Anatomy and Physiology of the Central Nervous System, Exams of Nursing

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CNS + Respiratory

What are the common drugs given for CNS & lung cancers? - ANS -Antiemetics -Corticosteriods -Analgesics -Antianxiety -Anticolvusants Which drug is given to prevent nausea and vomiting? - ANS Antiemetics Which drug is given to reduce inflammation and sometimes for adrenal deficiency? - ANS Corticosteriods Which drug is given to relieve pain? - ANS Analgesics Which drug helps calm anxious patients and relieves muscle spasms? - ANS Antianxiety Which drug is given to control seizures? - ANS Anticovulsants Describe the difference between coplanar and non-coplanar. - ANS Non-coplanar (vertex field): -any time the treatment table is rotated -involves floor kick rotations Coplanar: -table does not move -deep margins line up in lung What is a condition caused by paralysis of cervical sympathetic nerves? - ANS Horner's syndrome

Which condition causes shrinking of eyeball, ptosis of upper eyelid, slight elevation of lower lid, constriction of pupil, and flushing of affected side of face? - ANS Horner's syndrome Which condition is pain resembling sudden shock? - ANS L'hermitte's syndrome Which condition is produced by flexing of neck with some cervical trauma? - ANS L'hermitte's syndrome Which of the following is not currently a standard technique for breast surgery and is done in extremely rare incidences? a) Axillary dissection b) Radical mastectomy c) Modified radical mastectomy d) Simple mastectomy e) Total mastectomy - ANS b) Radical mastectomy Which of the following statements is correct concerning arm placement for external radiation therapy to the breast? a) Raising the ipsilateral arm above the head makes it easier to match the deep margins of the tangential portals b) Raising the ipsilateral arm above the head decrease the volume to the heart c) Raising the contralateral arm higher than the ipsilateral arm will decrease the chance of over- irradiating the spine d) Raising the ipsilateral arm to match the superior border of the medial tangent in order to avoid divergence into the ipsilateral lung e) Raising the contralateral arm to the same level of the ipsilateral arm so that the match line from the supraclavicular portal will have the correct lateral fall off for the axillary lymph nodes - ANS b) Raising the ipsilateral arm above the head decrease the volume to the heart To avoid beam divergence into the lung by the tangential fields:

a) The central axes of the tangential fields can be separated by slightly more than 180 until the deep margins become parallel b) The central axes of the tangential fields are most often planned to be 180 degrees, parallel opposed to ensure adequate coverage of the underlying chest wall c) The collimator can be rotated to follow the slope of the chest wall d) The couch can be turned 5 degrees toward the collimator when the medial field is treated and 5 away from the collimator when the lateral field is treated e) A matchline at the supraclavicular region with asymmetrical jaws can be planned to divert the beam divergence from the underlying lung while giving beam homogeneity over the whole breast - ANS a) The central axes of the tangential fields can be separated by slightly more than 180 until the deep margins become parallel The incidence of intraductal carcinoma of the breast has increased due to a) Mammographic screening b) Increased use of MRI as a screening tool c) Fine needle aspirations d) Fatty diets and alcohol e) Feeling palpable masses in the breast - ANS a) Mammographic screening Internal mammary fields are usually treated with electron energy to deliver ________________ of the dose to _____________________. a) 80% and 4 cm b) 90% and 3 cm c) 90% and 4 cm d) 100% and 3 cm e) 85% and 5 cm - ANS c) 90% and 4 cm Concomitant chemo/radiotherapy regimens could be prescribed for all of the following EXCEPT:

a) Anus cancer b) Pancreatic cancer c) Ovarian cancer d) Esophageal cancer e) Rectal cancer - ANS c) Ovarian cancer Infiltrating and invasive breast cancer is diagnosed by a) Bloodwork and tumor markers b) ER/PR c) Her 2 neu expression d) Core biopsy e) All of the above - ANS d) Core biopsy The second most common nodal site for breast cancer is the a) Axillary nodes b) Supraclavicular nodes c) Post axillary nodes d) Internal mammary nodes e) Hilar nodes - ANS d) Internal mammary nodes A common drug given to males with carcinoma of the prostate is a) 5-FU b) Androgen deprivation c) Cisplatin d) Adriamycin e) Zolodex - ANS b) Androgen deprivation

When treating a left sided breast cancer, what is the most radiosensitive organ at risk? a) The brachial plexus b) The lung c) The heart d) The liver e) The esophagus - ANS b) The lung When treating an intact breast or chest wall, an important feature of the tangential field arrangement is a) Treatment of the medial tangent using the enface planning b) The deep border of the medial tangent and the deep border of the lateral tangent form a single plane c) The non-coplanar nature of the medial tangent and supraclavicular port d) Avoidance of junctional inconsistancy between the peripheral lymphatic fields e) c and d - ANS b) The deep border of the medial tangent and the deep border of the lateral tangent form a single plane A suspected infiltrating breast cancer, when imaged with ultrasound will have a a) Wider than tall hyper-echoic appearance b) Taller than wide hyper-echoic appearance c) Taller than wide hypo-echoic appearance d) Same width and length hypo-echoic appearance e) The same appearance as a breast cancer with micro-califications - ANS c) Taller than wide hypo- echoic appearance A 51 year old female goes for her yearly mammogram. The radiologist notices an area of micro califications at the 8 o'clock position of her left breast that were not present one year ago on the patient's annual mammo. The radiologist reads the mammo as a BIRADS 4.

The patient is recommended for an ultrasound to confirm the mammographic findings. Which is true? a) The lesion is hypoechoic with a wider than tall appearance b) The suspected area of cancer does not show up on the image because of the pathology c) The lesion will appear to be larger on ultrasound d) The ultrasound will be negative for any new growth so the patient will be referred for an MRI e) a and c - ANS b) The suspected area of cancer does not show up on the image because of the pathology Lymphedema of the arm may occur as a result of a) An acute radiation exposure during fractionated course of radiotherapy b) Axillary lymphatic obstruction c) A chronic radiation exposure to the brachial plexus d) Treated the supraclavicular nodes on the affected side e) All of the above - ANS b) Axillary lymphatic obstruction The total dose of external beam radiation, which includes whole breast tangential ports, chest wall, scar boost is in the range of: - ANS 60 to 65 Gy When discussing breast cancer screening guidelines, for women in their 20's and 30's, a clinical breast exam should be performed as a part of their periodic health examination at least every _________________. - ANS 3 years Using inspiration breath holds, cardiac treatment volumes have been shown to decrease by as much as __________%. - ANS 50% The rationale behind the use of the partial breast irradiation is that

a) It reduces the risk of dry and moist desquamation b) It requires less set-up time thereby limiting the amount of intrafraction movement. c) It removes the dependence on indexing a breast board d) Most recurrences occur in the immediate vicinity of the original tumor e) It removes the risk of over irradiating the contralateral breast due to overlap of the medial tangent across mid-line for further breast irradiation - ANS d) Most recurrences occur in the immediate vicinity of the original tumor What is the tissue origin of gliomas? - ANS Astrocytes Which cells are an important part of the BBB? - ANS Glioma (astrocytes) What is the normal tissue of origin of medullablastomas? - ANS Primitive neuroectodermal cell or PNETs Which cells are the most common malignant nervous system tumors of childhood? - ANS Neuroectodermal cells (Medullblastomas) Which cells are compromised of 3 distinct coverings that protect the brain and the spinal cord? - ANS Meninges What is the tissue origin of lymphomas? - ANS Lymphocyte and microglia Which cells help support neurons and phagocytize bacteria and cellular debris? - ANS Microglial cells Which cells produce a fatty insulating substance called myelin, which insulates and protects nerves outside the CNS? - ANS Schwann cells Which part of the brain includes interpertation of sensory impulses and voluntary muscular activities? - ANS Cerebrum

What is the center of memory, learning, reasoning, judgment, intelligence and emotions? - ANS Cerebrum What is the part of the brain that plays a role in the coordination of voluntary muscular movement? - ANS Cerebellum What is the most common primary site of disease responsible for brain metastasis? - ANS Lung Where do most metastatic lesions occur in the brain? - ANS Cerebral hemispheres What is the origin of primary CNS tumors? - ANS Unknown Which genes are associated with less than 5% of the etiology of brain tumors? - ANS NF1 and NF2 genes What are the 3 most important prognostic factors for CNS tumors? - ANS -Age -Performance status -Tumor type What is of great importance and serves as a natural prognostic indicator for survival time and neurological defects? - ANS Tumor location What measures the neurologic and functional status, which allows for measurements of the quantity of neurologic defects? - ANS Karnofsky performance scale The KPS ranges from _______ to ________, _________ indicating normal and _______ indicating dead. - ANS 0-100, 100, 0 Tumor __________ rather than _________ is the primary factor involved with prognosis. - ANS grade, size

Which process is caused by the action of enzymes and can also affect part of a structure or an organ? - ANS Necrosis _______________ is the death of a cell or cell group that results from disease or injury. - ANS Necrosis The ECOG performance scale ranges from ______ to ______, _______ indicating fully active and _______ indicating completely disabled. - ANS 0-5, 0, 5 Which tumor grade is the tissue benign, the cells look nearly like healthy brain cells, and they grow slowly. - ANS Grade I Which tumor grade is the tissue malignant, cells look less like healthy cells than do the cells in a grade I tumor? - ANS Grade II Which tumor grade does the malignant tissue have cells that look very different than healthy cells, and the abnormal cells are actively growing (anaplastic)? - ANS Grade III Which tumor grade does the malignant tissue have cells that look abnormal and tend to grow quickly? - ANS Grade IV Which components provide an outer covering of protection for the brain? - ANS Cranial bones, meninges, and CSF The ___________ are cavities that form a communication network with each other, the center of the canal of the spinal cord & subarachnoid space. - ANS ventricles The ventricles, canals, and subarachnoid space are all filled with _________, which provides buoyancy, protection, chemical stability, and prevention of brain ischemia. - ANS CSF Which cells line the choroid plexus and are responsible for secreting about 0.5 L of cerebral spinal fluid each day into the ventricles? - ANS Ependymal cells

The lateral ventricles are able to communicate with the third ventricle via the _______________, which is a small oval opening. - ANS interventricular foramen What are the 2 major intracranial compartments? - ANS Supratentorial and infratentorial regions What is a fold of dura mater that separates the supratentorial and infratentorial regions? - ANS Tentorium What acts as a line of separation between the occipital lobe of the cerebrum and the upper cerebellum?

• ANS Tentorium Which regions are located in the supratentorial region? - ANS -cerebral hemispheres -sella -pineal -upper brainstem Which regions are located in the infratentorial regions? - ANS -Upper spinal cord -Brainstem -Pons -Medulla -Cerebellum Which part of the CNS contains the supportive nerve cells and related processes? - ANS Grey matter Which part of the CNS is composed of bundles of nerve fibers, axons that carry impulses away from the cell body, and dendrites that carry impulses toward the cell body? - ANS White matter Where does the blood supply for the brain come from? - ANS internal carotid arteries and vertebral arteries via circle of Willis

The ______________ is the continuation of the medulla oblongata and forms the inferior portion of the brainstem. - ANS spinal cord What are nerve cells that convey impulses from the brain to the cord? - ANS Motor neurons Which system allows for communication between the spinal cord and various parts of the brain? - ANS Motor neurons At what level does the spinal cord terminate? - ANS L1-L Where is blood supplied to the spinal cord from? - ANS -Vertebral arteries -Radicular branches of the cervical, intercostal, lumbar, and sacral arteries What hinders the penetration of some substances into the brain and the CSF and exists between the vascular system and brian? - ANS Blood-brain barrier Substances that pass through the BBB must be _____________ and include ___________, ____________, and ____________. - ANS lipid-soluble -alcohol, nicotine, heroine Water-soluable substances need a ____________ to cross BBB via ________ _________. - ANS carrier molecule, active transport What is a clear, colorless fluid that resembles water? - ANS CSF What components is the CSF composed of? - ANS -Proteins -Glucose -Urea -Salts

What is a compound formed in the liver and excreted by the kidney? - ANS Urea What are the functional roles of CSF? - ANS -Buoyancy to protect brain -Link in control of chemical environment of CNS -Exchange of nutrients and waste products -Channel for intracerebral transport What is the major symptom of interruption in the flow of CSF? - ANS Intracranial pressure (ICP) What symptoms can ICP cause? - ANS -Headaches -Vomiting -Lethargy -Seizures -Neurologic symptoms How do gliomas metastasize? - ANS Local invasion What is the common route of spread for medullablastomas & primitive neuroectodermal tumors (PNETs)? - ANS Seeding via CSF into spinal and intracranial subarachnoid spaces How do drop metastasis occur via? - ANS CSF and can form secondary tumors Where can secondary seeding grow cause? - ANS Along nerve roots, causing pain or cord compression How can central nervous system tumors be characterized by their? - ANS Heterogeneity What can the initial symptom of a CNS tumor be? - ANS Headache (worse in morning) What are common presenting signs of CNS tumors? - ANS -Headache

-Seizures -Difficulty with gait, balance & ambulation -aphasia -hemiplegia -paresis -decreased vision -oculomotor defects -ptosis -ophthalmic defects -mental/personality changes -short-term memory loss -hallucinations etc What symptoms may patients with spinal cord tumors present with? - ANS -Pain -Weakness -Loss of sensation -Bowel/bladder control problems What do ICP symptoms include? - ANS -Headache -Nausea -Vomiting -Blurred vision -Trouble with balance -Personality/behavioral changes -Seizures -Drowsiness -Coma (rare)

What test is designed to check for papilledema? - ANS Ophthalmoscopy If a tumor occurs in the frontal portion of the brain, what symptoms are likely to occur? - ANS - Personality changes -Memory defects -Gait disorders -Speech difficulties If a lesion is in the parietal region of the brain, what symptoms are likely to arise? - ANS -Loss of vision -Spatial disorientation -Seizures What is the CT number of bone? - ANS + What is the CT number air? - ANS - What is the most important prognostic factor for CNS tumors? - ANS Histopathologic diagnosis What are most patients prescribed with to reduce swelling and subside any symptoms that may exist? - ANS Steroids What are side effects of steroid uses? - ANS -Weight gain -Increased appetite -Difficulty sleeping -Increased risk of infection -Changes in mood What is indicated for malignant tumors that are incompletely excised, inaccessible from a surgical approach, and associated with metastatic lesions? - ANS Radiation therapy

What are factors considered in determination of the doses for radiation therapy treatment? - ANS - Tumor type -Tumor grade -Patterns of recurrence The total dose of radiation therapy must be limited by healthy tissue tolerance because _______________ (tissue destruction). - ANS radiation necrosis Which reactions are early-delayed that occur a few weeks until up to 3 months after treatment? - ANS Acute reactions Which portal fields are used for treatment of whole brain for palliative reasons? - ANS Lateral portal fields What is the inferior margin of the whole brain field? - ANS May intersect the superior orbital ridge and EAM In the selection of field size for whole brain irradiation, ________ of flash or shine should be seen at the anterior, posterior, and superior borders of the field. - ANS 1 cm What is the standard approach palliative dose for whole brain treatment? - ANS 3000-4000 cGy in 10- fx's of 250-300 cGy/fx What is the most common treatment for medullablastoma? - ANS Craniospinal axis: -delivery of radiation needs to encompass entire brain & spinal cord The central axis of the brain field remains __________, whereas the field size ___________ to expand superiorly and inferiorly. - ANS constant, changes Which tumor volume is seen on the MRI, CT scan or other imaging studies? - ANS GTV

What is the central nervous system tissue with suspected microscopic tumor; that usually extends 1- cm beyond the GTV? - ANS CTV What is the margin beyond the GTV and CTV and accounts for factors such as internal organ motion, setup variation, and patient movement? - ANS PTV Which volume is enclosed by the desired prescription isodose line (greater than 95%) and contains the GTV, CTV, and PTV? - ANS Treated volume (TV) What is the tissue volume that receives a significant dose of radiation and contains GTV, CTV, and PTV? - ANS Irradiated volume (IR) What are the OAR's of the whole brain? - ANS -Lens of eye -Optic nerve -Optic chiasm -brainstem -parotid glands -spinal cord Because tumor cells have been found in edema of patient, the area should be included in the treatment field with a _____________ cm margin for malignant tumors. - ANS 1-3 cm What dose does temporary hair loss occur as a result of radiation treatments to the cranium? - ANS 2000-4000 cGy What are early-delayed reactions of CNS that can occur up to 3 months after treatment? - ANS - Drowsiness -Lethargy -Decreased mental status What is a complication that rarely occurs 6 months to many years after irradiation to the CNS? - ANS Radiation necrosis

What is the TD 5/5 of the whole brain? - ANS 4500-5000 cGy What is the TD 5/5 for the partial brain? - ANS 6000 cGy For whole brain radiation field setups, which bones are used for reference marks? - ANS Supraorbital ridge (SOM) and mastoid tip What is the TD 5/5 of the eye lens? - ANS 1000 cGy What is the TD 5/5 of the optic nerve? - ANS 5000 cGy What is the TD 5/5 of the parotid gland? - ANS 3200 cGy What are the drugs of choice for CNS neoplasms? - ANS -Carmustine -Procarbazine -Vincristine -Lomustine Which lipid-soluble, alkylating agent is developed especially for treatment of malignant gliomas and has been showed positive results especially for those with recurrent disease? - ANS Temozolomide Karnofsky performance status (KPS) is: a) A measure of biologic grade of tumor. b) A measure of the neurologic and functional status of the patient. c) Measured in cGy. d) Direct measurement of the chance of 5-year survival. - ANS b) A measure of the neurologic and functional status of the patient.

The purpose of the blood-brain barrier is to: I. Hinder the penetration of some substances into the brain and CSF. II. Protect the brain from potentially toxic substances. III. Protect the brain from radiation. IV. Prevent the passage of lipid-soluble or water-soluable substances into the brain. - ANS I and II Which of the following are important factors to consider in the initial workup for a definitive diagnosis of CNS neoplasms? a) Family and social histories. b) Changes in behavior or personality c) Difficulties with speech, memory, or logical thought processes d) All of the above - ANS d) All of the above Which of the following does not belong in this group? a) High-dose fractionation b) Increased intracranial pressure c) Edema d) Papilledema - ANS a) High-dose fractionation Surgery for CNS neoplasms can be limited by: a) Tumor location and extent b) Patient status c) Risk of causing neurologic defects. d) All of the above - ANS d) All of the above

The most common brain lesion is: a) Astrocytoma b) Glioma c) Metastatic d) Medullablastoma - ANS c) Metastatic Little is known concerning the _________________ development and growth mechanisms of CNS tumors. a) Etiology b) Dose response c) Effects of alcohol d) BBB - ANS a) Etiology Which of the following does not provide protection for the brain? a) Cerebellum b) Cranial bones c) Meninges d) CSF - ANS a) Cerebellum Weakened proximal pelvic muscles, impotence, bladder paralysis, and decreased knee jerk may be signs of a spinal tumor in the ________________ region. a) Cervical b) Upper thoracic c) Lower thoracic d) Lumbosacral - ANS d) Lumbosacral

Side effects from radiation treatment of primary brain tumors include all of the following except: a) Dry and moist desqumation b) Edema c) Hair loss d) Spinal cord damage - ANS d) Spinal cord damage What is a primary tumor of the lung that arises in the bronchi referred to as? - ANS Bronchogenic carcinoma What is the most common cause of lung cancer? - ANS Tobacco exposure What are the most significant prognostic factors for cancer of the respiratory system? - ANS 1) Stage/extent of disease

2. Clinical performance status (KPS)
3. Weight loss (greater than 5% over 3 months) What is a malignancy associated with asbestos exposure? - ANS Malignant mesothelioma What is primarily associated with the production of mesothelioma? - ANS Asbestos fibers inhaled: -mining -asbestos-material manufactoring & insulation -railroads -shipyards -pipe insulation -gas mask procedures Which cancers represent the most common invasive malignancies in the United States? - ANS -bronchial tree

-lung -pleural surfaces What variables is the dose-response consistency related to a higher incidence of lung cancers associated with? - ANS 1) increased duration of smoking

2. Increased use of unfiltered cigarettes
3. Increased number of cigarettes consumed The use of chewing tobacco, cigars, and pipes, including hookahs, is generally associated with a higher incidence of malignancies in the _____________ rather than the lung. - ANS upper aerodigestive tract Which occupational exposures is lung cancer also been associated with? - ANS -Fumes from coal tar -Nickel -Chromium -Arsenic exposure to radioactive materials Alpha emissions in their various daughter products, such as __________ and ____________ are especially dangerous. - ANS uranium, radon The Environment of Protection Agency estimates that __________ is the second leading cause in the U.S. - ANS radon What parts does the respiratory system consist of? - ANS Nose, pharynx, larynx, trachea, and both lungs What parts does the lower respiratory system consist of? - ANS Trachea and lungs The ___________ is the major airway in the thoracic cavity. - ANS trachea Where is the area of the lung in which the blood, lymphatic vessels, and nerves enter and exit each lung? - ANS Hilum

What organs are part of the mediastinum? - ANS -Heart -Thymus -Great vessels -Esophagus -Aorta Which structures are where tumor cells gain access to the circulatory system? - ANS Lung hila and carina What is the term for oxygen and carbon dioxide exchange to the external environment? - ANS Ventilation What is a respiratory unit composed of? - ANS -Bronchioli -Alveolar ducts -Alveoli What is the process of in which carbon dioxide exchanges take place at the cellular level as a result of changes in pressure? - ANS Internal respiration What is the order carbon dioxide is removed from the cells, returned to the venous system to the capillaries in the lungs, and exhaled through the respiratory units? - ANS 1) alveoli

2. alveolar ducts
3. bronchioli to external environment What is one of the principal routes of regional spread of lung cancer? - ANS Lymphatic system At many points, the lymphatics _______________ (connect) with pulmonary arteries and veins. - ANS anastomose Which system is the lung connected to? - ANS Circulatory system

Lymphatic drainage of the lungs meets with the cardiac flow at the lymph at the ____________. - ANS carina (T4-T5) From the bifurcation of the trachea, access to the circulatory system occurs as the flow enters the ______________ and ______________. - ANS thoracic duct, aorta Lymph nodes are associated with __________ and ___________ blood supplies. - ANS arterial, venous The signs and symptoms of lung cancer are difficult to differentiate from the symptoms of _________________ disease that often occur. - ANS chronic obstructive pulmonary What are clinical presentation features associated with lung cancers? - ANS 1) Local disease in the bronchopulmonary tissues

2. Regional extension to lymph nodes, chest wall, or neurologic structures
3. Distant dissemination What structures does regional extension of disease usually occur to? - ANS -Central mediastinum -Paratracheal -Parahilar -Subcarcinal lymph nodes What symptoms does regional extension of disease produce? - ANS -Pain -Coughing -Dyspnea -Abscess formation from obstructive pneumonia What symptom does esophageal compression cause? - ANS Dysphagia (difficulty swallowing) What does compression to the superior vena cava produce? - ANS Superior vena cava syndrome

What symptoms does superior vena cava syndrome produce? - ANS -Dyspnea -Facial, neck, arm edema -Orthopnea (inability to lie flat) -Cyanosis (blue tinge to lips) What symptom may occur as a result of compression or invasion of the recurrent laryngeal nerve? - ANS Hoarseness What may occur as a result of phrenic nerve involvement, which produces diaphragmatic paralysis? - ANS Dyspnea What symptoms does a patient with true Pancoast tumors in the superior sulcus? - ANS 1) pain around the shoulder and down the arm

2. atrophy of the hand muscles
3. Horner syndrome
4. Bone erosion of the ribs & sometimes vertebrae What symptoms does Horner's syndrome include? - ANS -ipsilateral miosis (contracted pupil) -ptosis (drooping eyelid) -enophtalmos (recession of eyeball in orbit) -anhidrosis (loss of facial sweating) Erosion of the ________ and _________ ribs may cause arm pain. - ANS first, second True or false: All apical tumors are Pancoast. - ANS False What symptoms is distant metastasis of lung cancer associated with? - ANS -Anorexia (loss of appetite) -Weight loss -Fatigue

Patients with lung cancer may have ____________ ____________ that are thought to represent distant manifestations of the effect of chemicals or hormones produced by these tumors. - ANS paraneoplastic syndromes What do symptoms of paraneoplastic syndrome affect? - ANS Nerves, muscles, and endocrine glands What is manifested by clubbing of the distal phalanges of the fingers and is associated with benign, long- standing chronic obstructive pulmonary disease, and may be seen as a presenting sign of lung cancer? - ANS Hypertrophic pulmonary osteoarthropathy Which individuals qualify for low-dose (LD) CT screening? - ANS Those between ages of 55-74 years with a history of smoking at least a 30-pack year, of currently smoking, or of having quit in the last 15 years What remains the principal method of lung cancer detection? - ANS Conventional chest x-ray examinations with PA and lateral projections At initial presentation of lung cancer, what do the most frequent findings include? - ANS -Solitary soft tissue lesion -Mediastinal widening from lymphatic extension -Parabronchial/parahilar lymphadenopathy -Pleural erosion What may long-standing obstructive pneumonias lead to? - ANS Abscess formation What do the steps in the evaluation of a CT scan of the chest include? - ANS 1) Primary finding

2. Possibility of other pulmonary lesions
3. Involvement of mediastinal and paramediastinal structures
4. Pleural or chest wall involvement What are frequently used for determining whether lesions are benign or malignant based on their metabolic activity? - ANS PET scans