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2 Pulm: COPD, Neopl
Step Up to Medicine, Chap 2: COPD, Lung Neoplasms
| Question | Answer |
|---|---|
| How is emphysema diagnosed? | Pathologically: permanent enlargement of airspaces distal to terminal bronchioles due to destruction of alveolar walls |
| What is COPD's ranking in top causes of death in US? | 4th leading cause |
| What role does tobacco smoke play in the pathophys of emphysema? | Tobacco smoke increases the # of activated PMNs and macrophages which release lung-digesting elastase, inhibits alpha-1-antitrypsin which normally blocks elastase, and increases oxidative stress on the lungs via free radical production. Yuck! |
| MC type of emphysema? | Centrilobular (seen in smokers). Destruction ltd to respiratory bronchioles (proximal acini). Little change in distal acini. |
| Centrilobular emphysema has a predilection for which lung zones? | Upper |
| Which type of emphysema is more likely to be seen in pts with alpha-1-antitrypsin deficiency? | Panlobular (makes sense) |
| Where does the destruction take place in panlobular emphysema? Which lung zones are most likely to be affected? | Destruction involves both proximal and distal acini. Predilection for lung bases. |
| What must the TLC and FEV1 be in order to diagnose COPD? (general answer) | Normal or increased TLC with a decreased FEV1 |
| Do you typically see accessory muscle use in both types of COPD? | No. Usually don't see it in bronchitis. More characteristic of emphysema. |
| Name 3 things that entail clinical monitoring of COPD pts? | Serial FEV1 measurements, pulse ox, exercise tolerance |
| What is the most important intervention in COPD pts? | Smoking cessation! (Improves survival rate, but does not decrease it to that of a non-smoker.) |
| Which medication commonly used in pts with heart disease is contraindicated in acute COPD or asthma exacerbations? | Beta blockers |
| What is the best combo treatment for COPD? | Beta agonist albuterol + ipratropium bromide (bronchodilators) |
| Are corticosteroids a mainstay of treatment in COPD? | No. Reserved only for pts whose sx are not controlled by bronchodilators (beta agonist albuterol or ipratropium) |
| What is the mechanism of theophylline in COPD tx? | May improve mucociliary clearance and central respiratory drive. Use is controversial. |
| What role does oxygen therapy play in the tx of COPD? | Shown to improve survival and quality of life in pts with COPD and chronic hypoxemia. (controls pulmonary HTN which can lead to cor pulmonale) |
| 2 major criteria for continuous or intermittent oxygen tx in COPDers? | PaO2 <55 OR O2 sat <88% in the context of optimal medical therapy. Also PaO2 55-59 with polycythemia or cor pulmonale. |
| Vaccination needs for COPD? | Influenza annually. Pneumovax (anti-strep pneumo) q5-6y |
| Define acute COPD exacerbation. | Persistent increase in dyspnea not relieved with bronchodilators. |
| Corticosteroid use in acute COPD exacerbations? | IV methylprednisolone-> taper with oral prednisone on clinical improvement. Do NOT use inhaled corticosteroids in an acute exac. |
| 3 MCC of acute COPD exacerbations? | INfection, non-compliance with meds, and cardiac disease |
| MC organisms in COPD pulmonary infections? | Strep pneumo, H flu, mycoplasma pneumo, moraxella catarrhalis |
| Appropriate steps in management for pt presenting with acute COPD exac? | 1. CXR 2. Beta 2 agonists and anticholinergic inhalers 3. Systemic coricosteroids (NOT inhaled!) 4. Abx 5. Non-invasive positive pressure ventilation if needed |
| Asthma triad? | Airway inflammation, airway hyperresponsiveness, reversible airflow obstruction |
| Paradoxic movement of the abdomen and diaphragm on inspiration is sign of _________. | Respiratory failure |
| Diagnostic FEV1/FVC ratio for asthma? | <0.75 |
| Definition of reversible airway obstruction? | Increase of at least 12% in FEV1 or FVC after use of bronchodilators |
| Why is a high or normal PaCO2 level a bad sign in COPD/asthma pts? | Normally, pt should be hyperventilating and thus have low PaCO2 levels. If they stop hyperventilating, it may be a sign that they are fatigued and decompensating. Intubation may be necessary. |
| Side effects of oral corticosteroids? | Sore throat, oral candidiasis, and hoarseness |
| Asthma + nasal polyps. Association? | Aspirin-sensitive asthma |
| Permanent, abnormal dilation and destruction of bronchial walls with damaged cilia. | Bronchiectasis |
| Half of all bronchiectasis cases are caused by? | CF |
| Sx of bronchiectasis? | Chronic cough with large amts of mucopurulent, foul-smelling sputum. Dyspnea. Hemoptysis (ruptured BV near bronchial wall surfaces). Recurrent or persistent pneumonia. |
| Main goal in treating bronchiectasis? | Preventing complications of hemoptysis and pneumonia. |
| Diagnostic study of choice in bronchiectasis? | High resolution CT scan |
| Tx for bronchiectasis? | Abx for acute exacerbation (changes in sputum, fever, CP), hydration, chest drainage & percussion, and inhaled bronchodilators |
| Complications of CF? Average age of death? | Chronic pseudomonoas infections, pancreatic insufficiency, and other GI complications. 30yo. |
| MC type of lung cancer? | Non-small cell (includes SCC, adenocarcinoma, large cell CA, and broncheoalveolar cell CA) |
| Lung cancer with lowest smoking assoc'n? | Adenocarcinoma |
| Staging for small cell lung CA? | Limited (confined to chest and supraclavicular nodes) vs Extensive (outside chest and supraclavicular nodes) |
| Staging for non-small cell lung CA? | TNM system |
| Which lung cancers are usually centrally located? | SCC (subset of non-small cell) and small cell lung CA |
| Which lung cancers are usually peripherally located? | Adenocarcinoma and large cell carcinoma |
| In which type of lung cancer is cavitation seen on CXR? | SCC |
| Which type of lung cancer can be associated with pulmonary fibrosis/scars? | Adenocarcinoma |
| Which type of lung cancer tends to narrow bronchi by extrinsic compression and has characteristic wide-spread metastases? | Small cell |
| Single well-circumscribed nodule seen on CXR with no assoc'd mediastinal or hilar LN involvement. | Solitary pulmonary nodule |
| Management of solitary pulmonary nodule is suspicion of malignancy is high (pt >50yo and/or smoker)? | Surgical resection. (Perform transthoracic needle aspiration biopsy or fiberoptic bronchoscopy to rule out malignancy if suspicion is intermediate or surgical risk is high.) |
| Management for pt with benign solitary pulmonary nodule? | CXR or CT scan every few months initially--> every six months |
| Sign of benign solitary pulmonary nodule? | Stable size for 2+ years (malignant ones grow rapidly within months) |
| SVC syndrome most commonly occurs with which type of lung cancer? | Small cell |
| Findings in SVC syndrome? | Facial fullness, facial and arm edema, dilated vv over anterior chest/arms/face, JVD |
| Pain, upper extremity wekaness due to brachial plexus invasion, Horner's syndrome. What kind of tumor? | Pancoast's tumor; usually SCC |
| MC sites of lung cancer mets? | Brain, bone, adrenal glands, liver |
| Name the lung neoplasm associated with the following paraneoplastic syndrome: SIADH | small cell |
| Name the lung neoplasm associated with the following paraneoplastic syndrome: ectopic ACTH secretion | small cell |
| Name the lung neoplasm associated with the following paraneoplastic syndrome: PTH secretion | SCC |
| Name the lung neoplasm associated with the following paraneoplastic syndrome: hypertrophic pulmonary osteoarthropathy (severe long bone pain) | Adenocarcinoma and SCC |
| Name the lung neoplasm associated with the following paraneoplastic syndrome: Eaton-Lambert (similar to myasthenia gravis presentation) | small cell |
| Sputum cytology is only reliable for which type of lung neoplasm? | Central tumors (unable to diagnose peripheral lesions) |
| What does a stippled or eccentric pattern of calcification indicate in a lung mass? | malignancy (benign lesions tend to have a central laminated calcification) |
| What should you always do for intrathoracic lymphadenopathy? | Perform a biopsy |
| Tx for non-small cell lung CA (SCC, adeno, large cell, bronchoalveolar)? | Surgery. (Radiation as adjunct.) |
| Tx for small cell lung CA? | Chemo. (Radiation and surgery not that useful.) |
| MCC mediastinal mass in older pts? | Metastatic cancer, esp lung |
| Test of choice for mediastinal mass? | Chest CT |
| Management of pt with asymptomatic mediastinal mass and a CT suggestive of benign lesion? | Observation |
| Only reliable radiographic findings for a benign lung lesion? | Lack of growth for at least 2 years and a distinctive central laminated calicification pattern |
Created by:
sarah3148
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