Respiratory10

Question 1

Types of lung cancer. (6)

Answer 1

Adenocarcinoma
Squamous cell carcinoma
Small cell (oat cell) carcinoma
Large cell carcinoma
Bronchial carcinoid tumor
Mesothelioma

Question 2

Most common lung cancer in nonsmokers and females.

Answer 2

Adenocarcinoma

Question 3

What mutation is common in adenocarcinoma?

Answer 3

Activating mutation in k-ras

Question 4

Bronchioloalveolar (subtype of adenocarcinoma)

Answer 4

CXR - hazy infiltrates similar to pneumonia
Excellent prognosis

Grows along alveolar septa –> apparent “thickening” of alveolar walls

Question 5

What is adenocarcinoma associated with?

Answer 5

Hypertrophic Osteoarthropathy

Question 6

Which lung cancers are located in the periphery?

Answer 6

Adenocarcinomas

Large cell carcinoma

Question 7

Which lung cancers are centrally located?

Answer 7

Squamous cell
Small cell (oat cell)

Question 8

Hilar mass arising from bronchus.

Answer 8

Squamous cell carcinoma

Question 9

Characteristics of Squamous cell carcinoma.

Answer 9

Cavitation
Cigarettes
HyperCalcemia (produces PTHrP)

Question 10

Histo of Squamous cell carcinoma.

Answer 10

Keratin pearls

Intercellular bridges

Question 11

Characteristics of Small cell (Oat cell) carcinoma.

Answer 11

Undifferentiated --> AGGRESSIVE
May produce:
 - ACTH
 - ADH
 - Antibodies vs. presynaptic Ca++ channels
      (Lambert-Eaton syndrome)
 - Amplification of myc oncogenes

Question 12

Small cell carcinoma is a neoplasm of what cell type?

Answer 12

Neuroendocrine Kulchitsky cells

- small dark Blue cells

Question 13

How do you treat small cell?

Answer 13

Chemo

*Inoperable

Question 14

Characteristics of Large cell carcinoma.

Answer 14

Highly Anaplastic Undifferentiated tumor
Poor prognosis
Pleomorphic giant cells

*Less responsive to Chemo –> removed surgically

Question 15

Characteristics of Bronchial Carcinoid tumor.

Answer 15

Excellent Prognosis; metastasis rare
Symptoms d/t Mass Effect
Occasionally carcinoid syndrome

Question 16

What is Carcinoid syndrome?

Answer 16

Serotonin secretion –>

• Flushing
• Diarrhea
• Wheezing

Question 17

Histo of Bronchial Carcinoid tumor.

Answer 17

Nests of neuroendocrine cells

Chromogranin Positive

Question 18

Characteristics of Mesothelioma.

Answer 18

Malignancy of pleura associated w/ Asbestos
Results in:
- Hemorrhagic pleural effusions
- Pleural thickening

Question 19

Histo of Mesothelioma.

Answer 19

Psammoma bodies

Question 20

Histo of Small Cell Carcinoma.

Answer 20

Sheets of tumor cells w/ nuclear molding
High Mitotic Rate
Necrosis
“Salt & Pepper” neuroendocrine-type chromatin

Question 21

What is a Pancoast tumor?

Answer 21

Carcinoma that occurs in APEX of lung

May affect Cervical Sympathetic Plexus

Question 22

What may a Pancoast tumor cause?

Answer 22

Horner’s syndrome

Question 23

Findings in Horner’s syndrome.

Answer 23

Ipisilateral Ptosis
Miosis
Anhidrosis

Question 24

What is Superior Ven Cava Syndrome?

Answer 24

An obstruction of the SVC that impairs blood drainage from the Head, Neck, and Upper extremities

If severe can raise Intracranial Pressure:
- HA, dizziness, Risk of Aneurysm/Rupture of cranial arteries

*Medical Emergency

Question 25

Common causes of SVC syndrome.

Answer 25

Malignancy

Thrombosis from indwelling catheters