Pulm 2 Flashcards
What is the most common cause of mesothelioma?
Asbestos exposure
How do you treat mesothelioma?
Rarely curable
Treat with radical thoracic surgery, extra pleural pneumonectomy, or palliative chemo
What are the 6 types of lung cancer?
SCLC Adenocarcinoma SCC LCLC Mixed adeno-squamous cell cancer Broncho-alveolar cancer
A pt presents with a chronic cough, recent unintentional weight loss, hemoptysis, bone pain, dysphagia, and weakness. On exam you note asymmetric breath sounds, basilar dullness, and lymphadenopathy. What do you suspect? What diagnostic tests will you perform?
Lung cancer
Labs: CBC, chemistry profile, protime, & APTT
Radiographs: CXR, CT, PET-CT, brain MRI
Biopsy for lesion
You suspected lung cancer in one of your patients and you just got back the diagnostic results. What stage cancer does your pt have?
Size is 6.5cm
No lymph node involvement
Pt has Stage IIA lung cancer
Your pt has lung cancer and the diagnostic results are below. What stage cancer does the pt have? How do you treat him?
Size is 3.2 cm
No lymph node involvement
Stage IB lung cancer
Treat with ablative radiation surgery and chemo
How do you treat a 2.5 cm malignant mass with involvement of 1 lymph node?
Stage IA cancer
Treat with ablative radiation surgery
The diagnostic results for a pt you suspect of having lung cancer are below. What treatment do you recommend for the pt?
Size is 2 cm
Involvement of 1 lymph node
Stage IIA cancer
Treat with surgery and chemo
You suspect your pt has lung cancer. The biopsy result is a metastatic tumor. What treatment do you recommend for the pt?
Stage IV cancer
Treat with palliative chemo, anti-angiogenics (Bevacizumab), TKI’s (Erlotinib, Gafitinib)
A pt’s biopsy results are a non-resectable tumor of the upper right lobe. What treatment do you recommend for this pt?
Stage IIIB cancer
Treat with chemo and RT
What is the preferred surgical option for treating lung cancer?
Lobectomy
A 65 yo male presents with a non-productive cough, wheezing, fatigue, a maculopapular rash on his back, and erythema nodosum. On exam you note hepatosplenomegaly .What disease do you suspect? How will you confirm this diagnosis?
Sarcoidosis affecting the lungs and skin
Confirm with a biopsy of a non-caseating granuloma from any organ
You can also perform PFT’s, CXR, CBC, BUN/Creat/AST/ALT/ACE, EKG, HRCT, PET Scan
A 64 yo female pt presents with dyspnea, rhonchi, fatigue, blurry vision, light sensitivity, and chronic dry eyes which are not helped by artificial tears. Her CXR showed hilar, paratracheal, and upper lobe infiltrates. How do you treat this pt? Are you worried about complications?
Sarcoidosis affecting the lungs and eyes
Treat based on symptoms (e.x. artificial tears for her dry eyes), oral glucocorticoid, methotrexate
You are worried she could develop blindness because women are more at risk for complications
A 23 yo male pt comes in complaining of myalgia, arthralgia, dyspnea, fatigue, wheezing, and a non-productive cough. On his work-up you find non-caseating granulomas. What is the most likely etiology?
Sarcoidosis
Unknown
T-lymphocyte initiated alveolitis –> WBC recruitment –> non-caseating granuloma
A 58 yo male presents to your clinic. He has been a plumber for the past 32 years, but recently he’s been experiencing such bad symptoms that he has been unable to work. He complains of chest pain, dyspnea on exertion, and a productive cough. He has also noticed that his fingernails appear oddly large and rounded, and on exam you hear persistent, dry crackles bilateral in the lower lobes. What is the most likely cause of his disease? What is his diagnosis?
Asbestosis
Caused by inhalation of asbestos fibers
Asbestos fibers –> alveolitis –> inflammation –> scarring and fibrosis –> decreased pulmonary function
A 49 yo male presents with DOE, chest pain, and a non-productive cough. You notice reduced chest expansion and persistent dry crackles on exam. He has been a janitor at a high school for 30 years. What diagnostic tests would you perform? What disease do you suspect?
Asbestosis
Diagnose using CXR, PTFs, HRCT, and/or a lung biopsy
An insulation worker presented to your clinic with DOE and chest pain. During the visit you performed PFTs which showed decreased FVC, TLC, & DLCO but a normal FEV1/FVC. Today you get back his CXR, which shows pleural plaques and irregular, linear lower lobe opacities. What complications are you worried about this pt developing? What treatment are you going to recommend for him?
Asbestosis
You are worried he could develop cor pulmonale, a malignancy, pulmonary HTN, or right sided heart failure
Recommend that he switch jobs if possible (or switch schools) and get annual flu and PNA vaccines
You’re working in a clinic in western Maryland and a pt presents with a cough, dyspnea, and impaired lung function. He has an 18 pack year history of tobacco use. What disease are you most concerned this could be? What complications are you worried the pt might develop?
Complicated coal worker’s pneumoconiosis (CPW)
Complications include progressive massive fribosis, Caplan syndrome, TB, and cancer (SCC)
You’re also worried he could develop COPD
At an annual check up you see a 65 yo male. He and his wife have recently moved here since he retired from being a coal mine supervisor in Virginia. Although he is asymptomatic and has no complaints at today’s visit, what disease are you worried about?
Coal worker’s pneumoconiosis because of his occupational history and previous location (VA)
A pt presents with a cough and dyspnea. He has a 25 pack year history of tobacco use and he has worked in a coal mine in Kentucky for the past 10 years. You perform lung function tests, but the results are normal. What treatment do you recommend for this pt?
Coal worker’s pneumoconiosis
Recommend symptomatic treatment (ex. antitussives for cough), smoking cessation, flu and PNA vaccines, and a CXR to monitor his symptoms (to use as a baseline so you can monitor for complications in the future)
A pt comes in for his annual check-up. He has a 10 pack year history of tobacco use and he currenly works at a granite quarry. His physical exam is unremarkable. Why are you worried about this pt? What disease do you suspect he might have despite being asymptomatic? What would be the most common etiology?
Silicosis
Suspect because he is a smoker and works in a job at risk for silicosis
Quartz although silicosis is cause by inhalation of any crystalline silica containing dust
A pt presents with a cough and dyspnea. Due to his occupational history you perform a CXR which shows a ground glass appearance and calcified hilar lymph nodes. What disorder do you strongly suspect the pt has? What treatment options do you recommend?
Silicosis (calcified hilar lymph nodes are very characteristic of silicosis)
Treat by preventing silica exposure and getting annual flu and PNA vaccines
Recommend that the pt see a pulmonologist
A pt has advanced silicosis. What treatment option could potentially help?
A lung transplant
A 39 yo male presents to your clinic with difficulty breathing which he has noticed has slowly gotten worse over the past couple months although it has not prevented him from being able to work on electronics, which is his job. He has noticed a cough, chest pain, and a rash. What disease do you suspect? How would you confirm your diagnosis?
Chronic beryllium disease
Test his sensitization to beryllium via a BAL or BeLPT test
HRCT
Obstruction or restriction on spriometry
Your 42 yo pt used to work at a nuclear power plant. Recently he has noticed arthralgia, fatigue, and unintentional weight loss. On exam you find inspiratory crackles and hepatosplenomegaly. What disease do you suspect? What treatment would you recommend? What do you do if your 1st line treatment fails?
Chronic beryllium disease
Corticosteroids and symptomatic treatment are 1st line
Treat with methotrexate if corticosteroid therapy fails
Refer this pt to a pulmonologist
A 72 yo pt presents to you with DOE, progressive dyspnea, a non-productive cough, fatigue, a low-grade fever, and chills. She says that the dyspnea and cough are worse if she’s around her son-in-law who always smokes when she visits him and her daughter. On exam you find fine bibasilar inspiratory crackles and pedal edema. What disease do you think this is most likely to be? How do you treat it?
Idiopathic pulmonary fibrosis
There’s no treatment, just treat symptoms and complications
Recommend she avoid triggers (ex. smoke)
An 82 yo male presents with progressively worsening dyspnea, a non-productive cough, arthralgia, myalgia, fatigue, and a low-grade fever. He has arthritis, a 30 pack year history of tobacco use and is currently taking Amiodarone. On exam you notice clubbing and find an intense S2. His PFT show a normal FEV1/FVC, a low RV, and an FVC 55% of the expected value. On CBC you find chronic hypoxemia. What disease do you suspect?
Idiopathic pulmonary fibrosis
Another PA asks you to help out with his case. His pt had progressive dyspnea and a non-productive cough so he performed PFT’s which show mild restriction (FVC 75%). He’s worried his pt has idiopathic pulmonary fibrosis, but isn’t sure what other tests to run to confirm his diagnosis. What do you recommend he do?
HRCT! This is good for screening/early detection, diagnosis, severity assessment, and detecting any co-existing diseases
Cardioipulmonary exercise testing (look for decreased O2)
Echo to look for pulmonary HTN
Fiberoptic bronchoscopy
Surgical lung biopsy
You see a new pt who has recently been diagnosed with interstitial lung disease, but she can’t remember which kind. She has a 20 pack year history of tobacco use and had pneumonia 2 years ago. What kind of ILD does she most likely have?
Fibrosis ILD
What are the 2 types of ILD?
Fibrosis and Granulomatous
A pt has drug-induced ILD. What is the best/1st line treatment option for this pt?
Discontinue the drug
