Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
68 Cards in this Set
- Front
- Back
|
Which lung cancer has the lowest association with smoking?
|
Adenocarcinoma
|
|
|
Other than smoking, what are some RFs for lung cancer?
|
Asbestos, radon (basements), COPD
|
|
|
How is SCLC staged?
|
Limited = confined to chest + supraclavicular nodes (not cervical or axillary)
Extensive = outside of above |
|
|
What is the name of a superior sulcus tumor that involves C8 and T1-T2 nerve roots, causing shoulder pain radiating down the arm, usually a squamous cell cancer
|
Pancoast's tumor
|
|
|
What type of lung cancer...
Is usually central and shows up as a cavitation on CXR? |
Squamous cell carcinoma
|
|
|
What type of lung cancer...
Is often peripheral, less association with smoking, and can be a/w pulmonary scar/fibrosis? |
Adenocarcinoma
|
|
|
What type of lung cancer...
Is central, tends to narrow bronchi by extrinsic compression, and widespread mets are common (50-75% at presentation)? |
Small cell lung cancer
|
|
|
What are the most common sites for lungs to metastasize?
|
Brain, bone, adrenals, liver
|
|
|
Which lung disease presents with this paraneoplastic syndrome:
--SIADH |
SCLC (10% of them)
|
|
|
Which lung disease presents with this paraneoplastic syndrome:
--Ectopic ACTH secretion |
SCLC
|
|
|
Which lung disease presents with this paraneoplastic syndrome:
-PTH-like hormone secretion |
Squamous cell carcinoma
|
|
|
Which lung disease presents with this paraneoplastic syndrome:
hypertrophic pulmonary osteoarthropathy |
Adenocarcinoma and squamous cell carcinoma
|
|
|
Which lung disease presents with this paraneoplastic syndrome:
--Eaton-Lambert syndrome (similar to myasthenia gravis with proximal muscle weakeness/fatiguability, paresthesias, diminished DTRs) |
SCLC
|
|
|
What is the treatment for:
--NSCLC? --SCLC? |
NSCLC: surgery +/- RT
SCLC: chemo |
|
|
What is an effusion that is 2/2 either elevated capillary pressure in visceral or parenteral pleura, or decreased plasma oncotic pressure?
|
Transudative
|
|
|
What is an effusion that is caused by increased permeability of pleural surfaces or decreased lymphatic flow from pleural surface 2/2 damage to plerual membrans or vasculature?
|
Exudative
|
|
|
What is the criteria for an exudate?
|
1) Protein pleura:serum ratio >0.5
2) LDH pleura:serum ratio >0.6 3) LDH > 2/3 the upper limit of normal serum LDH (If not 1 of the following, it's transudate) |
|
|
What are some causes of a transudative effusion?
|
CHF, cirrhosis, PE, nephrotic syndrome, peritoneal dialysis, hypoalbuminemia, atelectasis
|
|
|
What are some causes of an exudative effusion?
|
Bacterial pna, TB, malignancy, mets, viral infection, PE, collagen vascular diseases
|
|
|
What are the signs/symptoms of a pleural effusion?
|
(Often asymptomatic)
DOE, peripheral edema, orthopnea, PND, dullness to percussion, decr breath sounds over effusion, decr tactile fremitus |
|
|
How much effusion must accumulate before you get blunting of costophrenic angles?
|
250 mL
|
|
|
What should you think of an effusion with:
-Elevated amylase |
Esophageal rupture, pancreatitis, malignancy
|
|
|
What should you think of an effusion with:
-Milky, opalescent fluid |
chylothorax
|
|
|
What should you think of an effusion with:
-frankly purulent fluid |
empyema
|
|
|
What should you think of an effusion with:
-bloody effusion |
malignancy
|
|
|
What should you think of an effusion with:
-lymphocytic exudative |
TB
|
|
|
What should you think of an effusion with:
-pH <7.2 |
parapneumonic effusion or empyema
|
|
|
What types of ILD's have granulomas?
|
Sarcoid, Histiocytosis X (Langerhans), Wegener's, Churg-Strauss
|
|
|
What skin and eye manifestations occur in sarcoid?
|
Skin: erythemia nodosum
Eyes: anterior uveitis |
|
|
What do you find typically on CXR for sarcoid?
|
Bilateral hilar adenopathy
|
|
|
What are some lab value changes typical in sarcoid?
|
Elevated ACE, hypercalciuria and hypercalcemia
|
|
|
How do you definitively diagnose sarcoid?
|
Transbronchial biopsy showing noncaseating granulomas in the context of clinical presentation
|
|
|
How do you treat sarcoid?
|
Systemic corticosteroids
|
|
|
What ILD...
-has chronic interstitial pna caused by anormal proliferation of histiocytes? ->90% smokers -systemic forms: Letterer-Siwe disease, Hand-Schuller-Christian dz -CXR - honeycomb, CT - cystic -Highly variable course-- give corticosteroids s.t., or transplant |
Histiocytosis X
|
|
|
What ILD...
-is a necrotizing granulomatous vasculitis -affect vessels of lungs/upper airway (upper/lower resp infections, pulm nodules), kidneys (glomerulonephritis) |
Wegener's granulomatosis
|
|
|
How do you diagnose Wegener's granulomatosis?
|
GS is tissue biopsy, but may also be + for c-ANCA (very high likelihood)
|
|
|
How do you treat Wegener's granulomatosis?
|
Immunosuppressive agents and glucocorticoids
|
|
|
What ILD...
-has granulomatous vasculitis ONLY IN PATIENTS WITH ASTHMA -presents with pulmonary infiltrates, rash, and eosinophilia -If systemic, may result in skin, muscle and nerve lesions |
Churg-Strauss syndrome
|
|
|
How do you diagnose Churg-Strauss syndrome?
|
Significant blood eosinophilia
p-ANCA |
|
|
How do you treat Churg-Strauss syndrome?
|
Systemic glucocorticoids
|
|
|
What ILD...
-has a predilection for lower lobes -presents >15-20 years after exposure -increased r/o bronchogenic carcinoma (smoking is synergistic) and malignant mesothelioma -CXR: hazy infiltrates with b/l linear opacities |
Asbestosis
|
|
|
How do you diagnose asbestosis?
|
Clinical findings and h/o exposure
|
|
|
How do you treat asbestosis?
|
No specific treatment available.
|
|
|
What ILD...
-has LOCALIZED and NODULAR peribronchial fibrosis, esp in upper lobes -can be acute or chronic -a/w an increased r/o TB -can occur from mining, stone cutting, and glass manufacturing -DOE is main symptom, also cough with sputum -pulmonary function abnormalities |
Silicosis
|
|
|
What pneumoconiosis presents on CXR with...
--Pleural plaques --Egg shell calcifications |
--Asbestosis
--Silicosis |
|
|
How do you treat silicosis?
|
Remove from exposure to silica
|
|
|
What ILD...
-has acute (diffuse) and chronic forms (granulomas, skin lesions, hypercalcemia) |
Berylliosis
|
|
|
How do you diagnose berylliosis?
|
Beryllium lymphocyte proliferate test
|
|
|
How do you treat berylliosis?
|
Glucocorticoid therapy (for both acute and chronic)
|
|
|
What ILD...
-has IgG and IgA to an inhaled antigen -acute (flu-like, CXR pulmonary infiltrates), chronic (insidious, difficult to diagnose) |
Hypersenstivitiy pneumonitis (extrinsic allergic alveolitis)
|
|
|
What are some examples of hypersensitivity pneumonitis?
|
Farmer's lung (moldy hay)
Bird-breeder's lung Air-conditioner's lung Bagassosis (moldy sugar cane) Mushroom worker's lung (compost) |
|
|
How do you treat hypersensitivity pneumonitis?
|
Removal of offending agent, +/- glucocorticoids
|
|
|
What ILD...
-presents with fever and peripheral eosinophilia -may be acute or chronic -CXR with pulmonary infiltrates |
Eosinophilic pneumonia
|
|
|
How do you treat Eosinophilic pneumonia?
|
glucocorticoids (but relapses may occur)
|
|
|
What ILD...
-Is an autoimmune dz caused by IgG Abs against glomerular and alveolar basement membranes (type II hypersensitivity rxn) -Presents with hemorrhagic pneumonitis and glomerulonephritis, hemoptysis, dypsnea, s.t. renal failure |
Goodpasture's syndrome
|
|
|
How do you diagnose Goodpasture's syndrome?
|
Tissue biopsy, serologic evidence of anti-GBM Abs
|
|
|
How do you treat Goodpasture's syndrome?
|
Poor prognosis... plasmapheresis, cyclophosphamide, corticosteroids
|
|
|
What ILD...
-Is a rare condition caused by accumulation of surfactant-like protein and phospholipids in the alveoli -Presents with dry cough, dyspnea, hypoxia, rales --CXR has ground glass appearance with b/l alveolar infiltrates that resemble a BAT SHAPE |
Pulmonary alveolar proteinosis
|
|
|
How do you diagnose Pulmonary alveolar proteinosis?
|
Lung biopsy
|
|
|
How do you treat pulmonary alveolar proteinosis?
|
Lung lavage mainstay, granulocyte-colong-stimulating factor is new
Don't give steroids (increased r/o infection already) |
|
|
What ILD...
-etiology unknown; is more common in men/smokers -presents with gradual onset of progressive dyspnea, nonproductive cough -mean survival 3-7 years after dx -CXR: ground glass or honeycombed appearance |
Idiopathic pulmonary fibrosis
|
|
|
How do you diagnose idiopathic pulmonary fibrosis?
|
CXR: ground glass or honeycombed appearance
Definitive - lung biopsy, may be nonspecific Exclusion of other ILDs |
|
|
How do you treat idiopathic pulmonary fibrosis?
|
Nothing efffective. >70% no improvement with therapy. Oxygen, steroids +/- cyclophosphamide and lung transplant may be beneficial.
|
|
|
What ILD...
-Is an inflammatory lung dz with similar clinical/radiographic features to infectious pna -a/w with many entities (viral, meds, CTDs) -Presents with cough, dyspnea, flu-like -CXR: b/l patchy infiltrates |
Cryptogenic organizing pneumonitis
|
|
|
How do you treat Cryptogenic organizing pneumonitis?
|
>60% recover with steroids
|
|
|
What ILD...
-Presents with a low-grade F, cough, chest fullness, dyspnea, pleuritic chest pain, hemoptysis, acute resp distress -CXR nl -CT diffuse infiltrates, ground glass density, patchy/homogenous consolidationg, pleural/pericardial effusions |
Radiation pneumonitis
|
|
|
When can radiation pneumonitis present?
|
Acute: 1-6 months after RT; Chronic: 1-2 years (alveolar thickening, pulm fibrosis)
|
|
|
How do you treat radiation pneumonitis?
|
Steroids
|
