Pulmo. pancoast, sickle, mesotel, bronc carcinoid

Question 1

pancoast. shoulder?

Answer 1

shoulder pain (most common) due to brachial plexus

Question 2

pancoast. horner?

Answer 2

ipsilateral ptosis, miosis, enophthalmos, anhidrosis

due to involvement of paravertebral sympathetic chain and inferior cervical ganglion (stellate ganglion)

Question 3

pancoast. neurologic?

Answer 3

invasion of C8-T2 nerves (ulnar)

weakness and atrophy of intrinsic hand muscles
Pain/paresthesia of 4th/5th digits and medial arm/forearm

Question 4

pancoast. weight and lymph?

Answer 4

Supraclavicular lymph node enlargement
weight loss

Question 5

pancoast = superior pulmonary sulcus tumor.

what most common? 2

Answer 5

Squamous cell lung carcinoma and lung adenocarcinoma

also can occur from non-hodgkin lymphoma

Question 6

pancoast. strongest risk factor?

Answer 6

smoking

Question 7

pancoast. location?

Answer 7

near thoracic inlet

Question 8

pancoast. symptoms?

Answer 8

Symptoms:
a. Weight loss
b. Arm pain and paresthesia
c. Weakness of arm and hand
d. Referred shoulder pain
e. Horner syndrome
f. Hoarseness (due to recurrent laryngeal nerve involvement)
g. Superior vena cava syndrome

Question 9

pancoast. Superior vena cava syndrome presentation?

Answer 9

edema in face and hands

Question 10

pancoast. why hoarseness?

Answer 10

recurrent laryngeal nerve involvement.

Question 11

pancoast. investigation?

Answer 11

xray

Question 12

Note: lung cancer can occur as a secondary malignancy (18.5 higher risk) in those who were treated with chemotherapy for cancers before the age of 30, especially in smokers. Other secondary malignancies: breast, thyroid, bone and gastrointestinal tumors.

Answer 12

.

Question 13

mezothelioma. arise from what?

Answer 13

mesothelial lining

Question 14

mezothelioma. exposure to what?

Answer 14

asbestos

Question 15

mezothelioma. cp?

Answer 15

cough, chest pain, dyspnea

Question 16

mezothelioma. diagnosis?

Answer 16

xray - pleural thickening with effusion

Question 17

HODGKIN LYMPHOMA TREATMENT COMPLICATIONS. in what patients?

Answer 17

Patients, especially those treated before age 30, can develop secondary malignancies from chemotherapy and/or radiation

Question 18

HODGKIN LYMPHOMA TREATMENT COMPLICATIONS. most common secondary solid-maligancies?

Answer 18

Most common secondary solid malignancies:
a. Lung (especially in smokers)
b. Breast
c. Thyroid
d. Bone
e. Gastrointestinal (eg, colorectal, esophageal, gastric tumors)

OTHER:
Other malignancies:
a. Acute leukemia
b. Non-Hodgkin lymphoma

Question 19

HODGKIN LYMPHOMA TREATMENT COMPLICATIONS. differential?

Answer 19

a. Radiation fibrosis
i. Chest pain occurs 4-24 months after therapy
ii. Chest X-ray shows volume loss with coarse opacities

Question 20

chronic dyspnea in sickle cell. table.
Cause - asthma. symptoms?

Answer 20

intermitent/chronic wheezing
may be worse at night or with exercise or upper respiratory infection

Question 21

chronic dyspnea in sickle cell. table.
Cause - PH. symptoms?

Answer 21

exertional dyspnea
signs of right-sided heart failure (JV distension, edema)

Question 22

chronic dyspnea in sickle cell. table.
Cause - pulmonary fibrosis. symptoms?

Answer 22

exertional dyspnea
progressive

Question 23

chronic dyspnea in sickle cell. table.
Cause - asthma. diagnostic findings?

Answer 23

PFT showing reversible airway obstruciton

Question 24

chronic dyspnea in sickle cell. table.
Cause - PH. diagnostic findings?

Answer 24

tricuspid regurgitation on cardioecho
incr. pulmo artery pressure on right sided heart cath.

Question 25

chronic dyspnea in sickle cell. table.
Cause - pulmonary fibrosis. diagnostic findings?

Answer 25

honeycomb pattern on chest CT
PFT shows restrictive pattern

Question 26

infections in sickle cell. table.
pneumonia?

Answer 26

strep pneumonia

Question 27

infections in sickle cell. table.
osteomyelitis/sept arthritis?

Answer 27

stap. aureus
salmonella spp

Question 28

infections in sickle cell. table.
bacteremia/sepsis?

Answer 28

Strep. pneumonia
hemophilus influenza type B

Question 29

infections in sickle cell. table.
meninigitis?

Answer 29

Strep. pneumonia

Question 30

what is upper airway?

Answer 30

nasal cavity, pharynx, larynx

Question 31

what is lower airway?

Answer 31

trachea, primary bronchi, lungs

Question 32

bronchial carcinoid. epidemiology?

Answer 32

Most common lung cancer in adolescents/young adults

Neuroendocrine tumor derived from bronchial Kulchitsky cells

Question 33

bronchial carcinoid. manifestation?

Answer 33

proximal airway obstruction (dyspnea, wheezing, cough)
Recurrent pneumonia distal to obstruction
Hemoptysis
Carcinoid syndrome is less common than with midgut carcinoid

Question 34

bronchial carcinoid. diagnosis?

Answer 34

chest imaging - contrast enhanced (vascular) tumor with endobronchial component

bronchoscopy with biopsy

Question 35

BRONCHOGENIC CARCINOMA VS MESOTHELIOMA IN ASBESTOSIS. smoking relations?

Answer 35

Bronchogenic carcinoma is more common, especially in smokers

Question 36

BRONCHOGENIC CARCINOMA VS MESOTHELIOMA IN ASBESTOSIS.

pleural mesothelioma presents as? 2

Answer 36

a. Unilateral pleural abnormality
b. Moderate-to-severe ascites

Question 37

BRONCHOGENIC CARCINOMA VS MESOTHELIOMA IN ASBESTOSIS. nieko

Answer 37

Note: Pleural plaques are consistent with asbestosis but not particularly with either bronchogenic carcinoma or mesothelioma. Plaques may be seen in both of these malignancies but that is because of asbestosis, not the malignancies themselves.