effusions.

A

Transudative, exudative, and lymphatic

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14
Q

Transudative pleural effusion is caused by ____ (increased/decreased) hydrostatic pressure or ____ (increased/decreased) oncotic pressure.

A

Increased, decreased

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15
Q

Name four causes of exudative pulmonary effusions.

A

Malignancy, pneumonia, collagen vascular disease, and states of increased vascular permeability (trauma)

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16
Q

What makes an exudate cloudy?

A

Exudates are cloudy because of their higher protein content

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17
Q

A patient develops a pleural effusion secondary to trauma. Is this more likely to be transudative or exudative?

A

Exudative (trauma is a state of increased vascular permeability)

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18
Q

A patient with an exudative pleural effusion requires immediate drainage of the effusion. Why is this the case?

A

Exudates have a high infection risk

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19
Q

A woman has a pleural effusion that consists of high triglyceride levels and has a milky appearance grossly. What type of effusion is this?

A

Lymphatic

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20
Q

What causes lymphatic effusions (chylothorax)?

A

Thoracic duct injury from trauma or malignancy

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21
Q

Name four types of pneumothorax.

A

Primary spontaneous, secondary spontaneous, traumatic, and tension

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22
Q

A tall young man has unilateral chest pain, dyspnea, and ruptured apical blebs. Which way is his trachea deviated?

A

Toward the affected lung (this is a spontaneous pneumothorax)

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23
Q

A tall, thin 15-y/o male has chest pain and dyspnea. There is decreased fremitus and hyperresonance on the left chest. What caused this?

A

Primary spontaneous pneumothorax occurs in tall, thin, young males as a result of apical bleb or cyst rupture

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24
Q

Name two causes of secondary spontaneous pneumothorax

A

Lung disease (e.g., emphysema, infections) and barotrauma from high pressures on use of mechanical ventilation

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25
Q

A patient is on mechanical ventilation. He then complains of unilateral chest pain and dyspnea. What happened?

A

He likely developed a pneumothorax from the high pressure of mechanical ventilation

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26
Q

A man presents after falling from the top of a roof. He has chest pain, dyspnea, diminished breath sounds, and tactile fremitus. Diagnosis?

A

This is likely a traumatic pneumothorax from blunt trauma, also seen in penetrating trauma (e.g., gunshot wounds)

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27
Q

A patient is involved in a motor vehicle crash and has a right-sided tension pneumothorax. Which direction is the trachea pointing?

A

Left (a tension pneumothorax deviates the trachea away from the affected lung)

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28
Q

List three bacterial causes of interstitial pneumonia.

A

Mycoplasma, Legionella, and Chlamydia

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29
Q

Which type of pneumonia is most often caused by viruses?

A

Interstitial (atypical) pneumonia

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30
Q

List four viruses that commonly cause interstitial pneumonia.

A

Respiratory syncytial virus, influenza virus, cytomegalovirus, and adenovirus

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31
Q

Interstitial pneumonia characteristically shows diffuse, patchy inflammation that is localized to what areas of the lung?

A

Interstitial areas at the alveolar walls

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32
Q

The distribution of interstitial pneumonia characteristically involves how many lobes?

A

At least one, usually more

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33
Q

Which category of pneumonia typically has a less acute presentation?

A

Interstitial pneumonia (walking pneumonia)

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34
Q

What is a lung abscess?

A

A localized collection of pus within the lung parenchyma

35
Q

Name two conditions that can predispose a patient to lung abscess formation.

A

Bronchial obstruction (e.g., tumor) or oropharyngeal content aspiration (e.g., loss of consciousness during seizures or heavy alcohol use)

36
Q

What finding on chest x-ray is suggestive of a lung abscess?

A

Air-fluid levels

37
Q

A roofer who smokes is noted to have hemorrhagic pleural effusions and pleural thickening. Is his smoking to blame?

A

Not likely, as this is mesothelioma secondary to asbestosis, for which smoking is not a risk factor

38
Q

A roofer is noted to have pleural thickening and a biopsy of the lesion is performed. What would it show on histology?

A

Psammoma bodies on histology (this patient has mesothelioma)

39
Q

A plumber has chest pain and dyspnea. Histology shows psammoma bodies. What kind of pleural effusion is associated with his condition?

A

Pleural effusion is exudative (this patient has mesothelioma from asbestos exposure)

40
Q

CT scan of the chest in a patient with dyspnea shows an apical lung mass. What neurologic structures are at risk of being compressed?

A

The cervical sympathetic plexus (this is a Pancoast tumor)

41
Q

When Pancoast tumor disrupts the cervical sympathetic plexus, it can result in what condition? What findings will be seen?

A

Horner syndrome; one sees ipsilateral ptosis, miosis, and anhidrosis

42
Q

A patient has cough, weight loss, and malaise. Exam shows ipsilateral eyelid droop, miosis, and no sweating. What does chest X-ray show?

A

Given the history, CXR will likely show an apical opacity characteristic of a Pancoast tumor

43
Q

A man is diagnosed with a Pancoast tumor. Other than Horner syndrome, what other findings may you find?

A

Sensorimotor deficits, hoarseness, and/or obstruction of the superior vena cava leading to SVC syndrome

44
Q

Superior vena cava syndrome is most likely caused by what?

A

Neoplasms and thromboses from indwelling catheters

45
Q

A patient with superior vena cava syndrome is rushed to the ED by his doctor. Why does the doctor consider this a major emergency?

A

If obstruction is severe, elevated cranial pressure may increase the risk of aneurysm formation or rupture of intracranial arteries

46
Q

Superior vena cava syndrome puts a patient at risk of rupture of what arteries?

A

Intracranial arteries, as a result of increased intracranial pressure

47
Q

A man with a left lung mass has headaches and dizziness. Brain angiography shows a berry aneurysm. What major vessel is blocked by the mass?

A

The superior vena cava (this is SVC syndrome)

48
Q

What type of cancer is the leading cause of cancer death?

A

Lung cancer

49
Q

A patient with a history of smoking has a cough and hemoptysis. Exam shows decreased breath sounds and wheezing. What do you suspect?

A

Lung cancer (a common clinical presentation is cough, bronchial obstruction, hemoptysis, and wheezing)

50
Q

• What are common presenting radiologic findings in lung cancer patients?

A

Pneumonic coin lesions on chest X-ray, noncalcified nodules on CT

51
Q

Name four common sites of metastases from primary lung cancer.

A

Brain, bone, liver, and adrenals

52
Q

In association with a primary lung cancer, what finding suggests bone metastases?

A

Pathologic fractures

53
Q

A patient is diagnosed with the leading cause of cancer death. What two findings on physical exam might suggest liver metastases?

A

Jaundice and hepatomegaly (this is likely lung cancer, the leading cause of cancer death)

54
Q

Metastases occur ____ (more/less) frequently than primary neoplasms when it comes to lung cancer.

A

More

55
Q

A patient is found to have multiple pulmonary tumors. If these are metastatic, name the most common sites they would have originated from.

A

Breast, colon, prostate, bladder

56
Q

What are the common complications of lung cancer?

A

SVC syndrome, Pancoast tumor, Horner syndrome, Endocrine (paraneoplasia), Recurrent laryngeal nerve symptoms, Effusions (SPHERE)

57
Q

A patient with lung cancer experiences unexpected voice changes. How is it changing, and why might this be happening?

A

It can become hoarse, due to compression of the recurrent laryngeal nerve

58
Q

Which potential spaces can develop effusions as a result of lung cancer?

A

Pleural and pericardial spaces

59
Q

List two forms of bronchogenic carcinoma that tend to arise peripherally in the lungs.

A

Adenocarcinoma and large cell carcinoma

60
Q

List risk factors that lead to lung cancer.

A

Asbestos exposure, family history, radon, smoking, secondhand smoke

61
Q

A patient is diagnosed with an oat cell carcinoma of the lung. In which area of the lungs does this cancer type typically arise?

A

Centrally (small cell [oat cell] cancer is a very aggressive type of lung cancer)

62
Q

Name three possible products of neoplastic neuroendocrine cells in small cell carcinoma.

A

ACTH, SIADH, and Antibodies against presynaptic calcium channels or neurons

63
Q

An elderly smoker with hemoptysis and known lung cancer develops muscle weakness that improves with activity. What is the diagnosis?

A

Lambert-Eaton syndrome (a paraneoplastic syndrome associated with small cell carcinoma of the lung)

64
Q

What is the treatment of small cell lung cancer?

A

This inoperable cancer is treated with chemotherapy

65
Q

A smoker is newly diagnosed with lung cancer, which has myc amplification, and chromogranin A positivity on histology. Treatment?

A

Treat with chemotherapy, as it is usually inoperable (this patient has small cell [oat cell] cancer)

66
Q

Name the non-small cell lung cancers.

A

Adenocarcinoma, squamous cell carcinoma, large cell carcinoma, bronchial carcinoid tumor

67
Q

A patient is diagnosed with lung cancer that is the most common nonsmoker subtype. In which area of the lungs does this typically arise?

A

Peripherally (this is adenocarcinoma of the lung)

68
Q

What is the most common type of lung cancer in nonsmokers and women?

A

Adenocarcinoma

69
Q

Adenocarcinoma has mutations in the ____ oncogenes. Small cell carcinoma has mutations in ____ oncogenes.

A

KRAS, EGFR, ALK; myc

70
Q

What lung cancer is associated with hypertrophic osteoarthropathy?

A

Adenocarcinoma

71
Q

A nonsmoker has cough, clubbing, and joint pain. Chest x-ray shows hazy infiltrates, suggesting cancer. Where is growth most likely to be?

A

Along alveolar septa giving an appearance of wall thickening (the patient has bronchoalveolar cancer [excellent prognosis])

72
Q

Bronchioloalveolar adenocarcinoma can present similarly to what other noncancerous pathological lung disease?

A

Pneumonia

73
Q

A woman has chest pain, dyspnea, and hemoptysis. Histology shows a glandular pattern and mucin (image). Did this woman smoke?

A

Unlikely, as this is adenocarcinoma, which classically arises in nonsmokers and women

74
Q

A patient is diagnosed with a squamous cell carcinoma of the lung. In which area of the lungs does this cancer type typically arise?

A

Centrally

75
Q

A patient with lung cancer has elevated calcium. Is the causative malignancy typically found centrally or peripherally?

A

Centrally, as this is squamous cell cancer, with release of parathyroid hormone–related peptide causing hypercalcemia

76
Q

What are the 3Cs of squamous cell carcinoma?

A

Cavitation, Cigarettes, and hypercalcemia (from parathyroid hormone–related protein)

77
Q

A patient is diagnosed with a large cell carcinoma of the lung. In which area of the lungs does this cancer type typically arise?

A

Peripherally

78
Q

What peripherally arising form of bronchogenic carcinoma is most anaplastic or undifferentiated?

A

Large cell carcinoma, which has a poor prognosis

79
Q

What is the usual approach to the treatment of large cell carcinoma of the lung?

A

Surgical removal (it is poorly responsive to chemotherapy)

80
Q

A patient with a lung mass has a biopsy showing pleomorphic giant cells that can secrete β-hCG. What cancer type is this?

A

Large cell carcinoma

81
Q

What two types of lung cancer have excellent prognoses?

A

Bronchial carcinoid and the bronchioloalveolar subtype of adenocarcinoma

82
Q

What are the classic symptoms of carcinoid syndrome? What is the cause?

A

Flushing, diarrhea, wheezing; the symptoms are caused by serotonin secretion into the bloodstream

83
Q

A patient with dyspnea, chest pain, and chronic cough now has flushing, diarrhea, and wheezing. What do you expect biopsy to show?

A

Nests of neuroendocrine cells that are chromogranin A positive (this is a bronchial carcinoid tumor)

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