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Flashcards in Lung Deck (69):
1

How are the lungs divided?

Right lung: 3 lobes, ten segments
Left lung: 2 lobes, 9 segments

2

Aspiration of gastric contents or foreign bodies is more likely to affect which lung? Why?

RIght lung, especially superior segment or R lower lobe and posterior segment of R upper lobe. It's bc the R main bronchus doesn't curve as much as the L one.

3

What is the arterial supply to the lung?

pulmonary artery
bronchial arteries (come from Ao and intercostal vessels)

4

What are the kinds of benign tumors of the lung?

First: these are very rare.
squamous papilloma (HPV 6,11)
angioma
fibroma
leiomyoma
chondroma

5

HPE of benign lung tumors

recurrent pneumonia
cough
hemoptysis
decreased breath sounds on affected side
other sx from postobstructive pneumonia (pneumonia that's distal to the bronchial obstruction)

6

Dx Eval of benign tumor

CXR- shows mass
there is often postobstructive pneumonia if the lesion narrows the bronchial lumen

7

Rx for angiomas

they frequently regress, so just observe

8

Rx for benign tumors

Surgical removal- relieves sx and establishes dx.
Partial lung resection or sleeve resection w re-anastomosis of bronchus or trachea.

9

What kind of benign lung ca has a high recurrence rate?

Squamous papillomatosis

10

What kind of lung tumors are usu not malignant but have "malignant potential"?

bronchial carcinoids (10% malignant)
adenoid cystic carcinoma
mucoepidermoid tumors
these are all rare

11

What kind of tumors cause paraneoplastic syndrome?

Carcinoid tumors

12

What kind of substances do carcinoid tumors release (which can cause paraneoplastic syndrome)?

histamine
serotonin
VIP
gastrin
GH
insulin
glucagon
catecholamines

13

HPE for lung tumors w malignant potential

Cough, dyspnea, hemoptysis, recurrent pneumonia
Carcinoid syndrome (infrequent)
Respi compromise or decreased breath sounds
Carcinoid tumors- valvular heart dz w pulm stenosis, tricuspid regurg

14

Dx Eval for tumors w malignant potential

CXR- show lesion or post-obstructive pneumonia
Bronchoscopy for tsu dx and to see anatomy
CT is routine for pre-op planning

15

Rx for tumors w malignant potential

Resect.

16

What is carcinoid syndrome?

flushing, diarrhea, plus manifestations of specific hormone excess (dep on which hormone it is)

17

T/F more than 80% of lung cancers are smoking related

True.
Lung cancer is the leading cause of cancer death in the US.

18

Carcinogens that can cause lung cancer

Smoking
Asbestos
Formaldehyde
Radon gas
Arsenic
Uranium
Chromates
Nickel

19

How is lung ca classified

Small cell (20-25%)
Non-small cell (75-80%)

20

How is non-small cell lung ca classified?

Non-small cell is 75-80% of all lung cancer.
It's divided into:
squamous cell carcinoma (30%)
adenocarcinoma (35%)
large cell carcinoma (10%)

21

Where is small cell cancer located?

Centrally.

22

T/F small cell lung cancer can be a/w paraneoplastic syndromes

True
5% of pts have SIADH
3-5% have Cushing's (from too much ACTH)

23

Where does squamous cell cancer usu occur? What other sx is it a/w?

Occurs centrally
A.w sx of hypercalcemia, secondary to production of PTHrP

24

Where does adenocarcinoma usu occur?

At the periphery

25

What signals that the tumor is obstructing the airway?

worsening cough with increased sputum
hemoptysis

26

Persistent chest, back, shoulder pain in lung ca is related to...

nerve involvement or direct tumor invasion

27

What are the sx of lung cancer mets?

Bone pain, neurologic sx
fatigue, loss of appetite, weight loss.

28

HPE of lung cancer

Diminished breath sounds dt pneumonia or malignant pleural effusion
Supraclavicular lymphadenopathy
Hoarsenss- recurrent laryngeal nerve

29

Why can Horner's syndrom be present in lung ca?

Superior sulcus tumor causes neural compression --> ptosis, myosis, anhidrosis

30

What is pancoast syndrome?

shoulder and arm pain on side with lung ca

31

What is superior vena cava syndrome

obstruction of SVC by malignancy, eg compression of wall dt R upper lobe tumors

32

Paralysis of the diaphragm indicates tumor involvement of which nerve?

Phrenic

33

Dx Eval for lung cancer

CXR
CT of chest + liver and adrenals- to see tumor size, lymphadenopathy, pleural effusion, distant mets
Bone scan, brain imaging
PET for distant dz
Invasive testing usu reqd for definitive dx
Flexible bronchoscopy- tsu biopsy, bronchial washings
Transthroacic CT-guided FNbiopsy- tsu sampling
Mediastinoscopy w lymph node biopsy- for staging

34

What size are T1 lesions?

<3 cm

35

What are T2 lesions?

>3 cm
or involve main bronchus >2cm from carina
or involve visceral pleura

36

What are T3 lesions?

Invade:
chest wall
diaphragm
mediastinal pleura
pericardium
main bronchus w/in 2cm of carina

37

What are T4 lesions

Invade:
heart
great vessels
mediastinum
trachea
esophagus
vertebral bodies
carina
or have malignant effusions or satellite tumors

38

What are N1 lesions?

Pos nodes in ipsi peribronchial or hilar region

39

What are N2 lesions?

pos nodes in ipsi mediastinal or subcarinal region

40

N3 lesions?

mets either to contralateral nodes or ipsi scalene or supraclavicular regions

41

Stage IA, Stage IB

1A: T1, N0, M0
1B: T2, N0, M0

42

T/F M1 automatically means Stage IV

True. Can be any T, any N.

43

T/F Surgery is rarely indicated for small cell lung cancer

True, bc it's usu widely disseminated at the time of dx. Only very early stage are considered potentially resectable.

44

Rx for small cell lung ca

Chemo- usu combo of cisplatin and etoposide
And radiation

45

What is the Rx if pts respond well to therapy and have complete remission?

Prophylactic whole-brain radiation, to decrease chances of cerebral mets

46

Rx for non-small cell lung cancer

Early stages- surgery followed by chemo
most commonly lobectomy

47

T/F all patients who have completely resected lung ca should get chemo

True

48

Chemo regimen for pts with resected lung ca

a platinum agent (cisplatin or carboplatin)
a nonplatinum agent (etoposide, irinotecan, paclitaxel, gemcitabine)
+Radiation if mediastinal lymph nodes involved

49

Where is most mesothelioma found?

Visceral pleura

50

Risk factors for mesothelioma

Asbestos (esp +smoking)

51

HPE for mesothelioma

chest pain from local extension
dyspnea secondary to pleural effusion
weight loss
unexplained night sweats
decrsd breath sounds on side of tumor dt pleural effusion

52

Dx eval for mesothelioma

CXR- shows pleural effusion
Thoracocentesis- bloody fluid, cytology neg for malignancy
Thoracoscopy and pleural biopsy- do this if there is suggestive hx and recurent pleural effusion and no clear etiology (even if neg fluid cytology)

53

Rx for mesothelioma

Pgx is poor
Early stg lesions may be resectable but req induction chemo followed by extrapleural pneumonectomy
If non-op: chemo + rad

54

What is a simple pneumothorax?

Air enters the potential space bt the visceral and parietal pleura, so lung falls away from chest wall

55

What is an open pneumothorax?

Defect in chest wall allows continuous air entry from outside

56

What is tension pneumothorax?

Air enters the potential space but can't escape- one-way valve going inward.
Prs increases, forcibly collapsing the lung, compressing mediastinal structures

57

What pts get spontaneous pneumothorax?

young thin males
older pts w bullous emphysema
pts on mechanical ventiliation, esp if high prs
pts w infection or tumors
iatrogenic causes (thoracocentesis, needle biopsy, operative trauma)

58

What infections can cause pneumothorax?

TB or Pneumocystic carinii

59

HPE for pneumothorax

Can be asx
Dyspnea, chest pain
Decreased breath sounds
Hyper resonance on affected side
If tension pneumo- tachycardia, hypotension, hypoxia, tracheal deviation

60

Dx Eval for pneumothorax

upright CXR- no lung markings in affected area (usu apex). see visible line corresponding to visceral pleural surf of lung. if tracheal dev or mediastinal shift, it's tension pneumo

61

Rx for simple pneumothorax

if <20%, just observe as long as there is no size increase on serial CXR
otherwise, chest tube

62

Rx for open pneumothorax

repair of deficit and tube thoracostomy

63

Rx for tension pneumothorax

surgical emergency- immed needle thoracostomy in mid-clavicular line, 2nd IC space
Then tube thoracostomy after

64

What is an empyema?

Infection within the pleural space

65

What causes empyema?

pneumonia
lung abscess
post-op complication of thoracic surgery
esophageal perf

66

What organisms cause empyema?

Staph
Strep
Pseudomonas
Klebsiella
Ecoli
Proteus
Bacteroides

67

HPE for empyema

Hx of prev pneumonia, thoracic surg, esophageal instrumentation
Fatigue, lethargy, shaking chills
Systemic illness
Fever
Decreased breath sounds at affected lung's base

68

Dx eval of empyema

WBC elevated
CXR- pleural effusion
Throacocentesis- aspiration of the pleural fluid shows exudate, high WBCs w PMN predominant, low pH, low glucose, high LDH. May see bacteria on gram stain/culture

69

Rx for empyema

TUbe thoracostomy and abx
(rarely, needle aspiration and abx are enough)