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Lung Flashcards

1
Q

How are the lungs divided?

A

Right lung: 3 lobes, ten segments

Left lung: 2 lobes, 9 segments

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2
Q

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

A

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.

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3
Q

What is the arterial supply to the lung?

A 
pulmonary artery
bronchial arteries (come from Ao and intercostal vessels)
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4
Q

What are the kinds of benign tumors of the lung?

A 
First: these are very rare.
squamous papilloma (HPV 6,11)
angioma
fibroma
leiomyoma
chondroma
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5
Q

HPE of benign lung tumors

A 
recurrent pneumonia
cough
hemoptysis
decreased breath sounds on affected side
other sx from postobstructive pneumonia (pneumonia that's distal to the bronchial obstruction)
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6
Q

Dx Eval of benign tumor

A

CXR- shows mass

there is often postobstructive pneumonia if the lesion narrows the bronchial lumen

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7
Q

Rx for angiomas

A

they frequently regress, so just observe

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8
Q

Rx for benign tumors

A

Surgical removal- relieves sx and establishes dx.

Partial lung resection or sleeve resection w re-anastomosis of bronchus or trachea.

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9
Q

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

A

Squamous papillomatosis

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10
Q

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

A

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

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11
Q

What kind of tumors cause paraneoplastic syndrome?

A

Carcinoid tumors

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12
Q

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

A 
histamine
serotonin
VIP
gastrin
GH
insulin
glucagon
catecholamines
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13
Q

HPE for lung tumors w malignant potential

A

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

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14
Q

Dx Eval for tumors w malignant potential

A

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

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15
Q

Rx for tumors w malignant potential

A

Resect.

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16
Q

What is carcinoid syndrome?

A

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

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17
Q

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

A

True.

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

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18
Q

Carcinogens that can cause lung cancer

A 
Smoking
Asbestos
Formaldehyde
Radon gas
Arsenic
Uranium
Chromates
Nickel
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19
Q

How is lung ca classified

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

How is non-small cell lung ca classified?

A 
Non-small cell is 75-80% of all lung cancer.
It's divided into:
squamous cell carcinoma (30%)
adenocarcinoma (35%)
large cell carcinoma (10%)
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21
Q

Where is small cell cancer located?

A

Centrally.

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22
Q

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

A

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

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23
Q

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

A

Occurs centrally

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

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24
Q

Where does adenocarcinoma usu occur?

A

At the periphery

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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

Surgery (20 decks)

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