Lung Cancers Overview
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Questions and Answers

What does the abbreviation UIP refer to in the context of respiratory conditions?

  • Usual interstitial pneumonia (correct)
  • Unilateral interstitial pneumonia
  • Urothelial inflammatory pneumonia
  • Unusual inflammatory process

What is the primary function of pirfenidone in the treatment of certain lung conditions?

  • To promote airflow in obstructive diseases
  • To stimulate alveolar repair
  • To enhance mucus production
  • To inhibit collagen synthesis (correct)

Which combination of conditions does a diagnosis of COPD typically imply?

  • Chronic bronchitis and emphysema (correct)
  • Chronic bronchitis and cystic fibrosis
  • Asthma and emphysema
  • Chronic bronchitis and asthma

How can hyperinflated lungs in a patient with COPD affect cardiac position?

<p>They may push the heart to the midline (C)</p> Signup and view all the answers

Which statement correctly differentiates the point of maximal impulse in COPD from that in left ventricular hypertrophy?

<p>It is palpated in the sub-xiphoid space in COPD (D)</p> Signup and view all the answers

What is a key histological feature of squamous cell carcinoma of the lung?

<p>Keratin pearls (B)</p> Signup and view all the answers

Which of the following is secreted by squamous cell carcinoma of the lung that mimics parathyroid hormone?

<p>Parathyroid hormone-related peptide (PTHrp) (A)</p> Signup and view all the answers

Which type of lung cancer is most likely associated with non-smokers, particularly females?

<p>Adenocarcinoma (A)</p> Signup and view all the answers

What is the typical location of adenocarcinoma in the lung?

<p>Apical or peripheral region (D)</p> Signup and view all the answers

What syndrome might be caused by apical tumors of the lung?

<p>Horner syndrome (C)</p> Signup and view all the answers

What might cause SVC syndrome and its related symptoms?

<p>Tumors in the apical region (B)</p> Signup and view all the answers

Which of the following lung cancers is associated with cavitation?

<p>Squamous cell carcinoma (B)</p> Signup and view all the answers

Which is a recognized risk factor for squamous cell carcinoma?

<p>Smoking (D)</p> Signup and view all the answers

What is the classic sign associated with worsening flushing and neck vein congestion when raising the arms above the head?

<p>Pemberton sign (A)</p> Signup and view all the answers

Which of the following tumors is most commonly associated with hypercoagulable states due to malignancy?

<p>Adenocarcinoma of the pancreas (D)</p> Signup and view all the answers

What is the primary urinary marker used for diagnosing carcinoid syndrome?

<p>5-hydroxy indole acetic acid (5-HIAA) (B)</p> Signup and view all the answers

What is the pediatric condition characterized by warts of the vocal cords?

<p>Laryngeal papillomatosis (A)</p> Signup and view all the answers

What is the major occupational risk factor associated with mesothelioma?

<p>Asbestos exposure (C)</p> Signup and view all the answers

Which cell type initiates pulmonary fibrosis in response to asbestos exposure?

<p>Macrophage (C)</p> Signup and view all the answers

Which of the following best describes the appearance of mesothelioma in imaging studies?

<p>Circumferential pleural-based tumor (D)</p> Signup and view all the answers

Which pneumoconiosis is associated with occupational exposure to beryllium?

<p>Berylliosis (A)</p> Signup and view all the answers

What mechanism is proposed to explain the fibrous proliferation in hypertrophic osteoarthropathy associated with lung cancer?

<p>Fibrovascular proliferation (D)</p> Signup and view all the answers

What is a potential consequence of silicosis in affected individuals?

<p>Egg-shelf calcifications in upper lobes (B)</p> Signup and view all the answers

What characteristic finding is seen in pulmonary biopsy of asbestosis?

<p>Ferruginous bodies (A)</p> Signup and view all the answers

What type of cancer is nasopharyngeal carcinoma categorized as?

<p>Squamous cell carcinoma (B)</p> Signup and view all the answers

What should be avoided in patients with pneumoconiosis due to the increased risk of tuberculosis?

<p>Anti-TNF-a agents (D)</p> Signup and view all the answers

Which symptom is typical of a restrictive lung disease in individuals over the age of 50?

<p>Unexplained dry cough lasting 6-12 months (C)</p> Signup and view all the answers

What condition is associated with black discoloration of the lung?

<p>Anthracosis (B)</p> Signup and view all the answers

Which condition may present with pulmonary nodules in patients with rheumatoid arthritis and pneumoconiosis?

<p>Caplan syndrome (B)</p> Signup and view all the answers

What specific imaging pattern is associated with restrictive lung disease?

<p>Reticular or reticulonodular pattern (D)</p> Signup and view all the answers

Which condition is indicated by a high-resolution CT scan showing honeycombing?

<p>Idiopathic pulmonary fibrosis (D)</p> Signup and view all the answers

What is the next best step to confirm a diagnosis of interstitial lung disease following imaging?

<p>Lung biopsy (A)</p> Signup and view all the answers

What might a vignette describe to suggest the presence of pulmonary hypertension?

<p>Loud P2 heart sound (D)</p> Signup and view all the answers

When would you expect a patient with idiopathic pulmonary fibrosis to display only a month of cough?

<p>Initial presentation of heart failure (D)</p> Signup and view all the answers

What spirometric finding is indicative of a restrictive pattern in lung function?

<p>Increased FEV1/FVC ratio (A)</p> Signup and view all the answers

Idiopathic pulmonary fibrosis is also known as which type of pneumonia?

<p>Usual interstitial pneumonitis (A)</p> Signup and view all the answers

What is often observed in patients over 50 years old with idiopathic pulmonary fibrosis?

<p>Clubbing of the fingers (D)</p> Signup and view all the answers

What does the term 'UIP' refer to in the context of lung conditions?

<p>Usual interstitial pneumonitis (B)</p> Signup and view all the answers

Which of the following most accurately describes the combination of conditions in a patient diagnosed with COPD?

<p>Chronic bronchitis and emphysema (D)</p> Signup and view all the answers

What heart position change might occur due to hyperinflated lungs in a COPD patient?

<p>Heart centrally displaced (D)</p> Signup and view all the answers

Which descriptive characteristic would be assessed to differentiate between COPD and left ventricular hypertrophy?

<p>Point of maximal impulse palpated in the sub-xiphoid space (A)</p> Signup and view all the answers

What is the primary function of pirfenidone in the treatment of lung conditions?

<p>Inhibit collagen synthesis (D)</p> Signup and view all the answers

What phenomenon is described by worsening flushing and neck vein congestion when raising the arms above the head?

<p>Pemberton sign (A)</p> Signup and view all the answers

What is the primary urinary marker used for the diagnosis of carcinoid syndrome?

<p>5-hydroxy indole acetic acid (5-HIAA) (B)</p> Signup and view all the answers

Which cancer is commonly associated with exposure to asbestos?

<p>Mesothelioma (B)</p> Signup and view all the answers

What condition is characterized by warts of the vocal cords that may spread to cervical lymph nodes?

<p>Laryngeal papillomatosis (D)</p> Signup and view all the answers

In relation to lung cancer, which of the following conditions is classified as a type of neuroendocrine tumor?

<p>Carcinoid tumor (C)</p> Signup and view all the answers

Which cell type is primarily responsible for initiating pulmonary fibrosis in response to asbestos exposure?

<p>Macrophages (A)</p> Signup and view all the answers

Which risk factor is most commonly associated with laryngeal cancer?

<p>Smoking (B)</p> Signup and view all the answers

What is the occupational exposure associated with the development of berylliosis?

<p>Aerospace/aeronautical industry (D)</p> Signup and view all the answers

What is the appearance of mesothelioma on imaging studies described as?

<p>An encasing rind of tumor (B)</p> Signup and view all the answers

What type of cancer often arises from prior exposure to asbestos?

<p>Mesothelioma (D)</p> Signup and view all the answers

What happens to lung function in patients with silicosis?

<p>Restrictive lung pattern (A)</p> Signup and view all the answers

Which condition is characterized by black discoloration of the lungs and may be described as coal miner's lung?

<p>Anthracosis (C)</p> Signup and view all the answers

Which condition is characterized by fibrovascular proliferation and is associated with lung cancer?

<p>Trousseau sign of malignancy (D)</p> Signup and view all the answers

What is a characteristic histological finding in squamous cell carcinoma of the lung?

<p>Keratin pearls (D)</p> Signup and view all the answers

Which group of symptoms is most likely observed in patients over the age of 50 with unexplained dry cough?

<p>Restrictive lung disease symptoms (C)</p> Signup and view all the answers

Which hormonal effect is seen due to squamous cell carcinoma of the lung?

<p>Increased PTHrp secretion (A)</p> Signup and view all the answers

What is a common risk factor for the development of pneumoconioses in patients with rheumatoid arthritis (RA)?

<p>Occupational exposure (C)</p> Signup and view all the answers

Which histological feature is associated with pulmonary nodules in patients suffering from Caplan syndrome?

<p>Granulomas (A)</p> Signup and view all the answers

What potential syndrome can result from Pancoast tumors?

<p>Horner syndrome (C)</p> Signup and view all the answers

Which lung cancer type is most commonly linked with smoking?

<p>Small cell carcinoma (A)</p> Signup and view all the answers

Which characteristic would indicate squamous cell carcinoma on an imaging study?

<p>Central cavitation (A)</p> Signup and view all the answers

What factor is a recognized risk for developing adenocarcinoma in the lung among non-smokers?

<p>Radon exposure (C)</p> Signup and view all the answers

What is the mechanism by which squamous cell carcinoma affects parathyroid hormone levels?

<p>Negative feedback due to high calcium levels (C)</p> Signup and view all the answers

What imaging pattern is typically seen in restrictive lung disease?

<p>Reticulonodular pattern (B)</p> Signup and view all the answers

Which condition is confirmed by a lung biopsy following imaging?

<p>Interstitial lung disease (C)</p> Signup and view all the answers

What is the relationship between idiopathic pulmonary fibrosis and usual interstitial pneumonitis?

<p>UIP is a form of idiopathic pulmonary fibrosis (C)</p> Signup and view all the answers

What spirometric finding indicates a restrictive pattern in lung function?

<p>Normal FEV1 with decreased FVC (A)</p> Signup and view all the answers

Which clinical sign may indicate pulmonary hypertension in a patient with restrictive lung disease?

<p>Loud P2 (D)</p> Signup and view all the answers

Which of the following is a common symptom in a patient over 50 with idiopathic pulmonary fibrosis?

<p>Shortness of breath with increasing fatigue (A)</p> Signup and view all the answers

What term is colloquially used to describe the reticular pattern seen in radiographic images for certain lung diseases?

<p>Honeycombing (D)</p> Signup and view all the answers

What is the next best step in management after performing imaging for interstitial lung disease?

<p>High-resolution CT scan of the chest (C)</p> Signup and view all the answers

Flashcards

Pemberton sign

A clinical sign characterized by worsening neck vein congestion and facial flushing when raising the arms above the head. Often associated with migratory thrombophlebitis, a condition known as Trousseau's sign, indicative of cancer.

Mesothelioma

A rare type of cancer arising from the mesothelial cells lining the chest cavity. Frequently linked to prior asbestos exposure.

Bronchogenic carcinoid tumor

A type of lung cancer that produces serotonin or serotonin-like substances, leading to a syndrome characterized by flushing, diarrhea, and tachycardia.

Laryngeal cancer

A type of cancer affecting the voice box (larynx). Smoking is a major risk factor.

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Nasopharyngeal carcinoma

A cancer of the nasopharynx, the upper part of the throat, often associated with infection by the Epstein-Barr virus (EBV).

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Usual Interstitial Pneumonitis (UIP)

A restrictive lung condition characterized by inflammation and scarring of the lung tissue, leading to shortness of breath and a dry cough. It is often idiopathic, meaning its cause is unknown.

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Chronic Obstructive Pulmonary Disease (COPD)

A chronic lung disease characterized by inflammation and narrowing of the airways, leading to airflow obstruction and shortness of breath. It is often caused by smoking.

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Chronic Bronchitis

A type of COPD characterized by inflammation and excessive mucus production in the airways, leading to a chronic cough and wheezing.

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Emphysema

A type of COPD characterized by destruction of the tiny air sacs (alveoli) in the lungs, leading to airflow obstruction and shortness of breath.

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Pirfenidone

A medication used to treat idiopathic pulmonary fibrosis (UIP). It inhibits the production of collagen, helping to slow down the scarring process.

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Squamous Cell Carcinoma

Lung cancer that starts centrally, often in the hilum or medially. Smoking is the biggest risk factor. Can cavitate, meaning it may form a cavity or hole within the tumor.

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Adenocarcinoma of the Lung

Lung cancer that frequently occurs in non-smokers, particularly women. Can be caused by radiation exposure from radon, like in a basement setting.

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Pancoast Tumor

A tumor that may develop in the apex (top) of the lung. Can cause Horner syndrome due to compression of the sympathetic nerves, and SVC Syndrome or brachiocephalic syndrome due to compression of veins.

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Small Cell Lung Cancer

Lung cancer that starts centrally, usually in the hilum or medially. Known for a strong association with smoking

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PTHrp (Parathyroid hormone-related peptide)

A hormone-like substance secreted by Squamous Cell Carcinoma. It behaves similar to Parathyroid Hormone (PTH) but isn't the same.

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SVC Syndrome

A sign indicating compression of the Superior Vena Cava (SVC) due to tumor growth, leading to swelling and redness in the face and neck.

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Horner Syndrome

A condition caused by compression of the sympathetic nerves, leading to drooping eyelid (ptosis), constricted pupil (miosis), and decreased sweating (anhidrosis).

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Brachiocephalic Syndrome

A condition caused by compression of the brachiocephalic veins, leading to swelling and redness of the right side of the face and neck.

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Laryngeal Papillomatosis

A condition that causes warts on the vocal cords in children, often due to HPV exposure during birth.

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Asbestosis

A type of pneumoconiosis caused by asbestos exposure, often seen in shipyard, construction, and electrical workers.

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Berylliosis

A type of pneumoconiosis caused by beryllium exposure, often seen in aerospace and aeronautical industries.

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Silicosis

A type of pneumoconiosis caused by silica exposure, common in foundry workers and quarry workers.

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Anthracosis

A type of pneumoconiosis caused by coal dust exposure, also known as "coal miner's lung."

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Caplan Syndrome

A condition where a patient with rheumatoid arthritis develops pulmonary nodules due to exposure to a pneumoconiosis.

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Idiopathic Pulmonary Fibrosis (IPF)

A chronic lung condition characterized by a dry cough that lasts for 6-12 months or longer in patients over the age of 50.

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Restrictive Lung Disease

A lung disease characterized by restrictive lung patterns and reduced lung volume. FEV1/FVC is often greater than in obstructive lung disease.

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Reticular/Reticulonodular pattern

A pattern on chest imaging that shows a network of lines and nodules, often seen in restrictive lung diseases like fibrosis.

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Spirometry

A test that evaluates the flow and volume of air in and out of the lungs, commonly used to assess lung function.

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High-resolution CT (HRCT) scan

A highly detailed imaging technique using X-rays to create cross-sectional images of the lungs, providing more information than a regular X-ray.

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Lung biopsy

A procedure where a small sample of lung tissue is taken for analysis under a microscope, often used to confirm diagnoses of lung diseases.

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Pulmonary hypertension

Increased pressure in the arteries supplying blood to the lungs, often a symptom of conditions affecting the lungs.

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Restrictive pattern on spirometry

A pattern on spirometry showing reduced lung capacity and airflow, often seen in restrictive lung diseases.

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Carcinoid tumor

A type of neuroendocrine tumor, typically found in the appendix or small bowel, but can also occur in the bronchi.

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5-HIAA

A test used to diagnose carcinoid tumors by measuring the level of 5-hydroxyindoleacetic acid (5-HIAA) in urine.

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What is COPD?

A chronic lung disease characterized by inflammation and narrowing of the airways, leading to airflow obstruction and shortness of breath. It is often caused by smoking.

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What is Emphysema?

A type of COPD characterized by destruction of the tiny air sacs (alveoli) in the lungs, leading to airflow obstruction and shortness of breath.

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What is Chronic Bronchitis?

A type of COPD characterized by inflammation and excessive mucus production in the airways, leading to a chronic cough and wheezing.

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What is Pirfenidone?

An anti-fibrotic agent used to treat idiopathic pulmonary fibrosis (UIP). It inhibits the production of collagen, helping to slow down the scarring process.

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How does COPD affect the heart?

Hyperinflated lungs in COPD (due to air trapping) can push the heart to the midline. NBME will say there’s a “long, narrow cardiac silhouette,” or a “point of maximal impulse palpated in the sub-xiphoid space.”

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Study Notes

Lung Cancers

  • Squamous Cell Carcinoma: Centrally located in the lung, strongly associated with smoking. Can cavitate (form a cavity). Stains positive for keratin.
  • Adenocarcinoma: More common in non-smokers. Often found peripherally in the lung. Often secretes PTHrp (parathyroid hormone-related peptide). May be associated with hypercoagulable state.
  • Small Cell Carcinoma: Also central, strongly associated with smoking.
  • Large Cell Carcinoma: A less common type of lung cancer.

Other Lung Conditions

  • Mesothelioma: Cancer of mesothelial cells, linked to asbestos exposure. Often appears as a white encasing rind around the lungs producing a "pancoast tumor". May cause Horner's syndrome; miosis, ptosis, anhidrosis, and SVC syndrome (flushing of the face + congestion of neck veins) or brachiocephalic syndrome (only the right side of face/neck).
  • Bronchogenic Carcinoid Tumor: A neuroendocrine tumor that can produce serotonin-like substances, causing carcinoid syndrome (tachycardia, flushing, diarrhea).
  • Nasopharyngeal carcinoma: A type of squamous cell carcinoma of the airway, associated with EBV.
  • Laryngeal Cancer: Squamous cell carcinoma of the vocal cords, strong smoking association. Spreads to cervical lymph nodes.
  • Laryngeal Papillomatosis: Pediatric condition characterized by vocal cord warts, usually due to HPV infection.
  • Pneumoconioses: A group of lung diseases caused by inhalation of inorganic dust particles.
  • Asbestosis: Resulting from asbestos exposure, which may eventually lead to mesothelioma.
  • Berylliosis: Resulting from beryllium exposure.
  • Silicosis: Resulting from silica exposure, often in foundry workers.
  • Anthracosis: Due to coal dust inhalation.
  • Caplan Syndrome: Combination of rheumatoid arthritis and pneumoconiosis.
  • Idiopathic Pulmonary Fibrosis (Usual Interstitial Pneumonitis): Restrictive lung disease characterized by reticular/reticulonodular pattern on CXR/CT.
  • Chronic Obstructive Pulmonary Disease (COPD): Combination of chronic bronchitis (productive cough for 3+ months/year) and emphysema (destruction of alveoli). Associated with smoking. Emphysema can be pan-acinar or centri-acinar. A1-antitrypsin deficiency is a genetic link to emphysema.
  • Chronic Bronchitis: Excessive mucus production in the bronchioles. Characterized by a "blue bloater" presentation.
  • Emphysema: Loss of alveoli, leading to decreased lung elasticity. Characterized by "pink puffer" presentation.
  • Asbestosis: Resulting from asbestos exposure. This may precede the development of mesothelioma.
  • Important Note About COPD Exacerbations: A COPD exacerbation is often indicated by increased CO2 levels.

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