Nichols Illness Scripts / Mutations / Immunostains Flashcards
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
Pneumothorax Spontaneous
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
Unusual Interstitial Pneumonia
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
Acute respiratory distress syndrome (severe end of acute lung injury spectrum)
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
Air Embolism
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
Fat Embolism
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)
Pulmonary Thromboembolism
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)
Pulmonary Mets
Late 60ish any-race male heavy smoker with insidious onset of weight loss, cough, dyspnea, weakness and central parabronchial lung mass with hilar lymphadenopathy
Small Cell Carcinoma
Late middle-aged black male smoker with insidious onset of persistent cough, dyspnea, anorexia, weight loss, hemoptysis and central endobronchial lung mass
Lung Primary Squamous Cell Carcinoma
Late middle-aged any-race female smoker with insidious onset of persistent cough, anorexia, weight loss and peripheral lung mass
Lung Primary Adenocarcinoma
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
Pneumocystic Pneumonia
Adult black male or female with immunocompromise, insidious onset of fever, cough, dyspnea, headache, tachycardia, tachypnea, stiff neck and nodular infiltrates
Cryptococcal Pneumonia
Any-age-race-sex adult with neutropenia, acute onset of fever, pleuritic chest pain, hemoptysis, tachycardia, tachypnea, pulmonary crackles and nodular infiltrates
Aspergillus Pneumonia
Pretty much just like tuberculosis except no sputum
Histoplasmosis
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
Tuberculosis
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
Mycoplasmic Pneumonia
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
Psudomonias Pneumonia
Any-age-race-sex smoker with acute onset of fever, rigors, cough, dyspnea, diarrhea, confusion, pulmonary crackles, bronchopneumonia, leukocytosis, hyponatremia and non-diagnostic sputum
Legionella Pneumonia
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
Staphylococcus aureus pneumonia
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
Pneumococcal Pneumonia
Small Cell Carcinoma Mutations
RASSF1 [>90%], RB1 [>90%], telomerase [>90%], bcl-2 [80%], FHIT [80%], p53 [75%]
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
Squamous cell Carcinoma
Non-Mucinous Adeno in situ What mutation ?
EFGR Mutation- From clara cells or type 2 pneumocytes. Usually in smokers
Mucinous Adeno in situ . What mutation ?
KRAS Mutation From respiratory goblet cells (Usually in nonsmokers)
Adenocarcinoma in a never smoker ?
EGFR Mutation
Adenocarcinoma in Smokers ?
KRAS Mutation
Adenocarcinoma that makes glands ?
Acinar Pattern
Markers for primary Adenocarcinoma
CK7 and CK20
Lung Primary Small Cell
Synaptophysin+ and Chromogranin+ TTF-1+
How do sarcomas spread ?
In the veins that is why they met- to the lung
Adeno from the Lung
CK7+ and TTF-1+
Colon Primary adenocarcinoma
CD20+ CDX2+
Breast adeno
CK7+
Kidney Adeno
No positive
Symptoms of Cushings syndrome
Truncal obesity & moon face, Decreased Lebido, diabetes, Depression, Hypertension, easy bruising, and small cell carcinoma
CDX2+
Metastatic Colon
CK5/6
Lung Primary Squamous
P63+
Lung Primary Squamous
Snaptochysin +
Lung Primary Small Cell
Chromogranin +
Lung Primary Small Cell
Most common way for lung cancer to kill people
Tumor Burden 30%
Infection 20%
Pulm Hemorrhage / Embolism 12-13% respectively
Diffuse Alveolar Damage 7%
Metastasis (Pericardial, Myocardial, Liver Brain) 7% and 3%
What factors affect the treatment of NSCLC
Resectability which is dependent on Stage and patients ability to undergo surgery
What determines the best treatment for lung cancer ?
The patients co morbidities
