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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
Treatment for adenocarcinoma of the lungs
Surgical resection in most cases
26
What are the characteristics of squamous cell lung carcinoma? CCCP
Centrally located Cavitary lesions Hypercalcemia Pancoast syndrome
27
Although biopsy is definitive diagnostic for squamous cell carcinoma, what is another unique thing that can diagnose it?
May be detected in the sputum since it is commonly central
28
Describe small cell (oat cell) carcinoma of the lungs
Aggressive type of lung cancer that is associated with early metastasis
29
Strongest risk factor for small cell/oat cell carcinoma
Smoking
30
Symptoms of small cell carcinoma
Cough, chest pain, dyspnea, hemoptysis, wheezing, weight loss -Paraneoplastic syndromes
31
Small cell carcinoma is usually located ________ and the treatment for most is usually ______
Centrally located Chemotherapy
32
What is a paraneoplastic syndrome
Set of systemic symptoms and/or signs due to release of hormones and cytokines by an immune response against the tumor
33
What is the MC tumor to present with paraneoplastic syndromes?
Small cell lung carcinoma
34
Superior vena cava syndrome, due to obstruction of blood flow through the SVC, presents with symptoms such as
Face and/or neck swelling Facial plethora Headache Dilated and prominent neck and chest veins
35
What does a CXR show in a person with SVC syndrome?
Right hilar mass or widening of mediastinum
36
Treatment for SVC syndrome
-Elevation of the head -Endovascular management
37
What is the pathophysiology of Lambert-Eaton Myasthetic Syndrome?
-Antibodies against presynaptic voltage-gated Calcium channels prevent acetylcholine release, leading to muscular weakness
38
Symptoms of Lambert-Eaton Syndrome
-Proximal muscle weakness that improves with repeated muscle use (unlike myasthenia gravis) -Dry mouth, erectile dysfunction, postural hypotension -Hyporeflexia, no muscle atrophy
39
Diagnostics to evaluate for Lambert-Eaton Syndrome
-Voltage-gated Calcium channel antibody assay -Electrophysiology
40
Treatment for Lambert-Eaton
Treat underlying malignancy Initial medical treatment: Pyridostigmine Second line: Plasmapheresis, IVIG, oral immunosuppressants
41
What is a pancoast tumor?
Tumor located near the superior sulcus (near the apex) with a distinct pattern of signs and symptoms
42
MC etiology of Pancoast tumors
Squamous cell lung carcinoma (non small cell lung carcinoma)
43
What is the pathophysiology of pancoast tumors
-Tumor compression of lower brachial plexus, ulnar nerve, and/or cervical sympathetic nerve chain
44
Symptoms of a pancoast tumor
-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
What are the three symptoms of Horner's Syndrome?
-Ipsilateral ptosis -Miosis (dilation) -Anhidrosis (inability to sweat normally)
46
Although a CXR is initially ordered for a pancoast tumor, an MRI gives more information. However, what is the definitive diagnostic?
Needle biopsy
47
Mesothelioma is a tumor originating from the pleura. 80% are due to
Chronic asbestos exposure
48
Symptoms of mesothelioma
-Pleuritic chest pain -Dyspnea -Fever -Night sweats -Weight loss -Hemoptysis
49
What is seen on CXR in mesothelioma
Unilateral pleural thickening, bloody pleural effusions
50
Treatment for mesothelioma
-Chemotherapy with resection or radiation therapy (it varies)

PANCE 2.0 (62 decks)

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