trigger - malignant neoplasms

Question 1

what mediastinal compartment contains the esophagus and descending thoracic aorta

Answer 1

posterior

Question 2

+ lab in thymic tumors

Answer 2

anti-acetylcholine receptor antiboies

Question 3

+ lab in germ cell tumorss

Answer 3

alpha fetoprotein and beta Hcg

Question 4

+ lab in seminomas and lymphoma

Answer 4

lactate dehydrogenase

Question 5

what biopsy to use if a mass is located immediatly adjacent to the airway

Answer 5

endobronchial biospy

Question 6

what makes up 80% of benign SPN

Answer 6

infectious granulomas

(MC d/t histoplasmosis, coccidioidomycosis, TB or non TB mycobacteria)

Question 7

CXR shows popcorn calcifications

Answer 7

hamartomas

(benign etiology of SPN)

Question 8

CT shows area of alternating fat and calcifications

Answer 8

hamartomas

(benign etiology of SPN)

Question 9

what do we NOT biopsy

Answer 9

AV malformations

Question 10

centrally presenting primary lung cancers

Answer 10

small cell carcinoma
squamous cell carcinoma

Question 11

peripherally presenting primary lung cancers

Answer 11

adenocarcinoma
large cell cancer (anywhere but often peripheral)

Question 12

this location of nodule in the lung is associated with higher rates of malignancy

Answer 12

upper

Question 13

Lesion described as loblar or spiculated in appearence

benign or malignant?

Answer 13

these are examples of il-defined markings = likely malignant

Question 14

peripheral halo on lesion on CT

benign or malignant?

Answer 14

likely a malignant lesion

Question 15

if a patient has an intermediate risk central SPN, what are non-invasive diagnostic options

Answer 15

sputum cytology

not used in peripheral lesions!!

Question 16

what is used for all SPN biopsies

Answer 16

CT transthoracic FNA or bronchoscopy

Question 17

please memorize this Billie.

Answer 17

Question 18

pembertons sign seen when

Answer 18

SVC syndrome in lung cancer as a complication

MC in Small cell lung cancer

Question 19

CXR showing mediastinal widening or right hilar mass

Answer 19

superior vena cava syndrome in lung cancer

Question 20

shoulder pain and atrophy of hand muslces

Answer 20

pancoast tumor in llung cancer

(tumor in apex of lungs compressing structures)

also seen:
horners syndrome
bone destruction

Question 21

horners syndrome
bone destruction
seen when?

Answer 21

pancoast tumor in llung cancer

(tumor in apex of lungs compressing structures)

also seen:
shoulder pain
atrophy f hand muscles

Question 22

what would be seen in a PET scan of people with:
diabetes
lesions <8mm
slow growing tumors

Answer 22

false negatives

Question 23

what would cause false positives in PET scans

Answer 23

certain infections and granulomatous disease (TB)

Question 24

imaging used in lymph node staging

Answer 24

integrated CT/PET

Question 25

what labs can be seen in paraneoplastic syndrome

Answer 25

• elevated antinuclear antibodies
• Elevated Creatine Kinase
• elevated calcium
• abnormal electrolytes and CBC

Question 26

what labs can be seen in liver metastases

Answer 26

• elevated alkaline phosphatase
• elevated AST/ALT and total bililrubin
• elevated LFTs

Question 27

pt with back pain worse at night

Answer 27

bone metastases

more common seen in SCLC

Question 28

elevated serum alkaline phosphatase
elevated serum calcium

Answer 28

bone metastases from lung cancer

MC in SCLC

Question 29

pt presents with papilledema, hemiparesis and visual field loss

Answer 29

lung cancer metastasised to brain/spine/nerves

evaluate with MRI w/contrast

also see:
HA, N/V, seizures, cranial/focal nerve deficit

Question 30

pt presents with headache, vomiting and decreased vision

Answer 30

lung cancer metastasised to brain/spine/nerves

evaluate with MRI w/contrast

also see:
seizures
papilledema
hemiparesis

Question 31

biopsy used mostly for peripherally located tumors

Answer 31

transthoracic percutaneous FNA

Question 32

Usually detected as a large hilar mass with bulky mediastinal adenopathy

Answer 32

Small cell carcinoma

Question 33

MC form of lung cancer in non smokers

Answer 33

adenocarcinoma

Question 34

centrally located and MC in smokers

Answer 34

squamous cell carcinoma and small cell carcinoma

Question 35

rapidly growing lung cancer occuring anywhere in lung

Answer 35

large cell carcinoma

more common in periphery but can be anywhere

Question 36

surgery alone usually curative for these patients

Answer 36

NSCLC stage 0

Question 37

surgical resection w/lymph node removal if needed and adjuvant chemo. post op radiation if needed

Answer 37

stage 2 and 3 NSCLC

Question 38

systemic therapy (chemo, ect), pallative radiation/surgery.

Answer 38

treatment for NSCLC stage 4

Question 39

what is it called when a tumor is limited to the unilateral hemithorax

Answer 39

limited stage SCLC

Question 40

polyuria, polydipsia, lethargy, constipation and NV are all s/s of what paraneoplastic syndrome

Answer 40

hypercalcemia

Question 41

irritability, confusion, seizures, coma, restlessness are all s/s of what paraneoplastic syndrome

Answer 41

SIADH (s/s result of hyponatremia)

MC assocaited with SCLC

Question 42

autoantibody formation resulting in impaired release of acetylecholine

Answer 42

lambert-eaton myasthenic syndrome

Question 43

muslce weakness, central weight gain, HTN and osetoporosis are s/s of what paraneoplastic syndrome

Answer 43

cushings syndrome

usually presents with hypokalemia and hyperglycemia!!

Question 44

this tumor presents before age 60 with no relation to smoking or other carcignogens

Answer 44

bronchial carcinoid tumor

Question 45

pt presents with flushing, diarrhea, wheezing and hypotension

Answer 45

this is carcinoid syndrome (its rare but i have a feeling were gonna be asked)

indicative of bronchial carcinoid tumors!!

Question 46

biopsy of this tumor results in significant bleeding

Answer 46

bronchial carcinoid tumor