Term
| T or f, As many as 35% of patients with head and neck squamous cell carcinoma develop lung cancer. |
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Definition
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Term
| What type of lung cancers are central and which are peripheral? |
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Definition
| Central - squamous, small cell; peripheral - adenocarcinoma, large cell |
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Term
| Which of the following characteristics of a solitary pulmonary nodule indicate malignancy - spiculation, calcification, mass >3cm, pleural effusion, hemidiaphragm elevation, adenopathy, bony destruction, volume loss. |
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Definition
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Term
| What is the SPHERE of complications of lung cancer? |
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Definition
| Superior Vena Cava Syndrome (upper swelling), Pancosts tumor (apex carcinoma causing horners), Horners syndrome (miosis, ptosis, anhidrosis), Endocrine paraneoplastic (ACTH, SIADH, Lambert-eaton, hi Ca), Recurrent hoarseness, Effusions |
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Term
| Most lung cancers are metastatic beofer they are resectable. Which type is surgery a cure for? |
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Definition
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Term
| What two types of imaging (with confirmation) are used to determine if non-small cell lung cancer is resectable? |
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Definition
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Term
| In lung cancer staging T and N stand for what? |
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Definition
| T is spread of tissue, N is nodal involvement |
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Term
| In non-small cell lung cancer stage 1,2 is resectable, Advanced stage 3a lung cancer is a potential surgical resection after neoadjuvant chemo, what stages are not candidates? |
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Definition
| 3b, 4 just palliative chemo/rads |
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Term
| Most presentations of small cell lung cancer are extensive metastasis, what is recommended tx? |
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Definition
| Chemo for all, some rads improve local control |
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Term
| Analysis of cells and genes in lung cancer helps discriminate primary vs metastat lung cancer, ID molecular targets in malign tissues, associate gene profiles like DNA methylation with poor outcome. What are the effects of these 3 factors EGFR-TK, VEGF, COX-2? |
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Definition
| EGFR-TK binding induces proliferation, invasion, metastat but is tx with competitve inhibitor getfinib; VEGF induces angiogenesis and proliferation tx with bevacizumab; COX-2 facilitates invasion and immune resistance tx with celecoxib |
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Term
| What are 3 common metastat point for lung caner? |
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Definition
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Term
| Name the lung cancer type - central, seen in smokers, hilar mass arising from main bronchus, cavitations, PTHrP, keratin pearls and intracellular bridges on histology. |
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Definition
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Term
| Name the lung cancer type - peripheral, develops in site of primary inflammation or injury, bronchial, not linked to smoking, can present like pneumonia, histology shows clarac and type 2 cells affected with multiple densities on CR. |
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Definition
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Term
| Name the lung cancer type - central, undiff, very aggressive, associated with ectopic ACTH, ADH, ANP, may lead to LEMS, responds to chemo, histo shows neoplasm of neuroendocrine cells and kulchitsky cells are small dark and blue. |
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Definition
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Term
| Name the lung cancer type - peripheral, highly anaplastic undifferentiated tumor, poor prognosis, less responsive to chemo, removed surgically, histo shows pleomorphic giant cells with leukocyte fragments in cytoplasm |
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Definition
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Term
| ID the type of pleural effusions - down protein < .5, up hydrostatic pressure, down colloid pressure, up transport of peritoneal fluid thru diaphragm. Can be due to CHF, nephritic syndrome, hepatic cirrhosis, PE. |
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Definition
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Term
| ID the type of pleural effusions - up protein content > .5, up cap permeability, down absorption by lymphatics. Due to malign, pneumonia, collagen vascular disease, trauma, PE, in states of increased vascular permeability. |
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Definition
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Term
| Name which group is signs of pleural effusion and which is pneumo thorax, 1. blunting of costophrenic angle, meniscus sign, contra lat displace trachea, 2. loss of lung markings, reflection, deep sulcus sign on supine, and contra lat displace of trachea in tension. |
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Definition
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Term
| Name the type of pleural effusion - milky fluid, high triglycerides, unilateral. |
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Definition
| Lymphatic block called chylothroax |
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Term
| What is the tx for simple, complicated, and empyema parapneumonic effusions? |
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Definition
| Antibios for all; simple - no drain, complicated - drain + fibrinolytics, epyema - drain + lytics, VATS |
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Term
| In pleural effusions, adenosine deaminase is checked and is positive in tuberculous pleurisy, epyema, pheumatoid pleurisy, malign. But a normal level is highly specific for abscene of __________. |
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Definition
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Term
| T or F, Approximately 60% of malignant effusions can be diagnosed by cytology. |
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Definition
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Term
| What is the cause of primary, secondary, iatrogenic, and traumatic pneumothorax? |
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Definition
| Primary is spontaneous blebs not due to disease or trauma seen in thin young males, secondary due to underlying disease, iatrogenic from central line/biopsy/ventilator, trauma |
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Term
| What is the preferred intervention for sclerosis in lung which treats recurring pneumothoraxs by inducing inflammation and bidning of parietal and visceral surfaces. |
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Definition
| VATS over chest tube with med |
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Term
| A person with occupational asthma without latency can be irritant induced or with very high dose of toxic material they can present with __________? |
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Definition
| RADS - reactant airway disease that is not allergic |
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Term
| Is latex reaction asthma with latency or not? |
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Definition
| Latency, needs sensitization |
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Term
| T or F, COPD is attributed to 1/3 people who never smoked. |
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Definition
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Term
| Name this pleural disease - diffuse pulmonary interstitial fibrosis caused by ihaled fibers, up risk of pleural mesothelioma, ivory white pleural plaques, affects lower lobes, smoking increases risk of bronchogenic carcinoma not mesolthelioma. |
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Definition
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Term
| Coal and silica dust affect the upper lobes in pneumoconiosis without functional defecits but risks progressing to __________. |
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Definition
| Progressive massive fibrosis nodule >1cm |
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Term
| ___________ is sthe infection/inflammation of lung parenchyma. |
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Definition
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Term
| Sputum grain stain and culture are nebulous in their actual effectiveness but sputum culture should be done on which of the following just incase it helps direct tx: ICU, outpatient failure, alcoholics, cavitray lesions, severe lung disease, pleural effusion. |
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Definition
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Term
| In determining which patients whould be admitted for Pneumonia ifthey have 2 or more CURB-65, which is? |
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Definition
| Confusion, Uremia BUN>20, RR>30, BP low, >65 |
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Term
| What are the principles of tx for pneumonia? |
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Definition
| Start anitbios within four hours wide spectrum narrowing later on, avoiding classes patient recently exposed to |
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Term
| Patients at risk for P. aeruginosa: structual lung disease such as bronchiectasis, steroid use (>10 mg/day prednisone), recent broad spectrum antibiotics, or malnutrition. How do you tx ICU patient if they do or dont have risk? |
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Definition
| No risk - antipneumo B-lactam + quinolone, Risk - antipneumo/pseudomonal B-lactam + cipro; tx for 7-10 days for typicals and 10-14 for atypicals while anaerobes for 6 weeks or clear CXR |
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Term
| T or f, Patient can be discharged from hospital if they qualify for oral antibiotics with these requirements : Improvement in cough and dyspnea, <100.0°F x2 8h apart, Decreasing WBC count, Functioning GI tract + good PO intake |
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Definition
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Term
| What bacteria is the main cause of pneumonia in outpatients, non-icu inpatients, and ICU? |
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Definition
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Term
| Name the organisms most frequently seen in lobar pneumonia with intra-alveolar exudates leading to consolidation, may involve entire lung? |
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Definition
| Pneumococcus most frequently |
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Term
| Name the organisms most frequently seen in bronchopneumonia with acute inflammatory infiltrates from bronchioles to adjacent alveoli, with patchy distribution involvgin >1 lobe. |
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Definition
| S. aureaus, H. flu, Klebsiella, S. pyogenes |
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Term
| Name the organisms most frequently seen in interstitial atypical pneumonia with a more indolent course, patchy infiltration, distribution >1 lobe. |
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Definition
| Viruses, mycoplasma pneumo, Legionella, Chlamydia |
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Term
| Name this congential lung cyst - most common cyst in infancy, many situated in the medistinum close to carina, closed epithelium lined sacs developed from primitive upper gut and respiratory tract, often saccular and lined with gastric mucosa. |
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Definition
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Term
| Name this congenital cyst - abnormality of lung development, 5 types from bronchial to peripheral. |
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Definition
| Congenital cyst adenomatoid malformation |
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Term
| Name this pediatric pulmonary problem - It is pulmonary tissues that is isolated from normal functioning lung and is nourished by systemic blood supply. |
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Definition
| Congenital pulmonary sequesteration |
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Term
| Name this pediatric pulmonary problem - large hyperlucent lobe, causes are partial obstruction as by mucosal flaps or twisting of the lobe on its pedicle, Presents with symptoms and signs similar to tension pneumothorax. |
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Definition
| Congential lobar emphysema |
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Term
| What is the tx for congential lung cysts? |
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Definition
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Term
| Define this pediatric pumonry disease: In a child younger than 2 years of age, the term refer to clinical syndrome characterized with rapid respiration, chest retractions and wheezing, CXR shows Hyperinflated lungs, peribronchial cuffing, and atelectasis. |
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Definition
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Term
| The mean pulmonary arterial pressure <20mmHg, with 25 being HTN. What 3 factors can independently increase pul arterial pressure? |
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Definition
| Left atrial pressure, pulm vascular resistance, pul blood flow |
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Term
| The genetic defect of BMPR2 genetic defect can induce pulm HTN through what menas? |
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Definition
| Doesnt inhibit smooth muscle proliferation in the vascular wall |
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Term
| In severe pulm HTN a lesion forms with abnormal angiogenesis and anuerysmal formations what is it called? |
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Definition
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Term
| On physical exam for pul htn, what is seen in >90%? |
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Definition
| Accentuated 2nd heart sound. |
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Term
| There is no definitive way to tell if a person has a PE, so based on __________ and __________. |
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Definition
| Clinical suspicion and definitive testing |
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Term
| Name some diagnostic tests to check for DVT/PE in low and high risk patients. |
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Definition
| DVT ultrasound and d-dimers in blood for low, for high CT angiography or V/Q scan if allergy to dye/renal/preggers |
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