Respi - lung granulomas

Question 1

causes of lung granulomas (3)

Answer 1

• infection (TB/ fungal)
• foreign material/ antigens
• idiopathic: sarcoidosis

Question 2

sarcoidosis

Answer 2

non-necrotising granuloma, more commonly affects intrathoracic lymph nodes/ lung
rare in SEA

Question 3

lung cancer causes + who is more susceptible

Answer 3

• cigarette smoking, ppl who work at industrial sites (industrial carcinogens - radioactive material, asbestos, heavy metal)

metastatic spread very common in lung cancer (>50%)

Question 4

types of lung cancer (3)

Answer 4

• small cell carcinoma
• squamous cell carcinoma
• adenocarcinoma

Question 5

potential spread of lung cancer

Answer 5

• local: lung, pleura, mediastinal structures, chest wall
• lymphatic
• transcoelomic (pleural/pericardial effusions)

Question 6

squamous cell carcinoma

Answer 6

associated w/ SMOKING
more in males
preceded by squamous metaplasia - cause the foreign pathogens from cigarette cause changes in epithelium
near hilum of lung

treatment: surgical excision

Question 7

adenocarcinoma / BAC

Answer 7

minimally invasive
looks like consolidation on X-ray
spreads along alveolar septa

Question 8

small cell carcinoma**

Answer 8

hyperchromatic
rapid growth
high association w/ smoking
but really low prognosis <5% - highly metastatic

treatment: chemotherapy sensitive

Question 9

poor prognosis of lung cancer

Answer 9

no early symptoms -> lesions would have spread by the time it is detected (picked up by CT scan)

Question 10

paraneoplastic syndromes

Answer 10

triggered by abnormal immune system against neoplasm

endocrine disturbances (for small cell carcinoma)
- SIADH**
- ectopic ACTH secretion**
- hypercalcemia**
neurological defects
hypertrophic pulmonary osteoarthropathy (HPOA)

Question 11

genetic causes of lung cancer

+ treatment

Answer 11

activating mutations of EGFR gene

treatment: tyrosine kinase inhibitors

Question 12

histological presentation of TB

Answer 12

granulomatous inflammation

• central necrosis
• CD4 T lymphocytes
• multinucleated giant cell
• epithelioid histeocytes (granuloma)

Question 13

local effects of lung carcinoma

Answer 13

• ulceration - hemoptysis
• obstruction of airway - lung abscess, lobar collapse
• spread into pleura - pleural effusion
• invade recurrent laryngeal nerve - hoarseness of voice
• compression of related structures - SVC/ esophagus, chest wall/ pericardium