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Path 15 Lung
LECOM Path Ch 15 Lung
| Question | Answer |
|---|---|
| Cell that secretes surfactant | type II pneumocyte |
| Bronchioles lack this vs Bronchi | cartilage and submucosal glands |
| Resorption atelectasis is caused by | blocked airpassage |
| Mediastinum shifts ____ resorption atelectasis | towards |
| Mediastinum shifts ____ compression atelectasis | away from |
| Only non-reversable atelectasis | Contractive |
| 2 causes of pulmonary edema | hemodynamic and microvacsular injury |
| Heavy, wet lungs, engorged alveolar capillaries, hemosiderin laden macrophages in alveoli Dx and most common cause | increased hydrostatic pressure and L sided heart failure |
| ALI or ARDS also called | Non-cardiogenic pulmonary edema |
| Histological hallmark of ARDS | diffuse alveolar damage |
| Finding in ARDS after DAD | alveolar hyaline membranes |
| This cell proliferates during resolution of ARDS | type II pneumocyte |
| Presence of these 2 factors implicate endolethium damage in ARDS | endothelin and von Willebrand factor |
| 4 signs implicating epithelial damage in ARDS | blebing, frank necrosis, swelling, vacuolization |
| Cell implicated in damaging lungs in ARDS | neutrophil |
| 4 common causes of ARDS | sepsis, diffuse pulmonary Infx, Gastric aspiration, trauma |
| What do type II pneumocytes give rise to, to re-line the epithelium | type I cells |
| X-ray finding in ARDS | diffuse bilateral infiltrates |
| Acid-base status in ARDS | respiratory acidosis |
| Idiopathic rapidly progressive widespread ALI Name? Age? | Acute Interstitial Pneumonia 50yo |
| Increase in resistance to airflow due to partial or complete obstruction Dx? | Restrictive airway disease |
| Reduced explansion of lung parenchyma and decreased total lung capacity | restrictive disease |
| 4 prototypical obstructive pulmonary diseases | emphysema, chronic bronchitis, asthma, bronchiectasis |
| Grouped to make COPD | emphysema and chronic bronchitis |
| Most causative agent of COPD | cigarette smoking in 90% of Pts but only 10% of smokers develop COPD |
| Restrictive Lung Disease: Total lung capacity | decreased |
| Restrictive Lung Disease: Residual volume | decreased |
| Restrictive Lung Disease: FEV1 sec | decreased |
| Restrictive Lung Disease: FVC | decreased |
| Restrictive Lung Disease: FEV1sec/FVC | normal to increased |
| Restrictive Lung Disease: PaO2 | decreased |
| Restrictive Lung Disease: A-a gradient | increased |
| Obstructive Lung Disease: FEV1sec | decreased |
| Obstructive Lung Disease: FVC | decreased |
| Obstructive Lung Disease: FEV1sec/FVC | decreased |
| Obstructive Lung Disease: PaO2 | decreased |
| Obstructive Lung Disease: A-a gradient | increased |
| Obstructive Lung Disease: Residual Volume | increased |
| Obstructive Lung Disease: Total lung capacity | increased |
| Irreversible enlargement of airspaces distal to the terminal bronchiole accompanied by destruction of their walls WITHOUT obvious fibrosis | emphysema |
| 3 associations with emphysema | cigarette smoking, women, blacks |
| MC type of emphysema | Centriacinar 95% |
| Central or proximal parts of acini affected, sparing distal alveoli Dx | centriacinar emphysema |
| Anatomical location most affected in centriacinar emphysema | upper lobe/apical |
| Walls of centriacinar type emphysema contain ? | black pigment |
| Uniformly enlarged acini from respiratory bronchiole to terminal aalveoli | Panacinar emphysema |
| Anatomical location most affected in panacinar emphysema | lower anterior / bases |
| Panacinar emphysema associated with: | α1-antitrypsin deficiency |
| Centriacinar emphysema is associated with: | heavy smoking |
| Anatomical location most affected in Paraseptal /distal acinar emphysema | upper half/ along the plura |
| Associated with paraseptal/distal acinar emphysema: | spontaneous pneumothorax |
| Anatomical with irregular emphysema: | scarring |
| Location of α1-antitrypsin gene | Chromosome 14 Pi loci |
| Hypothesis of pathogenesis of emphysema | too much neutrophil/protease too little α1-antitrypsin |
| 3 early finding of emphysema | Increase (SIG) smooth muscle, inflammatory cells, Goblet cells |
| 3 most common causes of death from emphysema | respiratory acidosis/coma; right sided heart failure: massive collapse of lungs from pneumothorax |
| Thin, tripoding Pt, with increased AP diameter, dyspneic, breathing through pursed lips Dx and name | emphysema; pink puffer |
| Emphysema can lead to this cascade w/ poor prognosis | cor pulmonale then congestive heart failure from pulmonary HTN |
| 2 collateral routes for filling from behind an obstruction | pores of Kohn, and canals of Lambert |
| Large apical subplural blebs larger than 1cm Dx | Bullus Emphysema |
| Filling of stroma/mediastinum /subcutaneous tissue with air from torn alveoli Dx? | interstitial emphysema |
| Persistent cough w/ sputum x 3 months in at least 2 years, without other cause | Chronic bronchitis |
| Earliest feature of Chronic bronchitis | hypersecretion of mucus in lare airways w/ hypertrophy of submucosal glands in trachea and bronchi |
| Physiologic cause of early chronic bronchitis Sxs | hypersecretion/obstruction in small airways |
| Reid index; describe | ratio of thickness of mucus gland layer to thickness of wall between epithelium and cartilage |
| Normal Reid index and increased or decreased in chronic bronchitis | 0.4; increased in chronic bronchitis |
| Lymphocytes in airways, enlargement of mucus glands in trachea and bronci Dx | Chronic bronchitis |
| Heavyset smoker Pt, Hypercapnia, hypoxia, mild cyanosis Dx and name | chronic bronchitis; Blue Bloater |
| Age of onset: Bronchitis ; Emphysema | Bronchitis: 40-45 Emphy.: 50-75 |
| Cough: Bronchitis ; Emphysema | Bronchitis: Early-lots of sputum Emphy.: late- little sputum |
| Infections Bronchitis ; Emphysema | Bronchitis: Common Emphy.: Occasional |
| Respiratory Insufficiency in : Bronchitis ; Emphysema | Bronchitis: Repeated Emphy.: Terminal |
| Cor Pulmonale in : Bronchitis ; Emphysema | Bronchitis: Common Emphy.: Rare, terminal |
| Radiograph findings: Bronchitis ; Emphysema | Bronchitis: prominent vessels and big heart Emphy.: hyperinflation and small heart |
| MC type of asthma and type of hypersensitivity reaction | Atopic Asthma; Type I IgE-mediated |
| Pt with negative RAST, respiratory distress common with viral Infx | Non-Atopic Asthma |
| Child, chronic rhinitis, and nasal polyps, respiratory distress and urticarial. What was the Pt given? | Asprin |
| Cell implicated in atopic asthma as being hypersensitive and cytokines produced by them | TH2; IL-4, IL-5, IL-13 |
| 2 difinitive mediators of acute asthma | leukotrienes CDE and acetylcholine |
| Chromosome and gene linked to asthma | Chromosome 5q; IL13 genes |
| BUZZ: Curshman spirals Dx and what are they | asthma, spiral mucus plug with shed epithelial cells |
| Lungs with numerous eosinophils with Charcot-Leyden crystals Dx and what are they | Asthma, granules collect to form galectin-10 crystals |
| 5 characteristics of asthmatic “airway remodeling” | - thickening of wall – deposition of collage I and III under BM collagen IV- increased vascularity – hyper-plasia –trophic mucus glands and bronchial smooth muscle |
| 2 bugs mostly found in children w. bronchiectasis | H. flu, and Pseudomonas Aeruginosa |
| Irreversible dilation of bronchi and bronchioles | bronchiectasis |
| 4 usual bacteria causing bronchiectasis | mycobacterium tuberculosis, Staph aureus, H. flu, Pseudomonas |
| 3 viruses causing bronchiectasis | adenovirus, influenza, HIV |
| Fungi causing bronchiectasis | Aspergillus |
| Most common underlying cause of bronchiectasis in USA | cystic fibrosis |
| Kartagener Syndrome cause and 3 associations | missing/short dynein arm in cilia; bronchiectasis, sinusitis, situs inversus |
| Most common area affected by bronchiectasis | lower lobes |
| X-ray: browded bronchial markings extending to periphery Dx? | bronchiectasis |
| Severe, persistent cough in a CF Pt, copious bloody foul smelling sputum Dx | bronchiectasis |
| Growth factor that is implicated as the “driving factor” in IPF and cell that releases it | TGF-β1; type I pneumocyte |
| Cobblestoned pleural surface of lung, lower lobe predominant fibrosis in subpleural regions and interlobular septa | IPF |
| Patchy interstitial fibrosis of different age, with fibroblastic foci | IPF |
| Dense fibrosis forming cystic spaces lined by hyperplastic Type II pneumocytes. BUZZ? | honeycomb fibrosis; IPF |
| Chronic interstitial inflammation, large amount of lymphocytes in uniform or patchy distribution | NSIP cellular pattern |
| Diffuse or patchy interstitial fibrosis without honeycombing, fibroblastic foci, or temporal heterogeneity | NSIP fibrosing pattern |
| Pt: Cough, dyspnea X-ray: peribronchial patchy airspace consolidation Micro: polypoid plugs of loose connective tissue in alveolar ducts Dx? And BUZZ? | Cryptogenic Organizing Pneumonia and Masson Bodies |
| Effects of this inhaled substance are significantly increased by contaminant tobacco smoking | asbestos |
| Simple CWP affects which regions preferentially | upper lobe and upper portion of lower lobes adjacent to respiratory bronchioles |
| Coal macule and noodule Micro and difference | carbon-laden marcrophages; nodule has delicate network of collagen fibers |
| Dilation of adjacent alveoli, ccentrilobular emphysema, with collections of carbon-laden macrophages w/ delicate collagen network Dx? | simple CWP with centrilobular emphysema |
| Multiple lesions >2cm in upper lobes with necrotic centers, surrounded by dense collagen and dark pigment Dx and cause ? | Complicated CWP or PMF in coal workers |
| What does CWP make Pt’s more susceptible to? | really nothing has been proven (maybe emphysema?) |
| FA Blue: Dust cell ? | alveolar macrophage with carbon in it |
| Most prevalent chronic occupational disease in the world? | silicosis |
| Pt with new job as Sand blaster for 6 mo with abundant lipoprotein rich material in alveoli diagnosed with alveolar proteinosis. What is the real Dx? | Acute Silicosis |
| Mine worker died from blunt force trauma to the head Autopsy: tiny, discrete pale->blackened nodules in the upper lungs Dx? | early chronic Silicosis |
| FA Blue: Eggshell calcifications in hilar LNs Dx? | Silicosis |
| PMF: massive upper lobe nodules, concentric layers of hyalinized collagen surrounded by dense capsule of more condensed collagen. How to Dx the cause? | polarized microscopy shows birefringent silica particles |
| Silicosis: 3 characteristic findings | fibrotic lesions in hilar LNs, Eggshell calcifications, birefringent particles in nodules |
| Silicosis increases Pt’s susceptibility to ? | tuberculosis and CA? |
| Silica particles are said to release this from macrophages, initiating fibrosis | TNF |
| Typical Silico-tuberulosis nodule appearance | Collagenous nodule with central caseation |
| More common? Amphibole or serpentine asbestos | Serpentine |
| More pathogenic? Amphibole or serpentine asbestos | amphibole |
| Lung carcinoma increase w/ asbestos exposure | 5 fold |
| Lung carcinoma increase w/ asbestos esposure and smoking | 55 fold |
| Diffuse pulmonary interstitial fibrosis is Dx. How to tell if asbestos is responsible? | presence of asbestos bodies |
| Describe asbestos body microscopically | golden-brown fusiform or beaded rods, translucent center and iron positive |
| Single asbestos body found in biopsy of Diffuse pulmonary interstitial fibrosis. Pathogenic? | No, common in normal people |
| Ferruginous body? What is it? | iron-protein coated inorganic inhaled particulates |
| Fibroblastic foci with varying degrees of fibrosis, progressing to honeycomb areas. DDx? | UIP and asbestosis |
| Better prognosis UIP or NSIP? | NSIP |
| Region preferentially affected by asbestosis | lower lobes and subpleural |
| Most common finding in asbestos exposed patients? What is it composed of? | pleural plaques of collagen and often calcium |
| MCC of Pleural plaques? | asbestos exposure |
| Pleural plaques are made of and contain what? | collagen and calcium, NO ASBESTOS BODIES |
| Increased risk of mesothelioma with asbestos exposure? | 1000 fold |
| What is more common with asbestos exposure | lung carcinoma and mesothelioma |
| What is more common in Asbestos +smoking than just asbestos | lung carcinoma (not mesothelioma) |
| X-ray: irregular, bilateral lower lobe linear densities, and circumscribed density over R hemidiaphragm Dx? And cause? | asbestosis and pleural plaque from asbestos exposure |
| Sarcoidosis is Dx by? | exclusion; r/o other granulomatous diseases |
| Sarcoidosis is driven by this cell and the cytokines it releases | CD4+ Helper T-cells; IL-2, IFN-γ |
| Typical description of sarcoid lesion in any tissue | noncaseating granuloma with tightly clustered epi-cells and Langhan or foreign body giant cells |
| Mikulicz syndrome | bilateral sarcoidosis of parotid/submaxillary/sublingual glands |
| Sarcoid Pt cc? x-ray? | SOB, cough, hemoptysis, CP; Bilateral hilar lymphadenopathy |
| Pt with cough, night sweats and fatigue, hilar and mediastinal LA with some calcifications. Broch biopsy shows giant cells, non-caseating granuloma, Schaumann and asteroid bodies Dx? | sarcoidosis |
| 3 findings consistent with Hypersensitivity Pneumonitis | interstitial pneumonitis w/ lymphs, plasma cells and macrophages; noncaseating cranuloma; interstitial fibrosis |
| What type(s) of hypersensitivity reaction is Hypersensitivity Pneumonitis | Type III and IV |
| Farmers Lung, what is responsible? | actinomyces spores |
| This attracts eosinophils | IL-5 |
| Irregular shaped shadows in lung fields on CT scan, thickened alveolar septa from infiltrates of eosinophils, peripheral eosinophilia, no noted vasculitis, fibrosis, or necrosis | Simple pulmonary eosinophilia |
| Rapid onset Fever, dyspnea, hypoxemic respiratory failure, diffuse lung infiltrates of >255 Eos. Dx and Tx? | Acute eosinophilic pneumonia w. respiratory failure; corticosteroids |
| Focal cellular consolidation of peripheral lung substance, lymphs and eos in alveoli and septal walls, F, night sweats, dyspnea Dx and Tx? | Chronic eosinophilia pneumonia and Corticosteroids |
| Numerous smokers’ macrophages in the airspace w/ iron and lamellar bodies made of surfactant, thickened alveolar septa with lymph infiltrates and plump cuboidal pneumocytes lining the septa | Desquamative Interstitial Pneumonia DIP |
| DIP without the pneumocyte destruction and hypertrophy | respiratory bronchiolitis-associated interstitial lung disease |
| Bilateral, patchy, asymmetrical pulmonary opacifications, lavage reveals acellular granular PAS+ in alveolar contents Dx? | PAP Pulmonary Alveolar Proteinosis |
| Pulmonary infarcts usually affect what part of the lung 75% | lower lobes |
| Emboli vs post mortem clot differentiation | Lines of Zahn; white lines |
| Physical finding in PE | friction rub |
| Pulmonary BP is usually what ratio of normal BP? | 1/8 |
| Pulmonary HTn is Dx at what PBP/SBP ration? | 1/4 |
| 5 classification of Pulmonary HTN | Pulm. Arterial HTN; P-HTN w/ L heart disease; P-HTN w/ lung disease/hypoxemia; P-HTN 2* multiple emboli; and misc. P-HTN |
| Changes in pulmonary arteries with P-HTN | medial hypertrophy, intimal fibrosis, arteriosclerosis, more prominent in the arterioles. |
| Lesions in certain P-HTNs with tufts of capillary formation spanning lumens | plexifor lesion |
| Mutation in this gene coding for a receptor lead to a common cause of P-HTN | BMPR2 |
| Major causes of secondary P-HTN | hypoxemia and respiratory acidosis |
| Goodpasture Syndrome most common in age? Sex? | 10-20yo males |
| Cause of Goodpasture Syndrome | autoantibodies to the α3-chain of collagen IV |
| Necrotizing hemorrhagic interstitial pneumonitis, 20yo white male smoker Dx? And what happens next? | Goodpasture; renal failure |
| Linear deposits on basement membrane of septal walls w/ necrosis of alveolar walls | Goodpasture |
| 10yo boy, cough, hemoptysis, anemia, diffuse pulmonary infiltration, blood in alveoli, no anti-basement membrane antibodies Dx? | Ideopathic pulmonary hemosiderosis |
| Hemoptysis, bronch biopsy: poorly formed granulomas and capillaritis Dx? | Wegner granulomatosis |
| MCC of acute, typical community acquired pneumonia? Describe | Strep Pneumonia; gram + “lancet” diplococci |
| MCC of exacerbation of COPD | H. flu |
| Child had “the flu” and started to feel a little better, then came down with patchy lobular consolidation on CXR. Child very sick with fibrin-rich exudate Dx? Describe | H. influenza; pleomorphic gram - rod, IgA protease, attachment pili |
| H. Influenza in the blood, capsulated or no? | yes |
| Second most common bacterial cause of COPD exacerbation | Moraxella Cattarrhalis |
| Child has the flu, then pneumonia. X-ray shows empyema. Most likely cause. | Staph Aureus |
| Alcoholic, pneumonia, thick gelatinous sputum Dx? And Description | Klebsiella pneumonia; Gram negative |
| Pneumonia in CF Pt, yellow-green sputum | Pseudomonas aeruginosa |
| Kidney transplant Pt, visits trashy uncle with crappy AC. Gets deadly pneumonia Dx? | legionella pneumophila |
| 4 stages in order for lobar pneumonia? | congestions, red hepatization, grey hepatization, resolution |
| MCC of community acquired atypical pneumonia | Mycoplasma pneumonia |
| Red/blue congested area of lung, with smooth pleura, and interstitial inflammation, mostly lymphs | atypical pneumonia |
| Children get what influenza type(s) | B, C |
| Deadly bird flu serotype | H5N1 |
| 2 MC groups of Hospital-Acquired Pneumonias | Enterobacteriaceae, Pseudamonas, Staph. Aureus |
| 2 common results of aspiration pneumonia | death or abscess |
| 2 common Gram + causes of lung abscess formation | Strep family and Staph Aureus |
| Most frequent mode of introduction of abscess forming bacteria to the lung | aspirations |
| Most likely causative organisms of post-pneumonia abscess | Step Pneumoniae, Staph. Aureus, K.pneumoniae |
| Typical presentation of aspiration abscess | R sided singular |
| Typical presentation of post-pneumonia | multiple, basal, scattered |
| Fungi found along the Ohio/Mississippi river and in the Caribbean | Histoplasma |
| Fungi found in the central and southeastern united states | Blastomyces |
| Fungi found Southwest, Far west, and Mexico | Coccidioides |
| Fungi from bird or bat dropping | Histoplasma |
| Difference in Dx of Coccidioides and Histoplasma | intra-macrophage Dx of small thin walled yeast for histoplasma and large, thick walled, non-budding sphere filled with endospores for Coccidioides |
| Epitheliod cell granuloma in apex of lung, undergoing caseating necrosis DDx? | Coccidioides and histoplasma |
| Tree-bark appearance of healed granuloma in lung | histoplasma |
| Granuloma with caseating necrosis, large spere with endospores in macrophages on biopsy Dx? | Coccidioides |
| Granuloma with caseating necrosis, small, thin walled yeast in macrophages on biopsy. Dx? | Histoplasma |
| Suppurative granuloma with extracellular thick walled round budding yeast with a nuclei on biopsy Dx? | Blastomyces |
| Viral pneumonia in immunocompromised host | CMV |
| Opportunistic fungal infection in Immunocompromised | Pneumocystis jiroveci |
| Opportunistic bacterial pneumonia in immunocompromised | Mycobacterium avium-intracellulare |
| Common type of infection of HIV Pt at CD4 >200 | bacterial and tuberculosis |
| Common pneumonia in HIV when CD4 <200 but >50 | Pneumocystis jiroveci |
| Common pneumonia in HIV when CD4 <50 | CMV and M.avium-intracellulare |
| MCC of early lung transplant infections | bacteria |
| MC timeframe for lung transplant infection? | 3-12 months |
| MC fungal infections in post lung transplant Pt? | Candida and aspergillus |
| Lung transplant Pt, biopsy with lymphs and plasma cells around small vessels and in the submucosa Dx? | Acute rejection |
| Lung transplant Pt, Biopsy: dissufe patchy fibrous occlusion of small airways, with very little inflammatory cells. Dx and type? | bronchiolitis obliterans and chronic rejection |
| 90-95% of lung tumors are carcinomas MCC of cancer mortality world wide | lung cancer |
| Lung Cancer presentation age | 40-70; peak 50-60 |
| Lung tumor of smokers shows this preference for gene mutation | G:C>T:A in the p53 gene |
| MC malignancy in those exposed to asbestos | lung cancer |
| 5 oncogenes common in lung cancer | c-MYC, c-MET, c-KIT, KRAS, EGFR |
| 4 common deletions or inactivations in lung cancer | p53, RB1, p16(INK4a), loci on 3p |
| MC mutations in small cell lung cancer | 3p(100%), RB(90%), p53(90%) BCL2(90%) |
| MC mutations in non-small cell lung cancer | p16(INK4a) (70%), p53(50%) |
| C-KIT: how is it altered in majority of lung cancers | overexpressed not mutated |
| Gene altered in familial clustering of lung cancer | CPY1A1 |
| Lung cancer in a non-smoker. Sex? Type? Mutations present? And absent? | Women; adenocarcinoma; EGFR mutation; lack KRAS and p53 changes |
| MC form of lung cancer in women | adenocarcinoma |
| 2 MC lung cancers in men | adenocarcinoma, squamous cell carcinoma |
| 2 MC types of lung cancer in smokers | squamous cell and small cell |
| Small Cell carcinoma Mets likely? Response to chemo? | highly metastatic; high initial response to chemo |
| Non-Small cell carcinoma Mets likely? Response to chemo? | less often metastatic; less responsive to chemo |
| Cancer in peripheral lung most likely | adenocarcinoma |
| Squamous cell carcinoma: early or late extra-thoracic metastasis? | late |
| 5 most common mets location for primary lung cancer, in order | hilar lymph nodes, adrenals, liver, brain, bone |
| Most Common Lung Cancer | Metastatic |
| 2 common positive substances in adenocarcinomas of the lung | muscin and TTF-1 |
| Adenocarcinoma: size? Mets rate? | Small, slow growing; metastasize widely and early |
| Type of adenocarcinoma with better outcome | “Scar” bronceoalveolar type |
| KRAS mutation, think this type of lung cancer | adenocarcinoma |
| Female, non-smoker, Asian. Lung cancer Dx. Type and mutation common? | adenocarcinoma and EGFR |
| Peripheral lung nodule made of columnar, peg shaped cells, that were spreading across the pre-existing lung architecture. The tumor was removed surgically. Dx? And likelihood of the Pt surviving? | non-mucinous broncioalveolar carcinoma. Excellent 5 year prognosis |
| Lobar pneumonia on x-ray. Biopsy: tall, columnar cells, with cytoplasmic and intra-alveolar muscin growing along alveolar septa without destruction. Dx? And 5-year prognosis post surgery? | Mucinous broncheoalveolar carcinoma, poor surgical candidate |
| Man, smoker, central cavitary lung tumor. MCC? | Squamous cell carcinoma |
| Squamous cell carcinoma. Most likely stain positive for what? | p53 |
| MC mutation in squamous cell carcinoma? | p53 |
| Overexpression with no mutation of this can be seen in 80% of squamous cell carcinoma | EGFR |
| Lung mass with cells staining positive for keratin. Darkly eosinophilic cytoplasm. Dx? | squamous cell carcinoma |
| 2 histologic hallmarks of squamous cell carcinoma | keratinization and or intercellular bridges. |
| MC genetic changes in Small cell carcinoma | p53 and RB1 mutations, high levels of BCL2 |
| Small cell carcinoma stains positively for this “CD” and the reason? | CD57; neuroendocrine origin |
| Small cell carcinoma: how aggressive? Mets? Surgical candidate? | most aggressive; widely metastasizing; not likely cureable by surgery |
| Lung mass biopsy: ill defined boarder, “salt and pepper pattern” chromatin, cells in clusters, extensive necrosis Dx? And another characteristic finding w/ stain? | small cell carcinoma; basophilic vascular walls from DNA of apoptosed cells, “Azzopardi effect” |
| Small Cell: smoking associated? | very highly associated: 99% are smokers |
| Lung mass biopsy: cells with large nuclei, prominent nucleoli, moderate amount of cytoplasm, no glands, no squamous cells. Dx? | Large Cell Carcinoma |
| P53, RB1, high levels of BCL2, neuroendocrine stains+, and organoid/ palisading/ rosette/ trabecular growth patterns. Dx? | Large cell carcinoma |
| Venous congestion and edema of head, neck, and arm Dx and cause? | superior vena cava syndrome; invasive lung carcinoma into superior vena cava |
| Bronchioloalveolar carcinoma: invasive? Metastatic? | non-invasive: non-metastatic: kills by suffocation if not resected |
| Tumor <2cm, no pleura/mainstem involvement | T1a |
| Tumor 2-3 cm, no pleura/mainstem involvement | T1b |
| Tumor 3-5cm or mainstem involcemnt 2cm from carina | T2a |
| Tumor 5-7cm or lobar atelectasis | T2b |
| Tumor >7cm | T3 |
| Tumor involving any surrounding pleura, entire lung atelectasis, or nodules in same lobe | T3 |
| Tumor with nodules in different ipsilateral lobe | T4 |
| Tumor invading any other organ or structure | T4 |
| N0 | no mets |
| N1 | ipsilateral hilar or peribronchial node involvement |
| N2 | ipsilateral mediastinal or sub-carinal nodes |
| N3 | any supraclavicular/scalene node or contralateral hilar or peribronchial node |
| M0 | No distant mets |
| M1a | contralateral lobe/pleura nodule/ malignant effusion/ |
| M1b | distant mets |
| Stage Ia | T1 N0 M0 |
| Stage Ib | T2 N0 M0 |
| Stage IIa | T1 N1 M0 |
| Stage IIb (1) | T2 N1 M0 |
| Stage IIb (2) | T3 N0 M0 |
| Stage IIIa (1) | T1-3 N2 M0 |
| Stage IIIa (2) | T3 N1 M0 |
| Stage IIIb (1) | Any T N3 M0 |
| Stage IIIb (2) | T3 N2 M0 |
| Stage IIIb (3) | T4 Any N M0 |
| Stage IV | Any T Any N M1 |
| Increased ACTh or ADH points to which lung cancer? | Small Cell |
| Hypercalcemia points to which lung cancer? | Squamous cell |
| Lung tumor in someone younger than 40, non-smoker Think___ | neuroendocrine, carcinoid |
| Collar-button lesion Dx? | carcinoid tumor |
| Finger-like mass in main stem bronchi, with intact mucosa overlying, Biopsy: uniform round nuclei, moserate eosinophilic cytoplasm, no necrosis, 1 mitoses per 10hpf Dx? | typical carcinoid tumor |
| Finger-like mass in main stem bronchi, with intact mucosa overlying, Biopsy: uniform round nuclei with prominent nucleoli, moderate eosinophilic cytoplasm, necrotic foci, 5 mitoses per 10hpf Dx? | atypical carcinoid tumor |
| Carcinoid tumor with Sxs: diarrhea, flushing, and cyanosis Dx? Also seen with? | Carcinoid syndrome; Small and Large cell carcinomas |
| Lung with multiple discrete tumors throughout, peripheral and central. Dx? | metastatic lung cancer |
| Mutations common in mesothelioma | Chromosomal deletions 1p,3p,6q,9p, or 22q EVEN Q |
| Mesothelioma prognosis | 50% dead in 1 year, rare to live 2 years |
| Positive stain of acid mucopolysaccharide, and perinuclear keratin stain, long microvilli on EM Dx? | mesothelioma |
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csheck
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