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98 Cards in this Set
- Front
- Back
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What is a solitary pulmonary nodule?
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-discrete opacity < 3cm in diameter
-completely surrounded by normal lung tissue -doesnt touch hilum or mediastinum -no associated adenopathy or atelectasis |
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What are the 5 causes of benign pulmonary nodules?
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granulomatous infection, hamartoma, lung abscess, inflammatory disorders, pulmonary arteriovenous malformations
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What are the 4 causes of malignant nodules?
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bronchogenic carcinoma, metastases, lymphoma, carcinoid
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What are the 6 risk factors for nodules?
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smoking history, secondhand smoke, age (50 or older), history of malignancy, history of TB or mycosis exposure, occupational exposure
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What are the symptoms of a pulmonary nodule?
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cough, hemoptysis, hoarseness, chest pain, weight loss, bone pain
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What symptoms might be found on physical exam?
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stridor, wheezing, clubbing, lymphadenopathy, hepatomegaly, bone pain
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What aspects of the nodule are xrays used to look at?
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size, margins, growth rate, calcifications
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What type of xrays are used to follow nodule growth over time?
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serial xrays
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What is the monitoring schedule for serial xrays?
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3 month intervals for first year
then 6 month intervals for next year then yearly for 5 years |
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What size nodule suggests malignancy?
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> 3 cm
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What type of nodule margins suggest malignancy?
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scalloped, speculated or corona radiate edges
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How long is doubling time of a nodule in infections like TB?
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< 1 month
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How long is doubling time of a benign nodule?
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> 18 months
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What 4 type of calcification suggests that a nodule is benign?
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diffuse, central, concentric, popcorn
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What type of benign nodule has popcorn calcification?
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hamartoma
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What type of nodule has eccentric calcification?
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active TB
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What imaging study is better at seeing small nodules and determining size and doubling rate?
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CT scan
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What test is good for evaluating potential malignancies or mediastinal metastases?
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PET scan
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What biopsy procedure is better for central lesions >2 cm?
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bronchoscopy
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What biopsy procedure is only used if lesion is > 2 cm, but risks causing pneumothorax?
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transthoracic needle aspiration
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What are the risk factors in lung cancer?
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cigarette smoking, 2nd hand smoke, environmental exposure, age > 65, family hx, preexisting lung diseases
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What is the most common occupational exposure causing nodules or lung cancer?
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asbestos
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Mutations in what oncogenes stimulate cell growth?
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RAS, MYC
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Mutations in what genes enhance growth factor signaling?
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EGFR, HER2/neu
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Mutations in what gene inhibits apoptosis?
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BCL-2
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Mutations of what genes inhibit tumor suppression?
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p53, APC
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What are 4 symptoms seen in local tumors in lung cancer?
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cough, dyspnea, localized chest pain, hemoptysis
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What symptoms are seen in regional lung cancer spread?
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pleuritic chest pain, hoarseness, dyspnea/hpoxia, upper extremity pain/weakness, dysphagia
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Ptosis, miosis, enophthalmos and anhidrosis are seen in what syndrome?
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Horners syndrome (tumor of superior sulcus)
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What blood levels would be elevated in bone metastases?
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alkaline phosphatase
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What new onset symptom in patients > 50 yo would suggest brain metastases?
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seizures
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Lymphadenopathy in what chains suggest cancer?
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supraclavicular nodes
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What syndrome causes bioactive substances to be released by a tumor or because of a tumors presence?
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paraneoplastic syndrome
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What are 4 paraneoplastic syndromes affecting the endocrine system?
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hypercalcemia (squamous cell cancer), hypophosphatemia, hyponatremia (SIADH), cushing syndrome
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What type of lung cancer is centrally located and is highly aggressive?
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small cell lung cancer
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What are the three types of non-small cell lung cancer?
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adenocarcinoma, squamous cell, large cell
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What is the most common type of lung cancer?
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adenocarcinoma
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Where is an adenocarcinoma usually located?
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peripheral
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Where is squamous cell lung cancer usually located?
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endobronchial region
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What 3 things are associated with squamous cell lung cancer?
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hemoptysis, postobstructive pneumonia, lobar collapse
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Which types of lung cancer metastasize early?
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small cell, adenocarcinoma, large cell
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What biopsy method is indicated for central tumors and hemoptysis?
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sputum cytology
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What biopsy method is indicated for pleural effusions?
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thoracentesis
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What is the gold standard for evaluating mediastinal lymph nodes?
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mediastinoscopy
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What biopsy methods can be diagnostic and therapeutic for peripheral tumors?
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thoracotomy or thoracoscopic surgery
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What staging system is used for non-small cell lung cancer?
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tumor size, lymph node location, prescense or absence of distant metastases
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When cancer cells are identified on sputum cytology but the tumor cant be found, the lung cancer is in what stage?
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occult stage
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Patients with a FEV1 of what can tolerate pneumonectomy?
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> 2L
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What treatment is used for limited small cell lung cancer?
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chemo and radiotherapy
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What treatment is used for extensive small cell lung cancer?
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chemo, cranial radiation for micrometastases
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What is the treatment for stage I, II and III non-small cell lung cancer?
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lobectomy or pneumoectomy resection, mediastinal lymph node biopsy
chemotherapy |
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What is the treatment for unresectable stage III non-small cell lung cancer?
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chemo and radiation therapy, surgery for metastases
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Which pleura of the lungs is innervated and causes pain in effusion?
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parietal pleura
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What are the 5 causes of increased pleural fluid formation?
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increased hydrostatic pressure, decreased osmotic pressure, increased capillary permeability, fluid gets through diaphragm, decreased pleural space pressures
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What are the 2 causes of decreased pleural fluid absorption?
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lymphatic obstruction, increase systemic venous pressure
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What pleural effusion of lymphatic fluid + lipids/proteins, is seen in lymphoma?
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chylous pleural effusion
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What are the symptoms of pleural effusion?
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pleuritic chest pain, dry cough, dyspnea
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What is seen on physical exam in pleural effusion?
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reduced tactile fremitus, dullness to percussion, diminished breath sounds
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A pleural effusion is visible on xray when it is how much fluid?
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50 ml
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A pleural effusion will obscure the hemidiaphragm on xray when it is how much fluid?
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500 ml
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Which pleural effusion is protein rich and signifies underlying pulmonary disease?
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exudates
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What are Light’s criteria for exudate?
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pleural fluid protein / serum protein ratio = > 0.5
pleural fluid LDH / serum LDH ratio = > 0.6 pleural fluid LDH > 2/3 upper limit of normal serum LDH |
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Low pleural fluid glucose is seen in what conditions?
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rheumatoid arthritis, TB, empyema, tumors involving pleura
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A pleural fluid pH of < 7.3 indicates what?
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inflammatory or infiltrative process
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What procedure is used if a complication effusion from pneumonia exists, or to relieve dyspnea?
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thoracentesis
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What treatment for pleural effusion produces chemical serositis and fibrosis?
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doxycycline sclerosis
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A hematocrit of pleural fluid greater than 50% the hematocrit of peripheral blood defines what?
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hemothorax
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What is the treatment for hemothorax?
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immediate chest tube thoracostomy
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What type of spontaneous pneumothorax has an underlying lung disease?
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secondary
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What are 2 causes of primary spontaneous pneumothorax?
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ruptured bleb, marfans syndrome
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What are 2 causes of secondary spontaneous pneumothorax?
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COPD, infection (pneumocystis carinii)
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What type of pneumothorax gets worse with each breath and can shift midline chest structures?
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tension pneumothorax
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What type of pneumothorax is caused by perforation of the visceral pleura while the chest wall is intact?
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closed pneumothorax
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Sharp trauma through the chest wall could cause what type of pneumothorax
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open pneumothorax
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What are findings of pneumothorax on physical exam?
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tracheal deviation, focal hyperresonance, absent breath sounds, decreased tactile fremitus
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What finding on a supine chest xray indicates pneumothorax?
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deep sulcus sign
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Patients with a large primary spontaneous pneumothorax are treated how?
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hospitalization and placement of chest tube
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70% of patients with pulmonary embolisms will have what?
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DVT
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What is Virchow’s triad in PE patients?
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venous stasis, vessel wall injury, hypercoagulability
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-What medications cause hypercoagulability?
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oral contraceptives, hormone replacement therapy
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Resistance to what 3 anticoagulants cause hypercoagulability?
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protein C (factor V leiden), protein S, antithrombin III
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What are symptoms of PE?
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dyspnea, pain on inspiration, tachypnea, cough, leg pain, hemoptysis, palpitations, wheezing, anginal pain
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What sounds on physical exam are appreciated in PE?
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crackles, pleural friction rub, 3rd heart sound, 4th heart sound
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What positive physical exam test with calf pain often indicates a DVT?
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Homans sign
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What are common EKG findings in PE?
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sinus tachycardia, nonspecific ST-T changes, S1Q3T3
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What condition is likely in a patient with profound hypoxia, normal chest xray, and no previous lung disease?
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PE
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What product of fibrin degradation is elevated when there is a thrombus?
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D-dimer > 500
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What rare sign on xray in PE pts is from the dilation of the pulmonary artery?
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Westermarks sign
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What rare sign on xray in PE pts is infiltrate with its apex toward the hilum?
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Hamptons hump
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What study using radioactive inhaled gas and radioactive injected albumin?
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V/Q scan
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What test in symptomatic pts is diagnostic for DVT?
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venous ultrasound
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What test is the reference standard for diagnosis of PE?
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pulmonary angiography
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What medications are given to stop thrombus from getting bigger?
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heparin, Lovenox
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What side effect of heparin therapy is not caused by Lovenox?
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heparin induced thrombocytopenia
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Coumadin therapy is needed for how long after a PE?
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at least 3 months
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What medications are used for thrombolytic treatment?
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streptokinase, urokinase, tissue plasminogen activator
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What are absolute contraindications to thrombolysis tx?
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active internal hemorrhage, stroke in past 2 mo, uncontrolled HTN, surgery or trauma in past 6 wks
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When would a inferior vena cava filter be placed in pts?
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high risk for DVT/PE but cant use anticoagulation therapy
recurrent embolism even when on anticoagulation |
