TEST 5 Flashcards by Asnathe .

Chapter 21: Pulmonary Vascular Disease
Explain the difference between a thrombus and embolus.

A clot that forms and remains in a vein is called a thrombus.
A blood clot that becomes dislodged and travels in another part of the body is called an embolus (embolism).

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Chapter 21: Pulmonary Vascular Disease
What are the major pathologic or structural changes of the lungs and heart associated with pulmonary embolism? (6)

Pulmonary hypertension
Right-heart failure (Cor pulmonale)
Pulmonary infarction (when severe)
Alveolar atelectasis
Alveolar consolidation
Bronchial smooth muscle constriction (bronchospasm)

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Chapter 27: Interstitial Lung Diseases
Goodpasture syndrome is a disease of unknown cause that involves what two organs?

Lungs
Kidneys

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Chapter 27: Interstitial Lung Diseases
A condition of unknown cause in which the alveoli become filled with protein and lipids.

Pulmonary Alveolar Proteinosis

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Chapter 27: Interstitial Lung Diseases
________________ is an intersitial lung disease more commonly seen in African-Americans.

Sarcoidosis

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Chapter 27: Interstitial Lung Diseases
What is characterized by infiltration of eosinophils, and, to a lesser extent, macrophages into the alveolar and interstitial spaces?

Chronic Eosinophilic Pneumonia

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Chapter 27: Interstitial Lung Diseases
More than ______ disease entities are characterized by acute, subacute, or chronic inflammatory infiltration of alveolar walls by cells, fluid and connective tissue.

180

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Chapter 27: Interstitial Lung Diseases
If left untreated, the inflammatory process of ILDs can progress to _________________.

Irreversible pulmonary fibrosis

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Chapter 27: Interstitial Lung Diseases
The anatomic alteration of ILD may involve _______________.

Bronchi
Alveolar walls
Adjacent alveolar spaces

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Chapter 27: Interstitial Lung Diseases
What are the major pathologic or structural changes associated with chronic ILDs? (7)

Destruction of the alveoli and adjacent pulmonary capillaries
Fibrotic thickening of the respiratory bronchioles, alveolar ducts and alveoli
Granulomas
Honeycombing and cavity formation
Fibrocalcific pleural plaques (Abestosis specifically)
Bronchospasm
Excessive bronchial secretions (caused by inflammation of airways)

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Chapter 27: Interstitial Lung Diseases
Sjogren syndrome is lymphocytic infiltration that primarily involves ____________ and _____________ glands.

Salivary glands (mouth)
Lacrimal glands (eyes)

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Chapter 27: Interstitial Lung Diseases
What is the most common pulmonary complication associated with rheumatoid arthritis?

Pluerisy with or without effusion
The effusion is generally unilateral (right side)
Men develop pleural complications more often than women.

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Chapter 27: Interstitial Lung Diseases
Where is scleroderma most commonly seen?

Women ages 30-50.

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Chapter 27: Interstitial Lung Diseases
One of the clinical hallmarks of sarcoidosis is an increase in what three immunoglobulins?

IgM, IgG, IgA

Also an elevation of the angiotensin converting enzyme (ACE test).
(G.A.M)

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Chapter 27: Interstitial Lung Diseases
Polymyositis-dermatomyositis is more often in women than men, at about a ________ ratio.

2:1

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Chapter 27: Interstitial Lung Diseases
With appropriate treatment, the 5-year survival rate of good pasture syndrome is ______%

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Chapter 26: Cancer of the Lung
Define neoplasm.

The abnormal growth of new cells.
Also called tumor.

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Chapter 26: Cancer of the Lung
A tumor that originates in the bronchial mucosa is called ______________.

Bronchogenic carcinoma

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Chapter 26: Cancer of the Lung
Lung cancer is the __________ most common cause of cancer in both men and women.

Second

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Chapter 26: Cancer of the Lung
What is the second leading cause of lung cancer in this country according to EPA?

Radon exposure

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Chapter 26: Cancer of the Lung
What is the most common cause of lung cancer?

Cancer sticks - Cigarette smoking

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Chapter 26: Cancer of the Lung
Small (oat) cell cancer accounts for about ______% of all bronchogenic carcinomas.

10-15

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Chapter 21: Pulmonary Vascular Disease
Although there are many possible sources of pulmonary emboli, what is the most common by far?

Blood clots

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Chapter 21: Pulmonary Vascular Disease
What are the three primary factors associated with the formation of DVT?

Venous stasis
Hypercoagulability
Injury to the epithelial cells that line the vessels

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**Chapter 21: Pulmonary Vascular Disease** Define pulmonary hypertension.

An increase in mean pulmonary artery pressure greater than 25 mm Hg at rest.

**Chapter 21: Pulmonary Vascular Disease** Explain what a saddle embolus is.

When a large embolus detaches from a thrombus and passes through the right side of the heart, it may lodge in the burification of the pulmonary artery.

**Chapter 21: Pulmonary Vascular Disease** D-dimer values greater than ___________ are considered positive.

500 ng/mL

**Chapter 21: Pulmonary Vascular Disease** In some cases, when an embolus disrupts pulmonary arterial blood flow, what may develop?

Pulmonary infarction, that may cause alveolar atelectasis, consolidation and tissue necrosis In addition, the embolus is thought to activate the release of humoral agents such as serotonin, histamine, and prostaglandins into the pulmonary circulation, causing bronchial constriction.

**Chapter 21: Pulmonary Vascular Disease** Bronchial smooth muscle _______________ occasionally accompanies pulmonary embolism.

Constriction

**Chapter 21: Pulmonary Vascular Disease** It is believed that embolisms cause the release of cellular mediators such as _serotonin, histamine, and prostaglandins from platelets_ which in turn leads to what?

Bronchoconstriction

**Chapter 21: Pulmonary Vascular Disease** An embolus may occur originate from where?

- One large thrombus - Occur as a shower of small thrombi and may or may not interfere with the right ventricle's ability to perfuse the lungs adequately.

**Chapter 21: Pulmonary Vascular Disease** Why is a saddle thrombus most often fatal?

It blocks the pulmonary blood from returning to the left ventricle and being pumped out to the systemic circulation.

**Chapter 21: Pulmonary Vascular Disease** ______________ and _______________ are often clinically insidious disorders.

- Deep Vein Thrombosis - Pulmonary Embolism

**Chapter 21: Pulmonary Vascular Disease** By contrast, sudden death is often the first symptom in about ______% of people who have a large pulmonary embolus.

**Chapter 21: Pulmonary Vascular Disease** What is one of the most common causes of sudden and unexpected death in all age groups?

**Chapter 21: Pulmonary Vascular Disease** Because of the subtle and misleading clinical manifestations associated with a PE, the possibility of a blood clot lodged in the lung is often not considered until autopsy in about ________% of cases.

70-80%

**Chapter 21: Pulmonary Vascular Disease** In the US, how many individuals die each year from a pulmonary embolism?

100,000

**Chapter 21: Pulmonary Vascular Disease** Pulmonary embolism is slightly more frequent in which gender?

More frequent with males than females. Incidence increases with age.

**Chapter 21: Pulmonary Vascular Disease** When does the health care practitioner actively work to confirm the diagnosis of a pulmonary embolism?

As soon as the suspicion arises

**Chapter 21: Pulmonary Vascular Disease** Where does most pulmonary blood clots originate?

They originate or break away from sites of DVT in the lower part of the body. (E.g, leg, and pelvic veins and inferior vena cava)

**Chapter 21: Pulmonary Vascular Disease** Explain what happens when a thrombus or piece of a thrombus breaks loose in a deep vein.

The blood clot (now called an embolus) is carried through the venous system to the right atrium and ventricle of the ❤️ and lodges in the pulmonary arteries or arterioles.

**Chapter 21: Pulmonary Vascular Disease** List a few risk factors associated with pulmonary embolism.

**Venous Stasis** - Inactivity - Prolonged bed rest - Prolonged sitting - CHF - Varicose veins - Thrombophlebitis **Surgical Procedures** - Hip surgery - Pelvic surgery - Knee surgery - Certain obstetric or gynecologic procedures **Trauma** - Bone fractures - Extensive injury to soft tissue - Postoperative or postpartum states

**Chapter 21: Pulmonary Vascular Disease** What are D-dimer tests for?

Used to check for an increased level of protein fibrinogen.

**Chapter 21: Pulmonary Vascular Disease** When are the results for a D-dimer usually available?

1 hr

**Chapter 21: Pulmonary Vascular Disease** What should be emphasized about D-dimer tests?

Many conditions can increase a patient's D-dimer level, including recent surgery so this test is usually used to supplement other clinical information.

**Chapter 21: Pulmonary Vascular Disease** How long does an ultrasonography take to perform?

30 mins. or less

**Chapter 21: Pulmonary Vascular Disease** Where is ultrasonography most accurate for the diagnosis of blood clots?

Behind the knee or thigh

**Chapter 21: Pulmonary Vascular Disease** List some signs and symptoms commonly associated with PE. (13)

- Sudden SOB - Cardiac arrhythmias - Weak pulse - Lightheadedness or fainting - Anxiety - Excessive sweating - Cyanosis - Cool or clammy skin to the touch - Cough - Blood-streaked sputum - Wheezing - Leg swelling - Chest pain that resembles a heart attack

**Chapter 21: Pulmonary Vascular Disease** Where is ultrasonography insensitive in detecting DVT?

**Below** the knee

**Chapter 21: Pulmonary Vascular Disease** Although the CXR result for PE is often normal in the patient, it can be used to rule out conditions that mimic a PE, such as what?

- Pneumonia - Pneumothorax

**Chapter 21: Pulmonary Vascular Disease** Infiltrates and atelectasis will be seen in about _______% of pulmonary embolism/infarction cases.

**Chapter 21: Pulmonary Vascular Disease** An elevated hemidiaphragm will be seen in about _______% of pulmonary embolism/infarction cases.

**Chapter 21: Pulmonary Vascular Disease** What is becoming the first-line test for diagnosing suspected pulmonary embolism?

Computed Tomography Pulmonary Angiogram - CTPA

**Chapter 21: Pulmonary Vascular Disease** ______________ provides a clear image of the blood flow the lungs' arteries.

Pulmonary angiogram It's invasive and time consuming (1 hr). It's only performed when other test failed to provide accurate diagnosis.

**Chapter 21: Pulmonary Vascular Disease** What may be used for patients with suspected PE, but their kidneys may be harmed by dyes used in X-ray tests and for women who are pregnant?

MRI

**Chapter 21: Pulmonary Vascular Disease** On admission to the hospital for a PE, immediate transfer to an intensive care unit is mandatory.

Just something to know.

**Chapter 21: Pulmonary Vascular Disease** Explain the use of fast acting coagulants.

Used to prevent existing blood clots from growing and prevent the formation of new ones.

**Chapter 21: Pulmonary Vascular Disease** List some low molecular weight heparins.

- Enoxaparin - Dalteparin - Tinzaparin

**Chapter 21: Pulmonary Vascular Disease** Heparin and warfarin are given together for how many days?

5-7 days, until blood tests show that the warfarin is preventing blood clotting. Then its discontinued.

**Chapter 21: Pulmonary Vascular Disease** What type of anticoagulant is warfarin?

Slow-acting, oral anticoagulant

**Chapter 21: Pulmonary Vascular Disease** Brand name for warfarin.

Coumadin, Panwarfarin

**Chapter 21: Pulmonary Vascular Disease** What are some thrombolytic agents?

- Streptokinase (Streptase) - Urokinase (Abbokinase) - Altepase (Activase) - Reteplase (Retavase)

**Chapter 21: Pulmonary Vascular Disease** What are some preventative measures for developing thrombo-embolic disease?

- Walking - Exercise while seated - Drink fluids - Wear graduated compression stockings

**Chapter 21: Pulmonary Vascular Disease** What are the chest assessment findings of a PE? (3)

- Crackles - Wheezing - Pleural friction rub (when the pulmonary infarction involves th pleura)

**Chapter 21: Pulmonary Vascular Disease** Normally, the pulmonary artery pressure is no greater than _______.

25/10 mm Hg

**Chapter 21: Pulmonary Vascular Disease** What are the radiologic findings of a PE?

- Increased density - Dilation of the pulmonary arteries - Pulmonary edema - Pleural effusion (usually small) - Cor pulmonale - Hyperradiolucency distal to the embolus

**Chapter 21: Pulmonary Vascular Disease** Explain what a inferior vena cava vein filter does.

Placed in the IVC to prevent clots from being carried into the pulmonary circulation.

**Chapter 21: Pulmonary Vascular Disease** Pulmonary hypertension is more often among _______ at a ratio of 3:1.

WOMEN

**Chapter 26: Cancer of the Lung** Cancer is a general term that refers to abnormal new tissue growth characterized by __________.

progressive, uncontrolled multiplication of cells

**Chapter 26: Cancer of the Lung** This type of tumor does not endanger life unless they interfere with the normal function of other organs or affect a vital organ.

Benign tumors

**Chapter 26: Cancer of the Lung** What are the major pathologic or structural changes associated with bronchogenic carcinoma? (8)

- Inflammation, swelling and destruction of the bronchial airways and alveoli - Excessive mucous production - Tracheobronchial mucus accumulation and plugging - Airway obstruction - Atelectasis - Alveolar consolidation - Cavity formation - Pleural effusion

**Chapter 21: Pulmonary Vascular Disease** What are some sources of pulmonary emboli's?

- Fat - Air - Amniotic fluid - Bone marrow - Tumor fragments

**Chapter 21: Pulmonary Vascular Disease** The diagnosis of a pulmonary embolism is primarily based on what?

Clinical manifestations that support the possibility of a PE

**Chapter 21: Pulmonary Vascular Disease** An ultrasonography test uses high-frequency sound waves to detect blood clots in the __________.

Thigh veins

**Chapter 21: Pulmonary Vascular Disease** What may be used to differentiate among blood (usual), thromboemboli, and tumor emboli in patients with malignancy?

Magnetic Resonance Angiography

**Chapter 21: Pulmonary Vascular Disease** Is heparin fast or slow-acting?

Fast

**Chapter 21: Pulmonary Vascular Disease** How is heparin administered?

Intravenously to achieve rapid effect.

**Chapter 21: Pulmonary Vascular Disease** Why must unfractioned heparin dosing be governed by frequent monitoring of APPT (activated partial thromboplastin time)?

Bleeding from unfractioned heparin can develop.

**Chapter 21: Pulmonary Vascular Disease** How long anticoagulants are given varies on what?

Patient's condition. If PE is caused by a temporary risk factor like surgery, treatment is given for 2-3 months. If the cause is from long-term conditions like prolonged bed rest, its usually given for 3-6 months.

**Chapter 21: Pulmonary Vascular Disease** Explain what thrombolytic agents do.

Dissolve blood clots

**Chapter 21: Pulmonary Vascular Disease** What are some drugs that alter blood's ability to clot?

- Over the counter acetaminophens - Ibuprofens - Herbal preparations - Dietary supplements - Foods that are high in Vitamin K (Broccoli, spinach, leafy greens, liver, grapefruit juice, green tea)

**Chapter 21: Pulmonary Vascular Disease** Describe the physical examination of a patient with a pulmonary embolism.

- Increased RR, HR - Systemic hypotension - Cyanosis - Cough and hemoptysis - Peripheral edema and venous distention - Chest pain and decreased chest expansion - Abnormal heart sounds

**Chapter 21: Pulmonary Vascular Disease** How does PE increase physiologic dead space?

When an embolus lodges in the pulmonary vascular system, blood flow is reduced or completely absent distal to the obstruction, so alveolar ventilation beyond the obstruction is wasted, dead space and no carbon dioxide-oxygen exchange occurs.

**Chapter 21: Pulmonary Vascular Disease** Is ventilation-perfusion ratio distal to a pulmonary embolus high or low?

High

**Chapter 21: Pulmonary Vascular Disease** What is normal mean pulmonary artery pressure?

About 15 mm Hg

**Chapter 21: Pulmonary Vascular Disease** A.) Most patients with a pulmonary embolism have a mean pulmonary artery pressure greater than ____. B.) What contributes to this?

A.) 20 mm Hg B.) - Decreased cross-sectional area of the pulmonary vascular system bc of the embolism - Vasconstriction induced by humoral agents - Vasconstriction induced by alveolar hypoxia

**Chapter 21: Pulmonary Vascular Disease** List some test used to diagnose pulmonary hypertension.

- Echocardiography - CXR - Electrocardiogram - Chest MRI - PFTs - V/Q scan - Right heart catheterization

**Chapter 21: Pulmonary Vascular Disease** Is the right-sided or left-sided heart failure more commonly the cause of pulmonary hypertension?

Left (CHF)

**Chapter 21: Pulmonary Vascular Disease** What are some treatment routes for pulmonary hypertension?

- Diuretics: Decrease fluid build up - Inhaled nitric oxide - Blood-thinning medications: Prevent clots - Cardiac glycosides: Help heart pump stronger

**Chapter 27: Interstitial Lung Diseases** Interstitial lung disease is also called ___________.

- Pulmonary fibrosis - Diffuse ILD - Fibrotic ILD

**Chapter 27: Interstitial Lung Diseases** In severe cases, the extensive inflammation associated with ILD leads to what?

- Pulmonary fibrosis - Granulomas - Honeycombing - Cavitation

**Chapter 21: Pulmonary Vascular Disease** List some common signs and symptoms of pulmonary hypertension.

- Dyspnea - Lightheadedness - Fatigue - NPC - Hemoptysis - Hoarseness - Fainting and syncope - Chest pain and decreased chest expansion - Racing heartbeat - Pain on the upper right side of the abdomen - Decreased appetite - Cyanosis - Raynaud's phenomenon - Fluid in the abdomen

**Chapter 27: Interstitial Lung Diseases** During the acute stage of any ILD, the general inflammatory condition is characterized by what?

Edema and the infiltration of a variety of WBCs in the alveolar walls and interstitial spaces

**Chapter 27: Interstitial Lung Diseases** During the chronic stage of any ILD, the general inflammatory response is characterized by what?

Infiltration of large numbers of various WBCs and some fibroblasts may be present in the alveolar walls and interstitial spaces.

**Chapter 26: Cancer of the Lung** Where is squamous cell (epidermoid) carcinoma commonly located?

Near a central bronchus or hilus and projects into the large bronchi.

**Chapter 26: Cancer of the Lung** Which cancer type arises from the mucous glands of the tracheobronchial tree?

Adenocarcinoma (previously called bronchioalveolar carcinoma)

**Chapter 26: Cancer of the Lung** Which lung cancer type has the weakest correlation with smoking?

Adenocarcinoma

**Chapter 26: Cancer of the Lung** Lung cancer can be divided into what two major categories?

- Non-small cell lung cancer - Small cell lung cancer

**Chapter 26: Cancer of the Lung** Which of the following spreads aggressively and responds best to chemotherapy and radiation? A. Small cell lung cancer B. Non-small cell lung cancer

A. Small cell lung cancer

**Chapter 26: Cancer of the Lung** SCLC accounts for _______ of all lung cancers in the US.

15-20%

**Chapter 26: Cancer of the Lung** NSCLC accounts for ________ of all lung cancers in the US.

75-85%

**Chapter 26: Cancer of the Lung** What are the subtypes of NSCLC?

- Squamous cell carinoma - Adenocarcinoma - Large cell carcinoma

**Chapter 26: Cancer of the Lung** Black men are ____% more likely to develop lung cancer than white men.

**Chapter 26: Cancer of the Lung** The average age at the time of diagnosis is about _________.

70 years old

**Chapter 26: Cancer of the Lung** About ___________ diagnosed with lung cancer are 65 years or older.

2 in 3

**Chapter 26: Cancer of the Lung** Malignant tumors are composed of what?

Embryonic, primitive or poorly differentiated cells.

**Chapter 26: Cancer of the Lung** Although malignant changes may develop in any portion of the lung, where do they most commonly originate?

Epithelium of the tracheobronchial tree

**Chapter 26: Cancer of the Lung** About ____% of all new cancers are lung cancer.

**Chapter 26: Cancer of the Lung** Lung cancer is the leading cause of cancer deaths, accounting for about ___ in _____ deaths.

1 in 4

**Chapter 26: Cancer of the Lung** Heavy smokers are _____ times for likely to develop lung cancer.

**Chapter 26: Cancer of the Lung** According to the ACS, what percent of lung cancer is thought to be caused by smoking?

80%

**Chapter 26: Cancer of the Lung** According to the ACS, secondhand smoke is thought to cause more than _____ deaths from lung cancer each year.

7,000

**Chapter 26: Cancer of the Lung** A naturally occurring radioactive drug that is produced from the breakdown of uranium in the soil and rocks.

Radon

**Chapter 26: Cancer of the Lung** SCLC category is composed of what?

- Small cell carcinoma (oat cell) - Combined cell carcinoma - Mixture of NSCLC and SCLC

**Chapter 26: Cancer of the Lung** When confined to a small area and diagnosed early, which lung cancer type can be removed surgically?

NSCLC

**Chapter 26: Cancer of the Lung** Squamous cell (epidermoid) carcinoma constitutes about ______% of the bronchogenic carcinomas.

25-30%

**Chapter 26: Cancer of the Lung** Which tumor type originates from the basal cells of the bronchial epithelium and grows through the epithelium before invading surrounding tissues?

Squamous cell (epidermoid) carcinoma

**Chapter 26: Cancer of the Lung** Does squamous cell carcinoma grow fast or slow?

Slow with a late metastatic tendency (mostly in hilar lymph nodes)

**Chapter 26: Cancer of the Lung** In one-third of cases, squamous cell carcinoma originates where?

Periphery of the lungs

**Chapter 26: Cancer of the Lung** What are common findings of squamous cell carcinoma?

Cavitation and necrosis within the cancer

**Chapter 26: Cancer of the Lung** How does chemotherapy respond to squamous cell carcinoma?

Limited effectiveness

**Chapter 26: Cancer of the Lung** What are often secondary complications of squamous cell carcinoma?

Pneumonia and atelectasis

**Chapter 26: Cancer of the Lung** Adenocarcinoma accounts for about _____% of all bronchogenic carcinomas.

**Chapter 26: Cancer of the Lung** Where is adenocarcinoma tumors most commonly found?

Peripheral regions of the lung parenchyma They're usually smaller than 4 cm

**Chapter 26: Cancer of the Lung** Adenocarcinoma typically arise from the _______________.

Terminal bronchioles and alveoli

**Chapter 26: Cancer of the Lung** What are secondary complications of adenocarcinoma?

Cavity formation and pleural effusion

**Chapter 26: Cancer of the Lung** What is the growth rate of adenocarcinoma?

Moderate and the metastatic tendency is early.

**Chapter 26: Cancer of the Lung** Large cell carcinoma (undifferentiated) accounts for ________ of all bronchogenic carcinomas.

10-15%

**Chapter 26: Cancer of the Lung** What are common secondary complications of large cell carcinoma?

Chest wall pain, pleural effusion, pneumonia, hemoptysis and cavity formation

**Chapter 26: Cancer of the Lung** What is the growth rate of large cell carcinoma?

Rapid growth rate and early and widespread metastasis

**Chapter 26: Cancer of the Lung** Where does large cell carcinoma arise?

Peripherally, may also be found centrally and often distort the trachea and large airways

**Chapter 26: Cancer of the Lung** Small cell (oat cell) carcinoma accounts for about ____% of all bronchogenic carcinoma.

10-15%

**Chapter 26: Cancer of the Lung** Where does small cell (oat cell) carcinoma arise?

Centrally near the hilar region. They tend to arise in the larger airways (primary and secondary bronchi)

**Chapter 26: Cancer of the Lung** What is the cell size range of small cell (oat cell) carcinoma?

6 to 8 um.

**Chapter 26: Cancer of the Lung** Which lung cancer subtype has the poorest prognosis?

Small cell (oat cell) lung cancer

**Chapter 26: Cancer of the Lung** What is the average survival time for untreated small cell carcinoma?

About 1 to 3 months

**Chapter 26: Cancer of the Lung** Which cancer type has the strongest association with cigarette smoking and is associated with the worst prognosis?

Small cell (oat cell) carcinoma

**Chapter 26: Cancer of the Lung** About ____% of patients respond to treatment for small cell lung cancer but nearly all relapse within 24 months.

**Chapter 26: Cancer of the Lung** Lung carcinoid tumors are made up of special cells types called what?

Neuroendocrine cells

**Chapter 26: Cancer of the Lung** Lung carcinoid tumors grow **fast or slow?**

Slow

**Chapter 26: Cancer of the Lung** Lung carcinoids account for about _____% of all lung cancers.

1-2

**Chapter 26: Cancer of the Lung** Where do most carcinoid tumors originate?

Digestive tract

**Chapter 26: Cancer of the Lung** Only about ____% of carcinoid tumors start in the lungs.

**Chapter 26: Cancer of the Lung** What are the four types of neuroendocrine lung tumors?

- Small cell lung cancer: Fastest growing and spreading of all cancers - Large cell neuroendocrine carcinoma: A rare cancer and subtype of NSCLC. - Typical carcinoids: Tend to grow slow and rarely spread beyond the lungs. About 90% of lung carcinoids are typical carcinoids. - Atypical carcinoids: Grow a little faster and are likely to spread outside of the lungs

**Chapter 26: Cancer of the Lung** Where are central carcinoids found?

The walls of large bronchi near the center of the lungs Majority of lung carcinoid tumors are central or typical.

**Chapter 26: Cancer of the Lung** Where are peripheral carcinoids found?

Smaller bronchioles toward the periphery of the lungs.

**Chapter 26: Cancer of the Lung** What are some symptoms associated with lung cancer?

- Progressively worsening cough that often includes bloody or rust-colored sputum - Chest pain, especially with deep breathing, coughing or laughing - Hoarse voice - Poor appetite and weight loss - SOB - Fatigue - Frequent bronchial infections or pneumonia episodes - Sudden onset wheezing

**Chapter 26: Cancer of the Lung** What is Horner syndrome?

When a tumor near the apex of the lungs damages the nerve that passes from upper chest to the neck; causing dropping or weakness of one eyelid, small pupil in the same eye, and reduced or no perspiration on the same side of the face.

**Chapter 26: Cancer of the Lung** What is Superior vena cava syndrome?

Tumor near the upper portion of the right lung compresses the SVC and obstruct venous blood flow. Causes headaches, dizziness, swelling in the face, neck, arms and upper chest, sometimes with a bluish-red skin color.

**Chapter 26: Cancer of the Lung** What are some common paraneoplastic syndromes caused by NSCLC?

- High blood calcium levels (Hypercalcemia) - Excessive growth of certain bones - Blood clots

**Chapter 26: Cancer of the Lung** The **definite** diagnosis of lung cancer is made by what?

Microscopic examination of tissue sample (Biopsy)

**Chapter 26: Cancer of the Lung** T.N.M staging - What does this represent?

T - represents the size/location of primary tumor N - denotes the regional lymph node involvement M - signifies the extent of metastasis

**Chapter 26: Cancer of the Lung** About _____% of the patients with SCLC have limited stage SCLC.

**Chapter 26: Cancer of the Lung** About _____% of the patients with SCLC have extensive stage SCLC.

**Chapter 26: Cancer of the Lung** Physical Examination of Lung Cancer

- Increased respiratory rate - Increased heart rate and blood pressure - Cyanosis - Cough - Sputum production/Hemoptysis - Crackles - Wheezing

**Chapter 26: Cancer of the Lung** What are the radiologic findings of lung cancer?

- Small oval or coin lesion - Large irregular mass - Alveolar consolidation - Atelectasis - Pleural effusion

**Chapter 26: Cancer of the Lung** What treatment provides the best chance to cure NSCLC?

Surgery

**Chapter 26: Cancer of the Lung** What may be used to treat early-stage lung cancers that are located in the pleura and peripheral part of the lungs?

VATS - Video-assisted thoracic surgery

**Chapter 26: Cancer of the Lung** What may be used for small lung tumors near the outer edge of the lungs?

RFA - radiofrequency ablation

**Chapter 26: Cancer of the Lung** What are the two primary types of radiation therapy?

- Brachytherapy - External beam radiation

**Chapter 26: Cancer of the Lung** ____________________ directs radiation from outside the body to the cancer cells.

External beam radiation

**Chapter 26: Cancer of the Lung** As a general rule, EBRT to the lung is administered 5 days a week for how long?

5-7 weeks

**Chapter 26: Cancer of the Lung** What are angiogenesis inhibitors used for?

To obstruct new vessels supplying blood to the tumors

**Chapter 26: Cancer of the Lung** Some NSCLC cancer cells have the rearrangement in the gene ALK. Where is this most often seen?

Nonsmoker who have adenocarcinoma

**Chapter 26: Cancer of the Lung** Agents called ____________ are used to block the cell growth signal of cancerous cells.

EGFR inhibitors

**Chapter 26: Cancer of the Lung** ____________ uses anticancer agents that can be injected into a vein or taken orally.

Chemotherapy

**Chapter 27: Interstitial Lung Diseases** Exposure to asbestos may cause ______________.

Asbestosis

**Chapter 27: Interstitial Lung Diseases** CWP is also known as ________.

Coal miner lung and black lung

**Chapter 27: Interstitial Lung Diseases** Simple CWP is characterized by what?

Presence of pinpoint nodules called coal macules (black spots) throughout the lungs.

**Chapter 27: Interstitial Lung Diseases** What are common sources associated with asbestos fibers?

- Acoustic products - Automobile undercoating - Brake lining - Cements - Clutch casings - Floor tiles - Insulation - Ropes

**Chapter 27: Interstitial Lung Diseases** Coal macules often develop around the first- and second-generation respiratory bronchioles and cause the adjacent alveoli to retract. What is this called?

Focal emphysema

**Chapter 27: Interstitial Lung Diseases** Complicated CWP or progressive massive fibrosis is characterized by what?

Areas of fibrotic nodules greater than 1 cm in diameter

**Chapter 27: Interstitial Lung Diseases** The fibrotic changes in CWP are usually caused by _____________.

Silica

**Chapter 27: Interstitial Lung Diseases** A steel-gray, lighweight metal found in certain plastics and ceramics, rocket fuels, and x-ray tubes.

Beryllium

**Chapter 27: Interstitial Lung Diseases** __________________ is common and diagnostic in patients with an asbestos exposure history.

Pleural calcification

**Chapter 27: Interstitial Lung Diseases** Asbestos fibers typically range ___________ in length. How about diameter?

50-100 um in length and 0.5 um in diameter

**Chapter 27: Interstitial Lung Diseases** What are the two primary types of asbestos fibers?

- Amphiboles - Chrysotile (most commonly used in industry)

**Chapter 27: Interstitial Lung Diseases** The pulmonary deposition and accumulation of large amounts of coal dust cause ______________________.

Coal Worker Pneumoconiosis

**Chapter 27: Interstitial Lung Diseases** ____________________ is caused by the chronic inhalation of crystalline, free silica, or silicon dioxide particles.

Silicosis

**Chapter 27: Interstitial Lung Diseases** Silica is the main component of more than _____% of the rocks of the Earth.

**Chapter 27: Interstitial Lung Diseases** Where is silica found?

Sandstone, quartz, flint, granite, some clays.

**Chapter 27: Interstitial Lung Diseases** ________________ is characterized by nodules that coalesce and form large masses of fibrous tissue, usually in the upper lobes and perihilar regions.

Complicated silicosis

**Chapter 27: Interstitial Lung Diseases** ________________ is characterized by small rounded nodule scattered throughout the lung.

Simple silicosis - Patients are usually symptom free.

**Chapter 27: Interstitial Lung Diseases** No single nodule for simple silicosis is greater than _____.

9 mm

**Chapter 27: Interstitial Lung Diseases** The acute inhalation of beryllium fumes or particles may cause a toxic or allergic pneumonitis sometimes accompanied by ___________________.

- Rhinitis - Pharyngitis - Tracheobronchitis

**Chapter 27: Interstitial Lung Diseases** The hypersensitivity pneumonitis caused by inhalation of moldy hay is called _____________.

Farmer lung

**Chapter 27: Interstitial Lung Diseases** _______________ is a cell-mediated immune response of the lungs caused by the inhalation of a variety of offending agents or antigens.

Hypersensitivity pneumonitis

**Chapter 27: Interstitial Lung Diseases** Hypersensitivity pneumonitis offending agents include:

- Grains - Silage - Bird droppings - Feathers - Wood dust - Cork dust - Animal pelts - Coffee beans - Fish meal - Mushroom compost - Mold that grows on sugar cane

**Chapter 27: Interstitial Lung Diseases**' ____________________ are by far the largest group of agents associated with ILD.

Chemotherapeutics (anticancer agents). **- Bleomycin** **- Mitomycin** **- Busulfan** **- Cyclophosphamide** **- Methotraxate** **- Carmustine (BCNU)** - Nitrofurantoin (Antibacterial used for UTIs) - Macrobid - Gold - Penicillamine (treatment for rheumatoid arthritis)

**Chapter 27: Interstitial Lung Diseases** When interstitial fibrosis is found with no infectious organisms or known industrial exposure, ________________ must be suspected.

Drug-induced interstitial process

**Chapter 27: Interstitial Lung Diseases** Radiation-induced lung disease is commonly divided into what two major groups?

- Acute pneumonic phase - Late fibrotic phase

**Chapter 27: Interstitial Lung Diseases** Acute pnuemonitis is rarely seen in patients who receive a total radiation dose of less than ______ rad.

3500

**Chapter 27: Interstitial Lung Diseases** Acute pneumonic phase develops about ________ months after exposure.

2-3

**Chapter 27: Interstitial Lung Diseases** Radiation doses in excess of ______ rad over 6 wks almost always cause ILD.

6000

**Chapter 27: Interstitial Lung Diseases** ___________________ is characterized by chronic hardening and thickening of the skin caused by new collagen formation.

Scleroderma

**Chapter 27: Interstitial Lung Diseases** Progressive systemic sclerosis is a rare autoimmune disorder that affects the __________________ .

Blood vessels and connective tissue

**Chapter 27: Interstitial Lung Diseases** _______________ is primarily an inflammatory joint disease.

Rheumatoid arthritis

**Chapter 27: Interstitial Lung Diseases** Who often develops rheumatoid arthritis pleural complications; men or women?

Men

**Chapter 27: Interstitial Lung Diseases** Of all the collagen vascular disorders, ______________ is the one in which pulmonary involvement is most severe.

Scleroderma

**Chapter 27: Interstitial Lung Diseases** Caplan syndrome is also called ______________.

Rheumatoid pnuemoconiosis

**Chapter 27: Interstitial Lung Diseases** Caplan syndrome is a progressive pulmonary fibrosis of the lung commonly seen in ______________.

Coal miners

**Chapter 27: Interstitial Lung Diseases** Rheumatoid interstitial pneumonitis is characterized by ________________.

- Alveolar wall fibrosis - Interstitial and intraalveolar mononuclear cell infiltration - Lymphoid nodules In severe cases: - Extensive fibrosing alveolitis - Honeycombing

**Chapter 27: Interstitial Lung Diseases** _______________ is characterized by rounded densities in the lung periphery that often undergo cavity formation and in some cases, calcification.

Caplan syndrome

**Chapter 27: Interstitial Lung Diseases** Does Sjogren syndrome occur more often in men or women?

Women (90%)

**Chapter 27: Interstitial Lung Diseases** Sjogren syndrome is commonly associated with _____________.

Rheumatoid arthritis (50% of patients with Sjogren syndrome)

**Chapter 27: Interstitial Lung Diseases** Pulmonary involvement frequently occurs in Sjogren syndrome and includes:

- Pluerisy with out without effusion - Intersitial fibrosis that is indistinguishable from that of other collagen vascular disorders. - Infiltration of lymphocytes of the tracheobronchial mucous glands - Atelectasis - Mucous plugging - Secondary infections

**Chapter 27: Interstitial Lung Diseases** ______________ is a diffuse inflammatory disorder of the striated muscles that primarily weakens the limbs, neck and pharynx.

Polymyositis-dermatomyositis

**Chapter 27: Interstitial Lung Diseases** _____________________ is the term used when an erythematous skin rash accompanies the muscle weakness.

Dermatomyositis

**Chapter 27: Interstitial Lung Diseases** Polymyositis-dermatomyosis primarily occurs in what two age groups?

- Before age 10 - 40 to 50 years of age

**Chapter 27: Interstitial Lung Diseases** Systemic lupus erythematous is a multisystem disorder that involves the ________________.

Joints and skin

**Chapter 27: Interstitial Lung Diseases** Involvement of the lungs appear in about _____% of systemic lupus erythematous cases.

50-70% **Manifestations ar characterized by:** - Pluerisy with out without effusion - Atelectasis - Diffuse ILD - Diffuse infiltrates and pnuemonitis - Uremic pulmonary edema - Infections - Diaphragmatic dysfunction

**Chapter 27: Interstitial Lung Diseases** What is the most common pulmonary complication of systemic lupus erythematous?

Pluerisy with out without effusion

**Chapter 27: Interstitial Lung Diseases** A relatively common chronic disorder of unknown origin characterized by the formation of tubercles of nonnecrotizing epithelioid tissue (noncaseating granulomas).

Sarcoidosis

**Chapter 27: Interstitial Lung Diseases** Common sites of sarcoidosis

- Eyes - Lungs - Spleen - Liver - Usually the involvement of the lymph glands

**Chapter 27: Interstitial Lung Diseases** Sarcoidosis occurs more frequently in what age group?

- Most commonly in ages 10-40. - Highest incidence at age 20 to 30.

**Chapter 27: Interstitial Lung Diseases** IPF is most commonly seen in _____________.

Men 40-70 years of age

**Chapter 27: Interstitial Lung Diseases** ________________ is characterized by connective tissue plugs in the small airways and mononuclear cell infiltration of the surrounding parenchyma.

Cryptogenic organizing pneumonia( COP) also known as bronchiolitis obliterans organizing pneumonia (BOOP)

**Chapter 27: Interstitial Lung Diseases** Cryptogenic organizing pneumonia( COP) : Obstructive or restrictive?

Both obstructive and restrictive findings are present.

**Chapter 27: Interstitial Lung Diseases** _____________ is a diffuse pulmonary disorder characterized by fibrosis and accumulation of lymphocytes in the lungs.

Lymphocytic interstitial pneumonia

**Chapter 27: Interstitial Lung Diseases** Lymphocytic interstitial pneumonia is commonly associated with ___________.

Lymphoma

**Chapter 27: Interstitial Lung Diseases** A rare lung disease involving smooth muscles of the airways and affects women of childbearing age.

Lymphangioleiomyomatosis (LAM)

**Chapter 27: Interstitial Lung Diseases** LAM causes obstruction of _________________.

Small airways and lymphatics

**Chapter 27: Interstitial Lung Diseases** The prognosis of LAM is poor; the disease slowly progresses over 2-10 years, ending in death resulting from _______________.

Ventilatory failure

**Chapter 27: Interstitial Lung Diseases** What are common clinical features associated with LAM?

Pneumothorax and chylothorax

**Chapter 27: Interstitial Lung Diseases** A smoking-related ILD characterized by midlung zone star-shaped nodules with adjacent thin-walled cysts.

Pulmonary Langerhans cell histiocytosis (PLCH)

**Chapter 27: Interstitial Lung Diseases** A condition of unknown cause in which the alveoli become filled with protein and lipids.

Pulmonary Alveolar Proteinosis

**Chapter 27: Interstitial Lung Diseases** The lipoprotein material in pulmonary alveolar proteinosis is similar to _________________.

Pulmonary surfactant produced by type II cells.

**Chapter 27: Interstitial Lung Diseases** Where is PAP most commonly seen?

Adults 20-50 years old. Men affected twice as often as women.

**Chapter 27: Interstitial Lung Diseases** Pulmonary Alveolar Proteinosis chest radiograph often reveals....

Bilateral infiltrates that are most prominent in the perihilar regions (butterfly pattern). Air bronchograms commonly seen.

**Chapter 27: Interstitial Lung Diseases** Pulmonary vasculities (also called granulomatous vasculatides) consist of a heterogenous group of pulmonary disorders characterized by _________________.

Inflammation and destruction of the pulmonary vessels.

**Chapter 27: Interstitial Lung Diseases** Which of the following are considered pulmonary vasculitides?

- Wegener granulomatosis - Churg-Strauss Syndrome - Lymphomatoid granulomatosis

**Chapter 27: Interstitial Lung Diseases** Laboratory findings: ILD

Increased hematocrit and hgb

**Chapter 27: Interstitial Lung Diseases** Chest Assessment Findings: ILD

- Increased tactile and vocal fremitus - Dull percussion note - Bronchial breath sounds - Crackles - Pleural friction rub - Whispered pectoriloquy

**Chapter 27: Interstitial Lung Diseases** In goodpasture syndrome and idiopathic pulmonary hemosiderosis, why is the DLCO often elevated?

Its in the response to the increased amount of hgb retained in the alveolar spaces

**Chapter 27: Interstitial Lung Diseases** CXR Findings: ILD

- Honeycombing - Granulomas - Cavity formation - Irregularly shaped opacities - Bilateral reticulonodular pattern - Pleural thickening - Pleural effusion

**Chapter 27: Interstitial Lung Diseases** __________________ is an entity of unknown cause that is characterized by recurrent episodes of pulmonary hemorrhage similar to that seen in Goodpasture syndrome.

Idiopathic pulmonary hemosiderosis

**Chapter 27: Interstitial Lung Diseases** What is the general management of ILD?

- Corticosteroids - Immunosuppressive agents - Bronchial lavage

**Chapter 27: Interstitial Lung Diseases** Treatment for Goodpasture syndrome.

Plasmapheresis directly removes anti-GBM from blood circulation

**Chapter 43: Croup and Croup-like Syndromes** Technically, the inspiratory barking sound heard in a patient with a partial airway obstruction is called ________________.

Inspiratory stridor

**Chapter 43: Croup and Croup-like Syndromes** The word _croup_ is a general term used to describe the inspiratory barking or brassy sound associated with a ____________.

Partial upper airway obstruction

**Chapter 43: Croup and Croup-like Syndromes** LTB and bacterial tracheitis cause ___________ airway obstruction.

Subglottic

**Chapter 43: Croup and Croup-like Syndromes** Acute epiglottitis is a _______________ airway obstruction.

Supraglottic It's SUPER serious, SUPRAglottic

**Chapter 43: Croup and Croup-like Syndromes** LTB is an inflammatory process that causes __________________.

Edema and swelling of the mucous membranes.

**Chapter 43: Croup and Croup-like Syndromes** What is the most common cause of croup and croup-like symptoms?

LTB

**Chapter 43: Croup and Croup-like Syndromes** A life-threatening upper airway obstruction caused by an invasive bacterial infection of the soft tissues of the trachea.

Bacterial Tracheitis

**Chapter 43: Croup and Croup-like Syndromes** The major site of bacterial tracheitis is at the _____________ level.

Subglottic

**Chapter 43: Croup and Croup-like Syndromes** What causes most cases of LTB?

Parainfluenza viruses **Type 1- Most common** Type 3 - Less common Type 2 - Infrequent

**Chapter 43: Croup and Croup-like Syndromes** The onset of LTB is slow, and it is most common during what season(s)?

Fall and winter

**Chapter 43: Croup and Croup-like Syndromes** Acute epiglottitis is a **bacterial infection** that was historically always caused by what?

Haemophilus influenzae type B

**Chapter 43: Croup and Croup-like Syndromes** How is Haemophilus influenzae type B transmitted?

Aerosol droplets

**Chapter 43: Croup and Croup-like Syndromes** Bacterial tracheitis is most commonly caused by what?

Staphylococcus aureus

**Chapter 43: Croup and Croup-like Syndromes** What is the most definite method for diagnosing bacterial tracheitis?

Direct visualization via laryngobronchoscopy of the airway

**Chapter 43: Croup and Croup-like Syndromes** Airway obstruction caused by tissue swelling just **above** the vocal cords.

Epiglottitis

**Chapter 43: Croup and Croup-like Syndromes** Airway & obstruction caused by tissue swelling and mucopurelent membranous secretins below the vocal cords.

Bacterial tracheitis

**Chapter 43: Croup and Croup-like Syndromes** Airway obstruction cause by tissue swelling below the vocal cords.

LTB

**Chapter 43: Croup and Croup-like Syndromes** What sound does acute epiglottitis produce?

Low pitched, muffled or even absent sound.

**Chapter 43: Croup and Croup-like Syndromes** Classic clinical findings of acute epiglottitis.

- Swollen, cherry-red epiglottis - Drooling - Severe respiratory distress

**Chapter 43: Croup and Croup-like Syndromes** CXR Finding: Steeple point or pencil point narrowing of the airway. What is this?

LTB

**Chapter 43: Croup and Croup-like Syndromes** CXR Finding: Classic "thumb sign", what is this?

Epiglottitis

**Chapter 43: Croup and Croup-like Syndromes** What type of radiograph is done to rule out epiglottitis?

Lateral neck radiograph

**Chapter 43: Croup and Croup-like Syndromes** Explain the physical examination findings.

- Increased RR - Diminished breath sounds - Prolonged inspiratory phase - Inspiratory stridor - Cyanosis - Substernal and intercostal retractions - Accessory muscle use