Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PULMONARY BOARDS > Neoplasia > Flashcards

Neoplasia Flashcards

1
Q

ASA classifications

A

I: healthy
II: mild systemic disease (HTN, mild diabetes without end organ damange)
III: severe systemic disease (stable angina, mod-sev COPD)

Think twice about taking the following to bronchoscopy
IV: incapacitating disease that is a constant threat to life (advanced COPD, heart failure)
V: moribund pt not expected to live 24h with or without surgery (ruptured ao aneurysm, massive PE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What comorbid condition makes TBBx (mostly) contraindicated

A

PH with mPAP >40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When should pre-bronch bronchodilators be given

A

in patients who have ASTHMA
not much benefit in COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When is it safe to do a bronch in pregnancy

A

Defer until 28wk GA
Avoid fluoroscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How long do you stop
clopidogrel
warfarin
UFH
LMWH
pre-bronch?

A

clopidogrel: 5-7 days
warfarin: 5 days –> resume 12-24h
UFH: 4-6h –> resume 24-72h after
LMWH: 24h therapeutic, 12h prophylactic –> resume in 24h, or 48-72h in high bleeding risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

True or False: There is no difference between complications in bronchoscopy with obesity, but there is a difference with morbid obesity

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Max dose of topical lidocaine in bronch

A

7 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Is it helpful to use atropine or glycopyrrolate to inhibit secretion during pre-bronch

A

no
Associated with arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Main complication of bronch (2)

A

PTX 1-4%
hemorrhage 9%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Does Rapid Onsite Cytologic Evaluation improve accuracy of EBUS TBNA?

A

No
BUT it leads to decreased needle passes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do you ALWAYS need to check in NSCLC

A

Driver mutations (EGFR, ALK, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Sensitivity for EBUS for lymphoma is ___

A

57%-67% only!
Non-Hodgkin is better sensitivity

Ok to do this first, then mediastinoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stage I survival

A

> 60% at 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most prevalent ca in men and women
Highest cause of death in women

A

Men: prostate
Women: breast

Lung ca = highest mortality in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Does COPD increase rate of lung ca than smoking alone?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cavitary lung lesion, hypercalcemia and Hypertrophic pulmonary osteoarthropathy

A

squamous cell ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lambert eaton, SIADH, smoker, lung nodule

A

Small cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you diagnose hypertrophic pulmonary osteoarthropathy?

A

Tc bone scan (most sensitive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

2 types of malignancy with low likelihood of PET avidity in the lungs

A

carcinoid
mucinous adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bronchorrhea, salt tasting sputum, lung nodule

A

mucinous adenocarcinoma (BAC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Two trials in Lung cancer screening and what did they show

A

NLST:
27% mortality reduction in women
8% mortality reduction in men
7% survival improvement

NELSON:
26% mortality reduction in men
39% mortality reduction in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Who should get LDCT

A

50-80
>20 py
quit within 15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Six independent predictors of malignant SPN

A
  1. Age
  2. Smoking status
  3. History of extrathoracic malignancy
  4. Diameter
  5. Spiculation
  6. Upper lobe location
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Calcification pattern that is likely to be malignant

A

stippled
eccentric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Calcification pattern likely to be benign

A

central
laminate
diffuse
popcorn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the Lung-RADS follow up rec:

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

WHen are false negative PET more likely to occur

A

<8-10 mm nodule
well differentiated adeno
BAC (mucinous adeno)
Carcinoid tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the categories by size in TNM (just the T)

A

T1a: <1cm (including 1 cm)
T1b: 1.1-2
T1c: 2.1-3
T2a: 3.1-4 (or any size involving main bronchus, visceral pleura leading to atelectasis up to or beyond hilum)
T2b: 4.1-5
T3: 5.1-7 (or any size in parietal pleura, parietal pericardium, chest wall, T1-2 nerve roots, phrenic nerve, or satellite tumor in SAME lobe as primary tumor)
T4 >7.1 (or any size invading mediastinum, diaphragm, trachea, main carina, recurrent laryngeal nerve, esophagus, visceral pericardium, vertebral body, great vessels, heart, cervical nerve roots, satellite tumor in SEPARATE lobe of ipsilateral lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the categories by NODE in TNM staging (node only)

A

N0 no regional lymph node involved
N1 Ipsilateral peribronchial hilar and intrapulmonary nodes (10,11)
N2 Ipsilateral mediastinal and subcarinal nodes (Ipsi 4, 7)
N3 Contralateral mediastinal, hilar, or any scalene or supraclavicular node

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the METASTATIC categories by TNM (only M)

A

M1a separate tumor nodule in cotralateral lung, pleural or pericardial involvement
M1b SINGLE extrathoracic metastasis
M1c Multiple extrathoracic metastases (one or more sites)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What does Stage IA1, IA2, and IA3 involve

A

IA1: T1a
IA2: T1b
IA3: T1c

N0 M0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What does Stage IB include

A

T2a N0 M0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

If T3 or less or N1 is involved, what stage are you AT LEAST at this point

A

Stage IIB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Stage IIB TNM?

A

T1-2b N1 M0
T3 N0M0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Stage IIIA TNM staging

A

T4 N0 M0
T3-4 N1 M0
T1-2 N2 M0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Stage IIIB TNM?

A

T3-4 N2 M0
T1-2 N3 M0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Stage IIIC TNM?

A

T3-4 N3 M0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Difference between Stage IVA and IVB

A

IVA: M1a-b
IVB: M1c (multiple mets outside the thorax)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What Lung-RADS is this:
nodule with benign features (central, popcorn, concentric ring calcification or fat containing

When do you follow up imaging

A

Lung-RADS 1 (negative)
Follow up 12 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What Lung-RADS is this:
Solid nodule <6 mm at baseline or NEW <4mm

When do you follow up imaging

A

Lung-RADS 2 (benign)

f/u 12 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What Lung-RADS is this and when do you follow up?

Non-solid slowly growing >30 mm nodule

A

Lung-RADS 2 (benign)
f/u 12 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What Lung-RADS is this and when do you follow up?

Part solid <6 mm in diameter at baseline

A

Lung-RADS 2 (benign)
f/u 12 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What Lung-RADS is this and when do you follow up?

Airway nodule SUBSEGMENTAL, at baseline, new, or stable

A

Lung-RADS 2 (benign)
f/u 12 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What Lung-RADS is this and when do you follow up?

Part solid 7 mm nodule with solid component that has been stable or decreasing in size since 6 mo ago

A

Lung-RADS 3
f/u 6 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What Lung-RADS is this and when do you follow up?

15mm nodule proven to be benign in etiology

A

Lung-RADS 2 (benign)
f/u 12 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What Lung-RADS is this and when do you follow up?

Solid nodule >6 to <8mm at baseline

A

Lung-RADS 3 (probably benign)
f/u 6 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What Lung-RADS is this and when do you follow up?

New 4-6 mm solid nodule from prior imaging

A

Lung-RADS 3 (probably benign)
f/u 6 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What Lung-RADS is this and when do you follow up?

Part solid >6 mm nodule with solid component <6mm or new <6 mm total mean diameter

A

Lung-RADS 3 (probably benign)
f/u 6 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What Lung-RADS is this and when do you follow up?

Non-solid nodule >30 mm at baseline or new

A

Lung-RADS 3 (probably benign)
f/u 6 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What Lung-RADS is this and when do you follow up?

Atypical pulmonary cyst (with growing component of thick-walled cyst)

A

Lung-RADS 3 probably benign
f/u 6 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What Lung-RADS is this and when do you follow up?

Category 4A lesion that is stable or decreased in size at 3 mo follow up (excluding airway nodules)

A

Lung-RADS 3 (probably benign)
f/u 6 mo LDCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What Lung-RADS is this and when do you follow up?

Solid nodule 14 mm

A

Lung-RADS 4A (suspicious)
f/u 3 mo LDCT, Consider PET/CT if there is a >8 mm solid component/nodule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What Lung-RADS is this and when do you follow up?

Growing <8 mm nodule

A

Lung-RADS 4A (suspicious)
f/u 3 mo LDCT, consider PET/CT if there is a >8mm solid component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What Lung-RADS is this and when do you follow up?

New 6-8 mm solid nodule after not being there before

A

Lung-RADS 4A (suspicious)
f/u 3 mo LDCT, consider PET/CT if there is a >8 mm solid component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What Lung-RADS is this and when do you follow up?

> 6mm part solid nodule with solid component >6 mm to <8 mm at baseline

A

Lung-RADS 4A (suspicious)
f/u 3 mo LDCT, consider PET/CT if there is a >8 mm solid component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What Lung-RADS is this and when do you follow up?

New part solid nodule with a new <4 mm solid component

A

Lung-RADS 4A (suspicious)
3 mo LDCT f/u, consider PET/CT if there is a >8 mm solid component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What Lung-RADS is this and when do you follow up?

Airway nodule, SEGMENTAL or more proximal - at baseline

A

Lung-RADS 4A (suspicious)
f/u 3 mo LDCT, consider PET/CT if >8 mm solid component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What Lung-RADS is this and when do you follow up?

Thick walled cyst
OR
multilocular cyst at baseline
OR
Thin or thick-walled cyst that becomes multilocular

A

Lung-RADS 4A (suspicious)
f/u 3 mo LDCT, consider PET/CT if there is a >8 mm solid nodule component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What Lung-RADS is this and when do you follow up?

Slow growing solid or part solid nodule over multiple screening exams

A

Lung-RADS 4B (very suspicious)
f/u now with HRCT
Consider PET/CT if > 8mm solid nodule/component
Tissue sampling +/- referral for further eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What Lung-RADS is this and when do you follow up?

Airway nodule, SEGMENTAL or more proximal, stable or growing (not baseline) - persisting

A

Lung-RADS 4B (very suspicious)
f/u now with HRCT
Consider PET/CT if > 8mm solid nodule/component
Tissue sampling +/- referral for further eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What Lung-RADS is this and when do you follow up?

Solid nodule >15 mm

A

Lung-RADS 4B (very suspicious)
f/u now with HRCT
Consider PET/CT if > 8mm solid nodule/component
Tissue sampling +/- referral for further eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What Lung-RADS is this and when do you follow up?

New or growing > 8 mm solid nodule

A

Lung-RADS 4B (very suspicious)
f/u now with HRCT
Consider PET/CT if > 8mm solid nodule/component
Tissue sampling +/- referral for further eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What Lung-RADS is this and when do you follow up?

Part solid nodule with a >8mm solid component

A

Lung-RADS 4B (very suspicious)
f/u now with HRCT
Consider PET/CT if > 8mm solid nodule/component
Tissue sampling +/- referral for further eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What Lung-RADS is this and when do you follow up?

New or growing part solid nodule with a new or growing >4 mm solid component

A

Lung-RADS 4B (very suspicious)
f/u now with HRCT
Consider PET/CT if > 8mm solid nodule/component
Tissue sampling +/- referral for further eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What Lung-RADS is this and when do you follow up?

thick walled cyst with growing wall thickness/nodularity

A

Lung-RADS 4B (very suspicious)
f/u now with HRCT
Consider PET/CT if > 8mm solid nodule/component
Tissue sampling +/- referral for further eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What Lung-RADS is this and when do you follow up?

Multilocular cyst with increased loculation or new/increased opacity (nodular ground glass or consolidation)

A

Lung-RADS 4B (very suspicious)
f/u now with HRCT
Consider PET/CT if > 8mm solid nodule/component
Tissue sampling +/- referral for further eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What Lung-RADS is this and when do you follow up?

Growing multilocular cyst (mean diameter)

A

Lung-RADS 4B (very suspicious)
f/u now with HRCT
Consider PET/CT if > 8mm solid nodule/component
Tissue sampling +/- referral for further eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Staging of small cell lung cancer

A

limited:
confined to one hemithorax, the mediastinum, or supraclavicular nodes
“all tumor is encompassed in a single XRT port”
NO contralateral hilar or supraclavicular node

extensive:
clinically detectible distant metastases
+ pleural and pericardial effusions
Bone, liver CNS, adrenal involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Contraindication for pneumonectomy and lobectomy (FEV1)

A

Pre-op
Pneumonectomy: FEV1 < 2L
Lobectomy: FEV1 <1.5 L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Risk stratification for surgical mass resection:
“low risk”

A

ppo FEV1 and ppo DLCO >60%

ppo FEV1 OR ppo DOCL >60% AND both >30% –> must do STAIR CLIMB or SHUTTLE WALK

If >22m or >400 cm –> low risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

When to get a CPET for risk stratification pre-lobectomy or greater (3 possibilities)

A

If one of the following
1. ppo FEV1 or ppo DLCO <30%
2. Shuttle walk < 400 m OR Stair climb <22 m
3. Positive high risk cardiac evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

CPET VO2max thresholds for “low”, “moderate”, or “high” risk

A

low: VO2 max >20 ml/kg/min or >75%
moderate: VO2 max 10-20 ml/kg/min or 35-75%
High VO2 max <10 ml/kg/min or < 35%

69
Q

Tumor makers for adenocarcinoma (4)

A

TTF1
CK7
Napsin A
MOC-31
Claudin-4

70
Q

Tumor markers for SCC (2)

A

CK5/6
P63
p40

71
Q

Tumor markers for SCLC (4)

A

TTF1 (but Napsin A neg)
Chromogranin A
Synaptophysin
CD 56

72
Q

Neuroendocrine markers (3)

A

CD56
Synaptophysin
Chromogranin

73
Q

Tumor markers associated with malignant mesothelioma (4)

A

BRCA associated germline BAP1 pathological mutation
Calretinin
Wilms tumor-1 gene product
Cytokeratin 5/6
(does not have to hav TTF-1 positive)

74
Q

When does survival decrease in stage I lung ca if not resected

A

> 12 weeks after last CT

75
Q

NSCLC IB-IIIA should get ___ as neoadjuvant if PDL1 status is >1% and if resectible

If unresectible, should get ___ as consolidation therapy

A

nivolumab (neoadjuvant)

durvalumab (consolidation)

76
Q

Wedge and lobectomy has the same 5 year survival in nodes size _____

A

2 cm or smaller

Altorki et al NEJM 2023

77
Q

Timing of checkpoint inhibitor pneumonitis

A

within 2 mo of treatment

78
Q

Timing of taxane-induced pneumonitis

A

within days to weeks after treatment
can be associated with peripheral eosinophilia

79
Q

Tumor markers in kaposi sarcoma

A

CD31, CD34, HHV 8

80
Q

mantle whorl “onion skin” on path

A

Castleman Disease

81
Q

Evidence behind IPC placement vs pleurodisis

A

IPC placement results in shorter hospital stays and fewer repeat pleural procedures

82
Q

What can NF-1 transform into if it is increasing in size

A

malignant peripheral nerve sheath tumor

83
Q

Surveillance for post NSCLC currative intent ca therapy (imaging)

A

CT Chest in 6 mo intervals for 2 years
Yearly until 5 years

If still eligible for LDCT, keep doing it (second primaries are common)

84
Q

Stain for carcinoid tumor

A

somatostatin

85
Q

MOC-31
Claudin-4
type of cancer?

A

adeno

86
Q

associated with insulin-like growth factor (hypoglycemia) and hypertrophic osteoarthropathy

A

solitary fibrous tumor of the pleura

87
Q

“patternless pattern” on pathology

A

spindle cell – solitary fibrous tumor of the pleura

88
Q

ppo DLCO is a predictor of ___

A

mortality
independent predictor of pulmonary complications, mortality, morbidity

89
Q

How to calculate post operative product (best surgical mortality) and cut off (for lobectomy/pneumonectomy)

A

ppo FEV1 x ppo DLCO expressed as %pred
POP <1650 found in 75% of deaths and only 11% of those who survived surgery

90
Q

V/Q scans should be done for ____

A

people being considered for pneumonectomy

91
Q

risk of pneumonectomy

A

6-10%

92
Q

If you suspect stage 1 disease what is the next intervention:

A

wedge/lobectomy and mediastinal node dissection

93
Q

SBRT vs. Radiotherapy vs. Radiosurgery vs. Stereotactic

A

SBRT: stereotactic ablative radiotherapy
Radiotherapy: use of ionizing radiation to eradicate areas of cancer
Radiosurgery: Precision delivery of high dose radiation to target areas in the body, with intent of destroying malignant tissue while sparing adjacent normal tissue
Stereotactic: 3-D coordinate system to correlate virtual target on imaging with actual target in a patient

94
Q

Alternative to surgery in stage I disease

A

SBRT (less number of fraction)

95
Q

Adjuvant chemotherapy therapy is NOT indicated in which stage

A

Stage IA

Worse survival if received adjuvant chemotherapy (platinum based doublet)

96
Q

Which stages of lung ca is surgery indicated

A

Stage IA
IB
IIA
IIB

97
Q

Stage I disease management

A

Surgery (radiation if inoperable 1A)

1B
If EGFR or ALK negative, neoadjuvant chemoimmune followed by surgery
Post-op targeted therapy for 1B EGFR or ALK +

Forde NEJM 2022
Tsuboi NEJM 2023

98
Q

Stage II disease management

A

Surgery with adjuvant chemo or

Targeted therapy for EGFR or ALK +
Neoadjuvant chemo immuno followed by surgery if EGFR or ALk are negative

(same with 1B)

99
Q

Pancoast tumor symptoms

A

brachial plexus invasion - numbness and tingling
Horner’s syndrome
Need MRI

100
Q

Horner’s syndrome

A

tumor involvement of sympathetic chain and stellate ganglion
ipsilateral enopthalmos, ptosis, meiosis, anhydrosis

101
Q

Pancoast tumor management

A

Induction chemoradiotherapy
En bloc resection

If resectable, good results, better results with pre-op chemorad with 5yr survival 54%

If not completely resectible or have N2, involvement, concurrent chemo-rads

102
Q

Stage 3 disease management

A

chemoradio + adjuvant immuno
Immuno for high PDL1
Adjuvant osimertinib for EGFR+, alectinib for ALK+

Neo adjuvant chemo immune followed by surgery if EGFR -

103
Q

Targeted therapy for EGFR + NSCLC

A

osimertinib
erlotinib

104
Q

CheckMate 816 trial outcome: platinum based therapy alone vs. nivolumab + platinum-based chemotherapy

A

Pathological complete response OR 13.94
Overall survival much improved in nivolumab

Included: IB through 3A disease

105
Q

Consolidation of Durvalumab (anti-PDL1) is associated with what benefit in contrast to placebo?

A

progression-free survival much better at 27 mo

Included: Stage III unresectable NSCLC; already completed radiation

PACIFIC Trial, Antonia NEJM 2017

106
Q

Treatment of Stage IV disease

A

platinum-based doublet chemo
Targeted therapy (immuno)
Supportive care

107
Q

KRAS+ targeted therapy

A

sotorasib
adagrasib

G12C inhibitor

108
Q

ALK+ targeted therapy

A

alectinib, brigatinib, and lorlatinib
(ALB!)
Goes through blood-brain barrier

109
Q

BRAF V600E target therapy

A

dabrafenib + trametinib
Vemurafenib

110
Q

HER-2 targeted therapy

A

trastuzumab
deruxtecan (Enhertu)

111
Q

Extensive SCLC treatment

A

Doublet platinum based therapy
-platin + paclitaxel/pemetrexed/irinotecan

Contrast to standard: cis-platin and etoposide (V16)

112
Q

Is XRT helpful in extensive SCLC?

A

No survival benefit for adding XRT to primary tumor
BUT can add XRT concurrently with some 5-7% survival benefit

Can give palliatively (for bone pain for example)

113
Q

When to give prophylactic cranial irradiation

A

Small cell lung ca (limited or extensive)- usually for people with disease that is responsive to therapy
3 year survival improves from 15% to 21%
5% improvement in median survival

+ QOL benefit

Without PCI 60% chance of developing CNS mets within 2-3 years
With –> decreases chance of CNS mets by 50%

114
Q

When to start corticosteroids for checkpoint-inhibitor pneumonitis

A

Grade 2 toxicity (symptomatic but with no limitation of usual activity) if not improving after holding therapy
OR
Grade 3-4 (symptomatic with O2 requirement or limitation of activity, severe or life-threatening

115
Q

LN 6 and 5 are on which side? And how do you get to it for biopsy?

A

Left only
Chamberlain (Mediastinoscopy) or VATS

116
Q

3As of Middle mediastinum tumors

A

Adenopathy
Malignant - lymphomas, metastases
Nonmalignant - sarcoid, drugs, silicosis
Anomalies developmental (bronchogenic/pericardial/forgut cysts)
Aneurysms or other vascular lesions

Others: lipomatosis, lymphangiomas

117
Q

If you suspect germcell tumor in a young man, next diagnostic step is ___

A

scrotal US

118
Q

Dotatate Ga-68 PET scan is useful to dx ___

A

neuroendocrine tumors

119
Q

Tumor markers to test with anterior mediastinal mass (5)

A

anti-acetylcholine receptor Ab
AFP
B-HCG
LDH
Thyroid studies

120
Q

M. gravis, hypogammaglobulinema, anterior mediastinal mass
Dx _____

A

thymoma

121
Q

How long does it take for M. gravis sd to go away after thymectomyy?

A

1-10 years

122
Q

Germ cell tumors are associated with what syndrome

A

Klinefelter (47, XXY) syndrome
(1/3 of men with mediastinal GCT)

123
Q

Anterior mediastinal mass with elevated b-HCG level, nl AFP

A

seminoma

124
Q

Management of seminomas

A

radiation +/- chemo (majority have metastatic disease)
80% cure rate

125
Q

Anterior mediastinal heterogenous mass with elevated AFP, +/- elevated b-HCG

A

nonseminomatous tumor

126
Q

Management of nonseminomatous tumor

A

cisplatin-based combination chemo
Tumor resection
Recurrence common

127
Q

Multinodular anterior mediastinal mass, young woman, mass effect

A

intrathoracic thyroid

128
Q

Fluid-filled mass in the middle mediastinum area, paratracheal or subcarinal. Dx ___

A

foregut malformation, duplicate cyst

129
Q

Management of pericardial cyst

A

no intervention unless mass effect

130
Q

Obesity, chronic steroids, Cushing’s or ectopic ACTH with anterior-mid mediastinal mass - smooth border

A

mediastinal lipomatosis

131
Q

fluid filled cystic lesion, multiloculated or solitary, water attenuation usually not next to esophagus

A

mediastinal lymphangioma

resection if feasible, no medical therapy

132
Q

If you suspect neurogenic tumor, possibly in spinal canal, next diagnostic step

A

MRI

133
Q

If multiple posterior thoracic tumors, suspect ___

A

NF1

134
Q

Most common type of neuroendocrine tumor

A

Peripheral Nerve Sheath Tumors
Benign (schwannoma - usually from intercostal nerve sheath)
Malignant: neuroblastoma, ganglioneuroblastoma

135
Q

Syndromes associated with NET

A

von-Hippel-Lindau
NF1
MEN2
Carney triad

136
Q

Posterior mediastinal mass in patient with thalassemia

A

extramedullary hematopoiesis

137
Q

Lateral meningocele is associated with ___

A

NF1

138
Q

Endobronchial lesion with hemoptysis
1. What is the likely to be the dx?
2. Could you use PET/CT for diagnosis?
3. Is it related to smoking?

A

Low-grade Carcinoid
Not related to smoking
Not PET/CT avid

Cannot be cured with resection

139
Q

“nests of palisading cells” on path

A

carcinoid tumor

140
Q

Management of lung carcinoid tumor

A

resection (or endobronchial laser if poor surgical candidate)
+/- chemo, everolimus, cytotoxic chemo, radiolabeled SSA (somatostatin analogues)

141
Q

Salivary gland types of carcinomas (2)

A
  1. mucoepidermoid carcinoma
  2. adenoid cystic carcinoma
142
Q

“ice berg” tumor

A

salivary gland types of carcinomas

143
Q

cells with t(11;19)(q21;p13) chromosomal translocation, mucus-secreting, squamous and intermediate cells; can be children to elderly

A

mucoepidermoid carcinoma

Tx: resection

144
Q

5th decade of life, mixed growth pattern, perineural invasion

A

adenoid cystic carcinoma

propensity to recur, worse prognosis than mucoepidermoid

145
Q

Most common benign neoplasm in lung

A

hamartoma

146
Q

malignant lung nodule associated with Sjogren’s

A

MALToma

147
Q

Tx of MALToma

A

Rituximab

148
Q

Where are plasmacytomas found and what can it develop into

A

bone

multiple myeloma

149
Q

Pulmonary sarcoma etiology

A

usually metastatic
Originates from soft tissue
for example kaposi sarcoma

150
Q

HU of blood

A

+30-+80

151
Q

HU of water

A

0

152
Q

HU of fat

A

-50 to -150

153
Q

HU of air

A

-1000

154
Q

Normal HU of lungs

A

-400 to -700

155
Q

HU of bone

A

+700 to +1000

156
Q

When do you follow up this incidental nodule:

solid <6 mm
low risk patient

A

no routine follow up

157
Q

When do you follow up this incidental nodule:

Solid <6 mm
high risk patient

A

optional CT in 12 mo

158
Q

When do you follow up this incidental nodule:

solid 6-8 mm
low risk patient

A

CT at 6-12 mo, then consider CT at 18-24 mo

159
Q

When do you follow up this incidental nodule:

solid >8 mm
low risk patient

A

consider CT, PET/CT or tissue sampling at 3 mo

160
Q

When do you follow up this incidental nodule:

solid 6-8 mm
high risk patient

A

CT at 6-12 mo
Then 18-24

161
Q

When do you follow up this incidental nodule:

solid >8 mm
high risk patient

A

Consider CT/PET CT or tissue sampling at 3 mo

162
Q

When do you follow up this incidental nodule:

multiple solid <6 mm
low risk patient

A

no routine follow up

163
Q

When do you follow up this incidental nodule:

multiple solid 6-8 mm
low risk patient

A

CT at 3-6 mo
then consider CT at 18-24

164
Q

When do you follow up this incidental nodule:

multiple solid >8 mm
low risk patient

A

CT at 3-6 mo,
then consider CT at 18-24

165
Q

When do you follow up this incidental nodule:

multiple solid <6 mm
high risk patient

A

Optional CT at 12 mo

166
Q

When do you follow up this incidental nodule:

multiple solid 6-8 mm OR >8mm
high risk patient

A

CT at 3-6 mo, then 18-24 mo

167
Q

When do you follow up this incidental nodule:

subsolid ground glass <6 mm

A

no routine follow up

168
Q

When do you follow up this incidental nodule:

subsolid ground glass >6 mm

A

CT at 6-12 mo to confirm persistence
then CT every 2 years until 5 years

169
Q

When do you follow up this incidental nodule:

subsolid part solid <6 mm

A

No routine follow up

170
Q

When do you follow up this incidental nodule:

subsolid part solid >6 mm

A

CT at 3-6 mo to confirm persistence
If unchanged and solid component remains <6 mm, annual CT for 5 years

171
Q

When do you follow up this incidental nodule:

subsolid multiple <6 mm

A

CT at 3-6 mo, if stable, consider CT at 2 and 4 years

172
Q

When do you follow up this incidental nodule:

subsolid multiple >6 mm

A

CT at 3-6 mo
subsequent management based on the most suspicious nodule(s)

173
Q

Pt with APML starts treatment, 5 days later develops fever, peripheral edema, pulmonary opacities, hypoxemia, respiratory distress, hypotension, acute kidney injury, and elevation of transaminase levels.

Dx and cause?

A

Differentiation syndrome

all-trans retinoic acid
OR
arsenic trioxide

174
Q

Tx of SCLC with limited disease

A

combination platinum-based chemotherapy, etoposide and concurrent radiation therapy

Prophylactic cranial irradiation should be added only if there is complete or partial response in both limited and extensive disease

175
Q

Tx of SCLC with extensive disease

A

platinum-based chemotherapy alone, with radiation added later on a case-by-case basis

Prophylactic cranial irradiation should be added only if there is complete or partial response in both limited and extensive disease

PULMONARY BOARDS (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions