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70 Cards in this Set
- Front
- Back
Most common pulmonary neoplasm
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mestastasis from breast
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most common primary pulmonary neoplasm
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carcinoma
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mortality rate of lung cancer
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52/100K?!
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Percent of heavy smokers that develop lung cancer
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10% [40 cigs/day]
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percent of pts with lung cancers with smoking history
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90%
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Some factors that correlate with lung cancer
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smoking, p53 mutation, radiation
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Clinical presentation of lung cancer:
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Cough
Weight loss Chest pain |
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The two major classes of carcinomas:
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small cell and non-small cell
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Types of non-small cell carcinomas:
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squamous, adenocarcinoma, bronchioalveolar carcinoma (to transition to adenocarc.), and large cell
SLAB |
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Which tpyes of lung cancer are found centrally?
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Scentrally
Squamous cell Small cell |
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Most common type of lung cancer and how it presents morphologically?
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adenocarcinoma, occurs peripherally around prior sites of injury
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What is lepidic?
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scale-like spread assocaited wit adenocarcinoma
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What genetic changes are associated with adenocarcinomas?
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gain of Ch5p
also mutations of HER2/KRAS/EGFR |
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Morphology of bronchioalveolar carcinomas
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peripheral, non-invasive, either mucinous or non-mucinous.
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Non vs mucinous bronchioalveolar carcinomas
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non - single, solitary;
mucinous - multiple nodules w pneumonia infiltrate |
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morphology of squamous cell carcinoma of lung?
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centrally located and larger, associated with necrosis and cavitation
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Genetic alterations associated with squamous cell carcinoma of lung?
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loss of 3p and 9p
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progression of squamous cell lung carcinoma:
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metaplsia, dysplasia, carcinoma in situ,, invasive carcinoma
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What is large cell carcinoma?
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heterogenous leftover classification, includes neuroendocrine carcinomas
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What are the types of neuroendocrine neoplasias of the lung?
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large cell NE, small cell and carcinoid
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Which neoplasia has the strongest association with smoking?
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small cell carcinomas
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Mutations in small cell carcinomas?
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p53, RB1,
overexpression of BCL2 and low expression of BAX |
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Where are carcinoid tumors found?
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centrally by corina or peripheral in nodules
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Typical vs atypical carcinoid tumors of lung?
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typical have less than 2 mitosis, no necrosis
atypical have 2-10 mitosis with necrosis |
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morphology of large cell neuroendocrine carcinoma
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like carcinoid but larger, more necrosis, and more mitoses
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Which two lung cancers have the poorest outcomes?
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small cell, also large cell neuroendocrine
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morphology of small cell carcinoma of lung
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centrally located, small cells, high mitosis
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Staging based upon what?
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Tumor (1-4), Nodes 0-3, metastasis 0 or 1
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Stace IV cancer
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means METASTASIS dun dun dun
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What do pancoast tumors cause?
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horner's syndrome (tumor of pulmonary apex)
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Most common paraneoplastic syndrome and what is it caused by?
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hyperCa, caused by calcemic humoral substance, not osteolysis
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paraneoplastic syndromes associated with small cell
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Cushing's, SIADH, Lambert Eaton
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Paraneoplastic syndromes associated iwth NSCLC
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carcinoid, dermatologic, osteoarticular like clubbing
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Who can and can't you use EGFR-TKI's?
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can: asian adenocarcinoma nonsmokers
can't - smokers with KRAS mutation |
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Radiation therapy used for:
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emergency situations and palliation for advanced local disease like SVC
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Factors that make metastasis to lung :)
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high CO, O2, molecular expression
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Which lung pleura has nerves?
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parietal
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What adheres the two pleura togethers?
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surface tension
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What is considered pleural effusion?
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>15ml of fluid
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Types of pleural effusion:
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transudate (increased hydrostatic P like in CHF)
exudate (>3 mg/dL protein and indicates vascular permability or decreased lymph drainage) |
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Pulmonary embolism causes which type of pleural effusion?
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mostly exudative b/c of imflammatory response
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Types of inflamammatory pleural effusions?
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THESE ARE ALL PLEURITIS
exudative: Serous/serofibrinous/fibrinous pleritis Suppurative (from infeciton like TB or pnemonia Hemorrhagic (blood from tumor) |
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Noninflammatory pleural effusions?
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hydrothorax (blood filtrate)
hemothorax (ruputred vessel) chylothorax (trauma, thoracic duct obstruction by tumor) |
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What is Meig's syndrome?
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Meg is irresponsible:
benign ovarian fibroma from sexing, ascites from drinking, and hydrothorax from smoking |
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Main clinical presentation of pleural effusion?
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PAIN
dyspnea hemoptysis cough |
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minimum fluid needed to cause effusion symptoms
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600 cc
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What neoplasm is also considered a disease of the pleural cavity?
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mesothelioma
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common cause of spontaneous pneumothorax
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subpleral bleb rupture
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What is seen in spontanous pneumothorax?
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tracheal deviation to side of collaps
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What is tension pneumothorax?
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increasing air incavity because of a flaplike defect; result of resucitation
compression of medistinal structures to contralateral side |
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What does benign mesothelioma usually attack?
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visceral pleura; no relation to asbestos!
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benign mesothelioma morphology?
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fibroblastic on visceral pleura, associated with hypoglycemia and pulmonary osteoarthropathy which regresses when tumor is resected.
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Smoking and malignant mesothelioma?
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no increased risk
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Presentation of malignent meso?
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chest pain, dyspnea, pleural effusions
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What does EM show in mesotheliomas?
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numerous long, slender microvilli (cs short plump microvilli in adenocarcinomas)
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Mesotheliomas stain positive for what?
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Cytokeratin, vimentin, calretinin, and negative for CEA
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What mechanisms may cause atelectasis?
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internal obstruction, external compression, or fibrosing contraction
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Obstructive vs compressive atelectasis?
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obstructive, mediastinum shifts TOWARD affected area;
compressive, the mediastinum shifts away from the tissue |
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Which atelectasis is irreversible?
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Contraction atelectasis because of fibrosing
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Example of thoracic space deformint that may be associated with hypoplastic lungs?
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congenital diaphragmatic hernia
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Most common TE fistula?
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blind upper and fistula between lower segment and trachea
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What are congenital lung cysts from?
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abnormal detach ment of developing foregut in hilum or middle mediastinum
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Most common lung cyst?
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bronchogenic cysts with bronchial epithelium and mucous glands
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Main complications of congeital cysts?
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infection (causing abcess) and rupture, causing hemoptysys or pneumothorax
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What are intralobar and extrapulmonary lobar sequestrations?
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pieces of lobe without airways; can be within the lung under pleura or extralobar like in thorax
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What problems may arise from lobar sequestrations?
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none really, just associated with recurrent infections
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SVC syndrome?
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compression of SVC causing facial swelling, dysphagia, perhaps intercrainal pressure; considered an oncologic emergency
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what is the distribution of mess lesions of the medastinum?
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most are benign (50%-70%, around 30-50% malignant, and around 10% are secondary to inflammatory process.)
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Acute mediastinitis?
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posterior mediastina cute inflammation due to edophageal perforation
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chronic mediastinitis?
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a chronic fibrosing condition which may stimulate tumor and produce SVC symptoms, obstructions, compression of trachea...
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