OnlineMedEd: Pulmonology - "Lung Cancer" Flashcards

1
Q

Why might you be suspicious of tuberculosis in a patient with lung cancer?

A

Similar symptom profile: fever, weight loss, and hemoptysis

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2
Q

Describe the diagnostic workup of suspected lung cancer.

A

•First, for patients with fever, hemoptysis, and weight loss, order an x-ray.
•Second, interpret the x-ray:
- If there’s a nodule, then do a CT and biopsy.
- If the XR is negative and they don’t have a paraneoplastic syndrome, then stop; if they do have a paraneoplastic syndrome, then do a CT and biopsy.
- If the XR shows effusion, then do a tap of the effusion and look for malignant cells. If positive then CT.

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3
Q

Describe the newer bronchoscopic technique.

A

Called EBUS (endobronchoscopic ultrasound), it involves doing a bronchoscopy with an ultrasound so that you can see any masses on the other side of the airway.

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4
Q

Peripheral lesions can be sampled with _________. Central lesions can be sampled with ___________.

A

CT-assisted biopsy; video-assisted sampling (VATS)

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5
Q

If a centrally located lesion looks highly suspicious for lung cancer, then you can _______________.

A

diagnose with resection

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6
Q

How is lung cancer staging done?

A

PET-CT (then do PFTs to get a baseline)

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7
Q

Who should receive low-dose CTs screening for lung cancer?

A

Those who are 55-80 yo, who have smoked for more than 30 pack years, and who quit smoking less than 15 years ago.

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8
Q

What are the “good” characteristics in a lung nodule?

A
  • Less than 8 mm in diameter (greater than 2 cm is bad)
  • Smooth borders (spiculated is bad)
  • No calcifications
  • Person is younger than 45 and who didn’t smoke
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9
Q

How frequently should LDCTs be done?

A

Yearly

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10
Q

If a pulmonary nodule has not changed in _________, then it is considered to be stable and no follow-up is needed.

A

2 years

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11
Q

If a pulmonary nodule is changing, what should you do?

A
  • For low-risk nodules (unclear criteria but I think it has to do with the nodule’s characteristics, mentioned in another card), do serial CTs.
  • For high-risk nodules (ditto), biopsy.
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12
Q

Give a rundown on small cell carcinoma.

A
  • Cannot do surgery, but usually sensitive to chemotherapy and radiation
  • Paraneoplastic syndromes: SIADH, Cushing’s, anti-cerebellar antibodies, LEMS
  • Smoking highly causative
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13
Q

What is the pathophysiology of hypercalcemia in squamous cell carcinoma?

A

PTH-rp (related-peptide) is released by the tumor –not PTH.

(Remember the Sketchy with the PHd sneaking out of the SCC cell.)

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14
Q

Adenocarcinoma –which is more common in non-smokers –is related to what exposure?

A

Asbestos

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