Lung Nodules

Question 1

What are the features of a benign lung nodule?

Answer 1

1. Young
2. Non smoker
3. Small
4. CXR: dense, central or popcorn calcifications
5. Very slow doubling time

Question 2

What does TNM stand for?

Answer 2

Tumor, nodes, metastasis

Question 3

What are the characteristics of a malignant lung nodule?

Answer 3

1. Older patient
2. Smoking hx
3. Larger size
4. CXR: shaggy border (speculated), pleural stranding
5. Rapid doubling time

Question 4

Squamous cell lung cancer

Answer 4

1. Rapidly growing non small cell

2. Forms cavitary lung lesions, often central

Question 5

Adenocarcinoma

Answer 5

1. Most common non small cell
2. Affects women and non smokers
3. Slow growing with peripheral nodules
4. Most commonly associated with paraneoplastic syndromes

Question 6

Common sites for lung cancer mets

Answer 6

Liver, adrenal glands, brain, bone

Question 7

Ddx for cavitary lung lesions

Answer 7

TB, squamous non small cell carcinoma, aspergillosis, Wegeners

Question 8

Ddx of anterior mediastinal mass

Answer 8

Thymoma, thyroid, teratoma, terrible lymphoma

Question 9

Pancoasts tumor

Answer 9

1. In lung apex, affects nerve roots

2. Hornets syndrome: MAP: miosis, anhydrosis, ptosis

Question 10

Infectious causes of lung nodules

Answer 10

1. TB, atypical mycobacterium, coccidiomycosis: cause granulomas
2. Bacterial abcess ( mouth flora)
3. PCP
4. Aspergillus

Question 11

Non-malignant causes of lung nodules

Answer 11

1. Infection
2. Benign neoplasm
3. Vascular
4. Developmental (cyst)
5. Inflammatory ( RA, sarcoid, Wegener’s)

Question 12

If metastasis are detected, what stage are they at?

Answer 12

Stage 4 lung cancer–> palliative care

Question 13

In a patient with hoarseness and B sx, what may be going on?

Answer 13

Mass compressing recurrent laryngeal nerve

Question 14

Is there a mortality benefit from lung cancer screening?

Answer 14

1. Not CXR, but maybe CT

Question 15

What is the differential for massive hemoptysis?

Answer 15

1. Lung cancer
2. Vasculitis
3. Pulmonary AVN
4. TB

Question 16

What is the most common primary bronchogenic carcinoma?

Answer 16

Adenocarcinoma

Question 17

Key features of small cell lung cancer

Answer 17

1. Acute onset
2. Association with smoking hx
3. Illness and constitutional SX
4. Central location
5. History of muscle weakness

Question 18

How is small cell lung cancer treated?

Answer 18

1. Cisplatin chemotherapy

2. Prophylactically radiate brain to prevent mets

Question 19

What should adenocarcinoma be investigated for?

Answer 19

1. Mutations: EGFR, ALK, ROS-1

2.

Question 20

If a malignant pleural effusion is present, what stage is the lung cancer?

Answer 20

Stage 4!