Pulm-Tumors Flashcards

1
Q

Evaluation of a pulmonary nodule <4mm

A

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
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2
Q

Evaluation of a pulmonary nodule >4-6mm

A

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
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3
Q

Evaluation of a pulmonary nodule >6-8mm

A

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
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4
Q

Evaluation of a pulmonary nodule >8mm

A

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
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5
Q

What is the definition of a pulmonary mass? How is it managed?

A

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.

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6
Q

Evaluation of a pulmonary nodule >8mm but less than 30mm

A

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
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7
Q

What is the first thing you should do when you see a pulmonary nodule?

A

Compare it to an old film

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8
Q

What are the most common histologic types of cancers?

A
  1. Non-small cell: 86%
  2. Small cell: 14%

Non-small cell:

  1. adenocarcinoma-38%
  2. squamous cell carcinoma-20%
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9
Q

What histologic types does a solitary pulmonary nodule suggest?

A

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

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10
Q

When should you use a CT scan to screen for lung cancer in patients?

A

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

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11
Q

What anatomical location do bronchial carcinoid tumors typically present?

A

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%

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12
Q

What is mesothelioma?

A

It arises from asbestos exposure. It is a pleural malignancy–pleural plaques or calcifications.

Most commonly presents with a slowly enlarging pleural effusion

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13
Q

How do pleural metastases typically present anatomically?

A

They typically present as multiple, peripheral, or sub pleural pulmonary nodules but can also present as solitary pulmonary nodules

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14
Q

What malignancy sites do pulmonary mets come from?

A

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

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15
Q

What is the most common cause of an anterior mediastinal mass?

A

Thymoma…

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16
Q

What is the most common lymphoma to impact the mediastinum?

A

Hodgkin lymphoma

17
Q

What is the most common cause of a middle mediastinal mass?

A

lymphadenopathy

18
Q

What is the most common cause of a posterior mediastinal mass?

A

neurogenic tumor

19
Q

Should overnight pulse ox be used to screen people for OSA?

A

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

20
Q

What is central sleep apnea?

A

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

21
Q

What is daytime hypercapnia a sign of?

A

IT is a sign of obesity hypoventilation syndrome, reflecting reduced ventilation during wakefulness and sleep that is not attributed to another causes

22
Q

How to treat high-altitude respiratory illness?

A

acetazolamide accelerates acclimatization by inducing a slight metabolic acidosis to stimulate ventilation and enhance gas exchange

23
Q

How do you treat high-altitude related cerebral edema?

A

urgent descent from altitude

24
Q

When does someone need to take O2 on flight?

A

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