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PANCE 2.0 > Pulmonology #7 (Lung Cancer, Paraneoplastic, Mesothelioma) > Flashcards

Pulmonology #7 (Lung Cancer, Paraneoplastic, Mesothelioma) Flashcards

1
Q

What are some signs that a solitary pulmonary nodule has an increased risk of malignancy?

A

-Spiculated nodule
-Large > 2 cm
-Irregular borders
-Asymmetric calcification
-Upper lobe location
-> 40 years of age
-Smoker
-Enlarging
-Abnormal PET scan

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2
Q

What are some signs that the nodule has a decreased risk of malignancy?

A

-Well circumscribed smooth borders
-Small < 1 cm
-Dense diffuse calcification
-< 30 years of age
-Nonsmoker
-No change in size
-Normal CT scan

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3
Q

Initial diagnostic done for a pulmonary nodule

A

CXR

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4
Q

Then, what is the next diagnostic study done to determine malignancy or not

A

CT chest

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5
Q

______ may be used to determine metabolic functioning of the nodule

A

PET scan

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6
Q

If the nodule has an intermediate risk of being malignant, what should be done?

A

Bronchoscopy if central lesion
Transthoracic needle aspiration if peripheral

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7
Q

With a high risk of malignancy, what should be done?

A

Resection with biopsy

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8
Q

MC site of bronchial carcinoid tumors

A

GI tract

Lung is second most common site

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9
Q

What are the symptoms of carcinoma syndrome?

A

-Periodic episodes of diarrhea (serotonin release)
-flushing
-Tachycardia
-Bronchoconstriction (histamine release)
-Hemodynamic instability (hypotension)

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10
Q

Although biopsy is definitive to diagnose a carcinoid tumor, what is seen on bronchoscopy?

A

Pink to purple well-vascularized centrally-located tumor

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11
Q

What medication can be used to decrease symptoms of carcinoid tumors?

A

Octreotide

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12
Q

What is the definitive management of carcinoid tumors?

A

Surgical excision–they are often resistant to chemotherapy and radiation

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13
Q

Bronchogenic carcinoma is the ______ MC cancer diagnosed in the US, after _______

A

2nd MCC

After prostate in men and breast in women

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14
Q

True or False: Bronchogenic cancer is the MCC of cancer-related deaths in the US

A

True

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15
Q

Where are the greatest tendency for METS of bronchogenic carcinoma?

A

-brain, bone, liver, lymph nodes, adrenals

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16
Q

MCC of bronchogenic carcinoma

A

Smoking

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17
Q

Second MCC of bronchogenic carcinoma

A

Asbestosis

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18
Q

Other risk factors for lung cancer

A

Genetics
Radon exposure (miners)
COPD
TB

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19
Q

What are the two types of lung cancer?

A

Non-small cell cancer
Small cell cancer

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20
Q

Non-small cell cancer is usually treated with _______ and includes what types?

A

Surgical resection

Adenocarcinoma
Squamous Cell
Large cell

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21
Q

Small cell cancer is usually _______ and the initial treatment of choice is

A

usually metastatic at time of presentation

Chemotherapy (with or without radiation)

22
Q

Who should have a low-dose CT scan of the lungs

A

55-80 who have no symptoms of lung cancer + 30 PPY smoking history who currently smoke or have quit within 15 years

23
Q

MC primary lung cancer in smokers, women, men, and nonsmokers

A

Adenocarcinoma

24
Q

Where is adenocarcinoma usually located in the lungs?

A

Typically peripheral

25
Q

Treatment for adenocarcinoma of the lungs

A

Surgical resection in most cases

26
Q

What are the characteristics of squamous cell lung carcinoma? CCCP

A

Centrally located
Cavitary lesions
Hypercalcemia
Pancoast syndrome

27
Q

Although biopsy is definitive diagnostic for squamous cell carcinoma, what is another unique thing that can diagnose it?

A

May be detected in the sputum since it is commonly central

28
Q

Describe small cell (oat cell) carcinoma of the lungs

A

Aggressive type of lung cancer that is associated with early metastasis

29
Q

Strongest risk factor for small cell/oat cell carcinoma

A

Smoking

30
Q

Symptoms of small cell carcinoma

A

Cough, chest pain, dyspnea, hemoptysis, wheezing, weight loss

-Paraneoplastic syndromes

31
Q

Small cell carcinoma is usually located ________ and the treatment for most is usually ______

A

Centrally located

Chemotherapy

32
Q

What is a paraneoplastic syndrome

A

Set of systemic symptoms and/or signs due to release of hormones and cytokines by an immune response against the tumor

33
Q

What is the MC tumor to present with paraneoplastic syndromes?

A

Small cell lung carcinoma

34
Q

Superior vena cava syndrome, due to obstruction of blood flow through the SVC, presents with symptoms such as

A

Face and/or neck swelling
Facial plethora
Headache
Dilated and prominent neck and chest veins

35
Q

What does a CXR show in a person with SVC syndrome?

A

Right hilar mass or widening of mediastinum

36
Q

Treatment for SVC syndrome

A

-Elevation of the head
-Endovascular management

37
Q

What is the pathophysiology of Lambert-Eaton Myasthetic Syndrome?

A

-Antibodies against presynaptic voltage-gated Calcium channels prevent acetylcholine release, leading to muscular weakness

38
Q

Symptoms of Lambert-Eaton Syndrome

A

-Proximal muscle weakness that improves with repeated muscle use (unlike myasthenia gravis)
-Dry mouth, erectile dysfunction, postural hypotension
-Hyporeflexia, no muscle atrophy

39
Q

Diagnostics to evaluate for Lambert-Eaton Syndrome

A

-Voltage-gated Calcium channel antibody assay

-Electrophysiology

40
Q

Treatment for Lambert-Eaton

A

Treat underlying malignancy

Initial medical treatment: Pyridostigmine

Second line: Plasmapheresis, IVIG, oral immunosuppressants

41
Q

What is a pancoast tumor?

A

Tumor located near the superior sulcus (near the apex) with a distinct pattern of signs and symptoms

42
Q

MC etiology of Pancoast tumors

A

Squamous cell lung carcinoma (non small cell lung carcinoma)

43
Q

What is the pathophysiology of pancoast tumors

A

-Tumor compression of lower brachial plexus, ulnar nerve, and/or cervical sympathetic nerve chain

44
Q

Symptoms of a pancoast tumor

A

-Shoulder and arm pain (MC initial symptom)
-Horner syndrome (ipsilateral ptosis, mitosis, and anhidrosis)
-Weakness and atrophy of muscles of hand
-Ulnar neuropathy
-Pulmonary symptoms uncommon until disease progresses

45
Q

What are the three symptoms of Horner’s Syndrome?

A

-Ipsilateral ptosis
-Miosis (dilation)
-Anhidrosis (inability to sweat normally)

46
Q

Although a CXR is initially ordered for a pancoast tumor, an MRI gives more information. However, what is the definitive diagnostic?

A

Needle biopsy

47
Q

Mesothelioma is a tumor originating from the pleura. 80% are due to

A

Chronic asbestos exposure

48
Q

Symptoms of mesothelioma

A

-Pleuritic chest pain
-Dyspnea
-Fever
-Night sweats
-Weight loss
-Hemoptysis

49
Q

What is seen on CXR in mesothelioma

A

Unilateral pleural thickening, bloody pleural effusions

50
Q

Treatment for mesothelioma

A

-Chemotherapy with resection or radiation therapy (it varies)

PANCE 2.0 (62 decks)

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