Pulmonary 2 (Step up son)

Question 1

A CXR/CT shows a solitary lung nodule

Answer 1

Granuloma
Hamartoma
Cancer...primary or metastasis (40% of time)
Carcinoid tumor
Pneumonia

Question 2

A solitary pulmonary nodule is seen on CXR. What is the next step?

Answer 2

Look at a previous CXR to compare

Question 3

A solitary pulmonary nodule was seen on CXR and compared to a previous CXR and was found to have changed (or there was no previous CXR). What is the next step?

Answer 3

Get a CT to determine location, progression, and size

Question 4

What are characteristics of a benign solitary pulmonary nodule? What should be done for follow up?

Answer 4

Patient is

Question 5

What are characteristics of a malignant solitary pulmonary nodule? What is done?

Answer 5

Patient is a smoker >45yo
New or progressive nodule
No calcifications or irregular calcifications
>2cm
Irregular margins

FDG-PET, biopsy, or immediate resection

Question 6

What percentage of lung cancers are metastases from another primary source? What are the common sources?

Answer 6

Metastases make up 10% of lung cancers

Breast, colon, prostate, endometrial, cervical cancers

Question 7

90% of primary lung cancers are related to smoking. What is the most common primary lung cancer in NONsmokers? Where is the cancer located in the lung?

Answer 7

Adenocarcinoma

Located in the periphery

Question 8

A nonsmoker is found to have a single pulmonary nodule on CXR. What is a possible low grade subtype?

Answer 8

Bronchioloalveolar cancer

Question 9

An old ship worker is found to have wide metastases and a pleural effusion. What is the diagnosis? What would be found in the effusion?

Answer 9

Adenocarcinoma secondary to asbestos exposure (more common than mesothelioma)

Increased hyaluronidase levels

Question 10

A patient is diagnosed with adenocarcinoma. What are syndromes caused by adenocarcinoma?

Answer 10

Adenocarcinoma can cause hemolytic problems (DIC, thrombophlebitis, and MAHA) and dermatomyositis

Question 11

A cavitary pulmonary lesion is seen that is attached to a hilar lymph node. What is it?

Answer 11

Squamous cell carcinoma

Question 12

What is a peptide produced by squamous cell lung cancers that can cause problems?

Answer 12

PTH-related peptide…hypercalcemia (if severe: polydipsia/polyuria, N/V/C, muscle weakness, bone pain, confusion, lethargy, and/or fatigue)

Question 13

A solid, central pulmonary nodule is seen on CXR and a PET scan shows many distant metastases. What is the likely diagnosis? What else can be seen?

Answer 13

Small cell carcinoma

Ectopic GH and ACTH (–> Cushing syndrome)
SIADH
Peripheral neuropathy and subacute sensory neuropathy
Antibodies to voltage-gated calcium channels –> Lambert-Eaton syndrome (similar to myasthenia gravis)
Subacute cerebellar degeneration
Limbic encephalitis
Dermatomyositis

Question 14

A guy comes in smelling of tobacco and with gynecomastia. A CXR shows a cavitary, peripheral lung lesion. What is the likely diagnosis? Besides gynecomastia, what other complication(s) can happen with this cancer?

Answer 14

Large cell carcinoma

Dermatomyositis

Question 15

What are some syndromes that can occur with any lung cancer?

Answer 15

Horner syndrome: miosis, ptosis, and anhidrosis
Pancoast syndrome: Horner + brachial plexus involvement
Superior vena cava syndrome: SVC obstruction –> head swelling and CNS symptoms

Question 16

Lung cancers are broken up into small cell and non-small cell for staging and treatment. A NSCLC is found to have mediastinal invasion. What is the stage? What is the treatment?

Answer 16

Mediastinal invasion automatically makes it stage III…so does distant nodes and/or metastases

Treatment is palliative

Question 17

Lung cancers are broken up into small cell and non-small cell for staging and treatment. A NSCLC is found to have NO lymph node involvement beyond ipsilateral hilar nodes, NO mediastinal invasion, and NO metastases. What is the stage? What is the treatment?

Answer 17

Stage I NSCLC

Treat with surgical resection*, +/- adjuvant chemotherapy, +/- radiation; radiation therapy if unable to do surgery

Question 18

Lung cancers are broken up into small cell and non-small cell for staging and treatment. A NSCLC is found to have extension to ipsilateral mediastinal nodes, but NO mediastinal invasion or metastases. What is the stage? What is the treatment?

Answer 18

Stage II NSCLC

Treat with radiation*, consider chemo induction and surgery

Question 19

Lung cancers are broken up into small cell and non-small cell for staging and treatment. A SCLC is found to have NO nodal spread or metastases. What is the stage? What is the treatment?

Answer 19

Stage I

Treat with Chemo* +/- adjuvant radiation, consider surgery if very small

Question 20

Lung cancers are broken up into small cell and non-small cell for staging and treatment. A SCLC is found to have nodal spread or metastases. What is the stage? What is the treatment?

Answer 20

Stage II

Treat with Chemo* +/- adjuvant radiation, NO surgery

Question 21

A guy comes in with a history of tobaccoism and alcoholism concerned about becoming progressively hoarse. What a potential diagnosis? What is the treatment?

Answer 21

Laryngeal squamous cell cancer

Partial/total laryngectomy; radiation as adjunct or as primary treatment if extensive; advanced cases may require surgery, radiation, and chemo