Miller Study Guide Flashcards
what to expect on chest x-ray with asbestos exposure?
- Small irregular opacities in lower lung fields
- Pleural plaques
- Blurring of costophrenic angle
- -> Consistent with diffuse pleural thickening
presentation of sarcoidosis
- Fever
- Malaise
- Fatigue
- Night Sweats
- Weight loss
PE findings of sarcoidosis
- Erythema Nodosum
- Maculopapular lesions
- Hyper/hypo pigmentation
- Lupus pernio: nose bridge & under eyes
- Anterior uveitis
- Retinitis
What to you look for with a person who has worked in coal mines?
Pneumoconiosis Fibrosis COPD Chronic bronchitis inspiratory crackles Clubbing Cyanosis
S/s from working in a coal mine develope after how many years after being exposed
10 yrs
How do you treat Idiopathic interstitial pneumonia
Eliminate further exposure
Supplemental oxygen for hypoxia
Glucocorticoids for suppression therapy
Refer to pulmonologist for management
Presentation of Idiopathic interstitial pneumonia?
Fever Hemoptysis Pleural chest pain Bilateral basilar: - Wet quality: alveolar filling - Dry quality: no alveolar filling "velcro rales" Clubbing
What is Lofgren’s sign?
Erythema nodosum and hilar adenopathy in Sarcoidosis
Simple Fibrosis
- Can be asymptomatic even with abnormal CXR
- Fine crackles
- Coarse crackles (end inspiration)
- Rhonchi
- Wheezes
- CXR: Innumerable small rounded opacities in upper lung fields
Progressive Massive Fibrosis S/Sxs?
- Severe cough
- Exertional dyspnea
- Decreased breath sounds
- No crackles
- Signs of respiratory failure and cor pulmonale
- CXR: Small opacities, gradually enlarge and connect to form larger opacities, distributed in the upper or middle lung fields
Presentation of lung cancer
a. Cough
b. Weight loss
c. Dyspnea
d. Chest pain
e. Hemoptysis
f. Bone pain
g. Clubbing
h. Fever
i. Night sweats
j. Weakness
k. Anorexia
L. Persistent pneumonia
Diagnostic CXR for lung cancer
initial diagnostic modalities
Diagnostic chest CT for lung cancer
Confirmation of suspected lesion
Diagnostic PET scan for lung cancer
Defines the nature of primary lung lesions and extend of disease
(combo PET-CT is best means of staging)
Diagnostic sputum cytology for lung cancer
May prove lung cancer and cell type only
Diagnosic Percutaneous transthoracic fine-needle biopsy for lung cancer
Peripheral lesions risk of pneumothorax
Diagnosic Video assisted thoracoscopic surgery (VATS) for lung cancer
- Incision to visualize and remove samples of lesions
- Used in pts who may not tolerate pneumothorax
What would make you consider malignant mesothelioma
Smoker and Asbestos exposure
Presentation of lung cancer located - Central endobronchial
- Cough
- Hemoptysis
- Dyspnea
- Wheeze
Presentation of lung cancer located - Peripheral
- Pain from pleura or chest wall involvement
- Dyspnea
- Lung abscess from tumor cavitation
Presentation of lung cancer located - Regional spread of tumor in thorax:
- Tracheal obstruction
- Esophageal compressions
- Laryngeal paralysis-hoarseness
- Horner’s syndrome:
- Ptosis
- Enophthalmos
- Miosis
- Anhydrosis
Presentation of lung cancer located - pleural effusion
- Pain
- Dyspnea
- Cough
What presentation do you expect with a superior sulcus tumor?
- Pancoast syndrome
- Horner syndrome
What is Pancoast syndrome (syndrome associated with superior sulcus tumor)
Pain that may arise in the shoulder of the chest wall or radiate to the neck or ulnar surface of the hand
What is Horner syndrome (syndrome associated with superior sulcus tumor)
- d/t invasion of paravertebral sympathetic chain results in;
- Enophthalmos
- Ptosis
- Miosis
- Anyhydrosis
What presentation would key you toward bronchial carcinoid tumor?
- Slow growing and rarely metastasize
- Carcinoid syndrome:
- Flushing- Diarrhea
- Wheezing
- hypotension
Characteristics of a malignant nodule
- Subsolid nodules: pure ground glass or part solid in nature, noncalcified or eccentric calcification
- Obscure lung architecture
- Irregular or speculated borders
- Double in size ranges from 1 month to 1 yr
- Size is >10mm
Characteristics of a benign nodule
- Solid nodules: diffuse, central, popcorn, or concentric
- Smooth border
- Doubling in size rages from less than 1 month to more than 1 yr
- Size is <5 mm
When would a PET scan be cost-effective in assessing a nodule?
- Most cost-effective when the clinical pretest probability of malignancy and the results of the CT are discordant/conflicting.
- -> low to intermediate pretest probability of malignancy
American College of Chest Physicians (ACCP) Recommends?
- Recommends using the 7th edition if the TNM (tumor size, nodes, metastasis) staging system for prognosis and placement into clinical trials.
- Do not perform CT screening for lung cancer among pts at low risk for lung cnacer
U.S preventive service Task Force (USPSTF) Recommends?
- Annual low dose CT to screen for lung cancer in pts 50 to 80 yrs of age with at least a 20 pack-year history who currently smoke or have quit within the past 15 yrs.
- Recommend screening every pt for tobacco use and encourage smoking cessation for smokers at every appointment
