1. Chest (Airways)

Question 1

Trachea - anatomy (2)

Answer 1

Posterior membrane can bow inward on expiration (normal).
Max diameter should be 2.5cm.

Question 2

Post intubation stenosis - features

Answer 2

Focal subglottic circumferential stenosis with hourglass configuration.

Question 3

Relapsing polychondritis - features (3)

Answer 3

Spares posterior membrane. No calcifications.
Diffuse thickening of trachea.
Recurrent episodes of cartilage inflammation and recurrent pneumonia.

Question 4

Wegener’s - features (3)

Answer 4

Circumferential thickening, can be long segment or focal.
No calcifications.
Subglottic involvement is common.

Question 5

Tracheobronchopathia Osteochondroplastica (TBO) - features (2)

Answer 5

Spares posterior membrane.
Cartilaginous and osseous nodules within the submucosa of trachea and bronchial walls.

Question 6

Amyloidosis - features (3)

Answer 6

Focal or short segment thickening.
Can involve posterior membrane.
Calcifications are common.

Question 7

Saber sheath trachea - features

Answer 7

Coronal diameter of less than 2/3 sagittal diameter.
Main bronchi will be normal size.
Tracheal wall will be normal thickness.

Question 8

Saber sheath trachea - trivia

Answer 8

Associated with COPD

Question 9

Tracheal tumours - types

Answer 9

Squamous cell,
Adenoid cystic,
Mets,
Squamous cell papilloma

Question 10

Squamous cell (trachea) - (3)

Answer 10

Most common.
Associated with smoking.
Often multifocal (10%).
Favours lower trachea/proximal bronchus.

Question 11

Adenoid cystic (trachea) - (3)

Answer 11

2nd most common.
Prefers upper, posterolateral trachea.
Varied appearance: thickening, mass or nodule

Question 12

Mets (trachea) -

Answer 12

Usually direct extension (lung, thyroid, oesophagus)

Question 13

Squamous cell papilloma (trachea) (2)

Answer 13

Commonest benign tumour.
Single papilloma - smoking. Multiple papillomas - HIV

Question 14

Cystic fibrosis - features (5)

Answer 14

Bronchiectasis (Progresses from cylindrical to varicoid).
Apical predominance.
Hyperinflation.
Pulmonary artery hypertension.
Mucus plugging (finger in glove).

Question 15

Primary ciliary dyskinesia - features (5)

Answer 15

Bilateral lower lobe bronchiectasis.
Chronic sinusitis from early age.
Impaired fertility.
Chronic mastoid effusions and conductive hearing loss.
50% have Kartagener’s syndrome

Question 16

Kartagener’s syndrome - features (2)

Answer 16

Primary Ciliary Dyskinesia & Situs Inversus

Question 17

Williams Campbell Syndrome - features (2)

Answer 17

Congenital cystic bronchiectasis.
Due to deficiency in cartilage in 4-6th order bronchi.

Question 18

Mounier-Kuhn (Tracheobronchomegaly)

Answer 18

Massive trachea (>3cm), not much else

Question 19

Bronchiolitis - Definition/types (3)

Answer 19

Inflammation of small airways.
Can be infectious (viral pattern in kids).
Can be inflammatory (asthma in kids, RB-ILD in smokers).

Question 20

Air trapping - imaging (2)

Answer 20

Areas of lung more lucent than others.
Technically can only be called on expiratory phase imaging.

Question 21

Air-trapping cause (2)

Answer 21

Bronchiolitis obliterans in setting of lung transplant.
Small airway disease (asthma or bronchiolitis)

Question 22

Tree-in-bud (4)

Answer 22

Associated with small airways disease.
Caused by dilatation and impaction of centrilobular airways.
These are centered 5-10mm from pleural surface, so that’s where tree-in-bud will be.
Usually associated with centrilobular nodules.

Question 23

Follicular bronchiolitis (3)

Answer 23

Inflammatory process, associated with RA or Sjogrens.
Poorly understood, related to lymphoid hyperplasia.
Centrilobular ground glass nodules with scattered bronchial dilatation.

Question 24

Constrictive bronchiolitis (3)

Answer 24

Due to viral illness, drugs, transplant or inhalation injury.
Secondary to mononuclear cells –> granulation –> plug the airway.
Air trapping on expiratory imaging.

Question 25

Aspiration pneumonia (4)

Answer 25

Favours posterior segment of upper lobes and superior segment of lower lobes if supine when aspirating.
Favours basal lower lobes if upright.
May favour right side, like ET tube.
Complications include empyema, which can cause broncho-pleural fistula.

Question 26

Aspiration of gastric acid

Answer 26

Airspace opacity. Can look like pulmonary oedema if massive

Question 27

Aspiration of water/neutralised gastric content

Answer 27

Fleeting opacity, resolves in hours

Question 28

Aspiration of bugs (often mouth bugs) (2)

Answer 28

Pneumonia,
Can get parapneumonic effusion, empyema or broncho-pleural fistula.

Question 29

Aspiration of oil (often mineral oil)

Answer 29

Lipoid pneumonia. Low density.