Pulm-Tumors Flashcards
Evaluation of a pulmonary nodule <4mm
If…
- Low pre-test probability: no follow-up needed
- High pre-test probability: follow-up CT at 12 months if unchanged, no further follow-up
Evaluation of a pulmonary nodule >4-6mm
If…
- Low pre-test probability: Follow-up CT at 12 months; if unchanged, no further follow-up
- High pre-test probability: Initial follow-up CT at 6 to 12 months then at 18-24 months if no change
Evaluation of a pulmonary nodule >6-8mm
If…
- Low pre-test probability: Initial follow-up CT at 6-12 months then at 18 to 24 months if no change
- High pre-test probability: Initial follow-up CT at 3-6 months then at 9 to 12 months and 24 months if no change
Evaluation of a pulmonary nodule >8mm
If…
- Low pre-test probability: Follow-up CT at around 3, 9, and 24 months; dynamic contrast-enhanced CT, PET, and/or biopsy
- High pre-test probability: Same as for low risk
What is the definition of a pulmonary mass? How is it managed?
It is greater than 3cm in diameter and highly suspicious for a malignancy. This is managed by either biopsy for tissue diagnosis or surgical resection.
Evaluation of a pulmonary nodule >8mm but less than 30mm
If…
- Low pre-test probability: surveillance CT at 3 to 6, 9-12, and 18-24 months (re-evaluate for PET imaging, tissue diagnosis, or excision if evidence of growth)
- Intermediate pre-test probability: PET/CT imaging, tissue diagnosis or biopsy if nodule demonstrates high metabolic activity; at leasts short-term surveillance if negative but consider more aggressive evaluation depending on individual patient factors
- High pre-test probability: PET/CT first, then surgical excision
What is the first thing you should do when you see a pulmonary nodule?
Compare it to an old film
What are the most common histologic types of cancers?
- Non-small cell: 86%
- Small cell: 14%
Non-small cell:
- adenocarcinoma-38%
- squamous cell carcinoma-20%
What histologic types does a solitary pulmonary nodule suggest?
A solitary pulmonary nodule is more likely to be a non-small cell tumor. It is very rare for small cell to show up as a solitary pulmonary nodule
When should you use a CT scan to screen for lung cancer in patients?
USPSTF recommends low dose CT screen for lung cancer in patients between the ages of 55-79 who have a 30 PACK YEAR smoking history and who are currently smoking or quit within the last 15 years
What anatomical location do bronchial carcinoid tumors typically present?
These typically present in the proximal airways–a typical carcinoid is considered a low-grade tumor with an excellent 5-year survival rate of 92-100%
What is mesothelioma?
It arises from asbestos exposure. It is a pleural malignancy–pleural plaques or calcifications.
Most commonly presents with a slowly enlarging pleural effusion
How do pleural metastases typically present anatomically?
They typically present as multiple, peripheral, or sub pleural pulmonary nodules but can also present as solitary pulmonary nodules
What malignancy sites do pulmonary mets come from?
carcinomas from: colon, kidney, breast testicle, thyroid, bone, melanoma/skin
Lymphangitic spread can also occur with adenocarcinoma: lung, breast, and GI tract, melanoma/skin, lymphoma, leukemia
What is the most common cause of an anterior mediastinal mass?
Thymoma…
What is the most common lymphoma to impact the mediastinum?
Hodgkin lymphoma
What is the most common cause of a middle mediastinal mass?
lymphadenopathy
What is the most common cause of a posterior mediastinal mass?
neurogenic tumor
Should overnight pulse ox be used to screen people for OSA?
No, overnight pulse ox has a high rate of false-positive and false negative results and has not yet been validated as a screening tool for OSA
What is central sleep apnea?
It is defined by the loss of neural output originating from the respiratory centers in the central nervous system to the respiratory pump machinery, resulting in pauses in breathing
What is daytime hypercapnia a sign of?
IT is a sign of obesity hypoventilation syndrome, reflecting reduced ventilation during wakefulness and sleep that is not attributed to another causes
How to treat high-altitude respiratory illness?
acetazolamide accelerates acclimatization by inducing a slight metabolic acidosis to stimulate ventilation and enhance gas exchange
How do you treat high-altitude related cerebral edema?
urgent descent from altitude
When does someone need to take O2 on flight?
when O2 saturation is less than 92% at sea level OR for patients how are already on long-term supplemental O2, doubling the flow rate during flight is typically adequate to prevent hypoxia
