Nichols Illness Scripts / Mutations / Immunostains

Question 1

Tall thin young any-race male smoker with sudden onset of dyspnea associated with unilateral chest pain and decreased breath sounds on the same side, and collapsed lung on chest x-ray

Answer 1

Pneumothorax Spontaneous

Question 2

Late middle-aged any-race male smoker with the insidious onset of dyspnea and persistent dry cough, bibasilar dry “Velcro” pulmonary crackles and bilateral reticular lung opacities in periphery and at the bases

Answer 2

Unusual Interstitial Pneumonia

Question 3

Any-age-race-sex hospital patient with shock, sepsis, pneumonia, acute onset of rapidly worsening dyspnea, respiratory distress, tachypnea, diffuse pulmonary crackles and progressive pulmonary infiltrates

Answer 3

Acute respiratory distress syndrome (severe end of acute lung injury spectrum)

Question 4

Any age-race-sex patient with trauma, surgery or vascular catheter insertion or removal, sudden onset of dyspnea, single gasp or cough, lightheadedness, tachypnea, tachycardia, hypotension, hypoxemia and mill wheel heart murmur

Answer 4

Air Embolism

Question 5

Any age-race-sex patient with long bone fracture 1-3 days ago or young black patient with sickle cell crisis, now with acute onset of dyspnea, confusion, tachypnea, and hypoxemia

Answer 5

Fat Embolism

Question 6

Any-race-sex adult with recent surgery, central venous catheterization, malignancy, long-haul travel, obesity or smoking, sudden onset of dyspnea associated with chest pain, leg pain and swelling, tachypnea, hypoxemia and normal chest x-ray (not normal computed tomography)

Answer 6

Pulmonary Thromboembolism

Question 7

Late middle-aged any-race-sex patient with insidious onset of anorexia, weight loss, malaise, fatigue and numerous small rounded lung nodules (more in lower lobes)

Answer 7

Pulmonary Mets

Question 8

Late 60ish any-race male heavy smoker with insidious onset of weight loss, cough, dyspnea, weakness and central parabronchial lung mass with hilar lymphadenopathy

Answer 8

Small Cell Carcinoma

Question 9

Late middle-aged black male smoker with insidious onset of persistent cough, dyspnea, anorexia, weight loss, hemoptysis and central endobronchial lung mass

Answer 9

Lung Primary Squamous Cell Carcinoma

Question 10

Late middle-aged any-race female smoker with insidious onset of persistent cough, anorexia, weight loss and peripheral lung mass

Answer 10

Lung Primary Adenocarcinoma

Question 11

Middle-aged any-race male with immunocompromise, insidious onset of dyspnea, dry cough, low-grade fever, tachycardia, tachypnea, elevated lactate dehydrogenase and bilateral reticular infiltrates

Answer 11

Pneumocystic Pneumonia

Question 12

Adult black male or female with immunocompromise, insidious onset of fever, cough, dyspnea, headache, tachycardia, tachypnea, stiff neck and nodular infiltrates

Answer 12

Cryptococcal Pneumonia

Question 13

Any-age-race-sex adult with neutropenia, acute onset of fever, pleuritic chest pain, hemoptysis, tachycardia, tachypnea, pulmonary crackles and nodular infiltrates

Answer 13

Aspergillus Pneumonia

Question 14

Pretty much just like tuberculosis except no sputum

Answer 14

Histoplasmosis

Question 15

Elderly black male with insidious onset of fatigue, anorexia, weight loss, low-grade fever, chills, night sweats, mild cough, mucopurulent sputum, apical cavitary nodules and acid-fast bacilli in sputum

Answer 15

Tuberculosis

Question 16

Young any-race-sex outpatient in winter with insidious onset of malaise, low-grade fever, persistent intractable dry cough, normal white blood cell count, cold agglutinins and bronchopneumonic, reticular or reticulonodular infiltrates that look worse than patient

Answer 16

Mycoplasmic Pneumonia

Question 17

Any-age-race-sex intubated hospital patient with acute onset of fever, chills, confusion, purulent sputum, tachycardia, tachypnea, hypotension, pulmonary crackles, bilateral bronchopneumonia, neutropenia and Gram-negative rods in sputum

Answer 17

Psudomonias Pneumonia

Question 18

Any-age-race-sex smoker with acute onset of fever, rigors, cough, dyspnea, diarrhea, confusion, pulmonary crackles, bronchopneumonia, leukocytosis, hyponatremia and non-diagnostic sputum

Answer 18

Legionella Pneumonia

Question 19

Any-age-race-sex hospital patient with acute onest of fever, cough, dyspnea, tachycardia, tachypnea, hypotension, pulmonary crackles, abscessing bronchopneumonia, leukocytosis and Gram-positive cocci in sputum

Answer 19

Staphylococcus aureus pneumonia

Question 20

Middle-aged any-race male smoker with acute onset of single strong rigor, high fever, productive cough, rusty sputum, tachypnea, pulmonary crackles, tubular breath sounds, lobar consolidation, leukocytosis and Gram-positive diplococci in sputum

Answer 20

Pneumococcal Pneumonia

Question 21

Small Cell Carcinoma Mutations

Answer 21

RASSF1 [>90%], RB1 [>90%], telomerase [>90%], bcl-2 [80%], FHIT [80%], p53 [75%]

Question 22

squamous metaplasia of bronchial mucosa and cumulative mutations in genes controlling cell proliferation caused by carcinogens in cigarette smoke, the type of lung cancer most likely to cause hypercalcemia due to the production of a substance resembling parathyroid hormone

Answer 22

Squamous cell Carcinoma

Question 23

Non-Mucinous Adeno in situ What mutation ?

Answer 23

EFGR Mutation- From clara cells or type 2 pneumocytes. Usually in smokers

Question 24

Mucinous Adeno in situ . What mutation ?

Answer 24

KRAS Mutation From respiratory goblet cells (Usually in nonsmokers)

Question 25

Adenocarcinoma in a never smoker ?

Answer 25

EGFR Mutation

Question 26

Adenocarcinoma in Smokers ?

Answer 26

KRAS Mutation

Question 27

Adenocarcinoma that makes glands ?

Answer 27

Acinar Pattern

Question 28

Markers for primary Adenocarcinoma

Answer 28

CK7 and CK20

Question 29

Lung Primary Small Cell

Answer 29

Synaptophysin+ and Chromogranin+ TTF-1+

Question 30

How do sarcomas spread ?

Answer 30

In the veins that is why they met- to the lung

Question 31

Adeno from the Lung

Answer 31

CK7+ and TTF-1+

Question 32

Colon Primary adenocarcinoma

Answer 32

CD20+ CDX2+

Question 33

Breast adeno

Answer 33

CK7+

Question 34

Kidney Adeno

Answer 34

No positive

Question 35

Symptoms of Cushings syndrome

Answer 35

Truncal obesity & moon face, Decreased Lebido, diabetes, Depression, Hypertension, easy bruising, and small cell carcinoma

Question 36

CDX2+

Answer 36

Metastatic Colon

Question 37

CK5/6

Answer 37

Lung Primary Squamous

Question 38

P63+

Answer 38

Lung Primary Squamous

Question 39

Snaptochysin +

Answer 39

Lung Primary Small Cell

Question 40

Chromogranin +

Answer 40

Lung Primary Small Cell

Question 41

Most common way for lung cancer to kill people

Answer 41

Tumor Burden 30%
Infection 20%
Pulm Hemorrhage / Embolism 12-13% respectively
Diffuse Alveolar Damage 7%
Metastasis (Pericardial, Myocardial, Liver Brain) 7% and 3%

Question 42

What factors affect the treatment of NSCLC

Answer 42

Resectability which is dependent on Stage and patients ability to undergo surgery

Question 43

What determines the best treatment for lung cancer ?

Answer 43

The patients co morbidities