2022 Pulmo Residents Exam

Question 1

What is the most common PRIMARY malignant diaphragmatic lesion? (Brant 4th ed., p. 525)

Answer 1

fibrosarcoma

Question 2

Most common primary rib malignancy?

Answer 2

Chondrosarcoma

Question 3

Most common malignant soft tissue neiplasm of chest wall

Answer 3

Fibrosarcoma & Liposarcoma

Question 4

What is the most sensitive method for detecting enlarged hilar lymph nodes and masses? (Brant 4th ed., p. 360)

Answer 4

Helical CT

Question 5

What is the most common mediastinal germ-cell tumor? (Webb pp. 683-695)

Answer 5

Mature teratoma

Question 6

Which of the following thoracic lymph node station is most commonly involved in active tuberculosis? (Webb p. 762)

Answer 6

Right paratracheal

Question 7

Which of the following is the most common complication of the diffuse pattern of fibrosing mediastinitis? (Webb p. 765)

Answer 7

Superior vena cava obstruction

Question 8

What is the most common primary mesenchymal tumor of the esophagus? (Webb p. 800)

Answer 8

Leiomyoma

Question 9

What is the most common mechanism of pulmonary edema? (Brant 4th ed., p. 396)

Answer 9

change in the normal Starling forces

Question 10

Most common carcinoma to contain central necrosis and cavitation? (Webb 3rd ed p. 360)

Answer 10

Squamous cell

Question 11

What is the MOST COMMON cause of intrathoracic compression of fetal lungs? (Brant 4th ed., p. 1136)

Answer 11

congenital diaphragmatic hernia

Question 12

What is the most common cause of massive pleural effusion in the neonate? (Brant 4th ed., 1151)

Answer 12

Chylothorax

Question 13

What is the most common benign tracheal tumor? (Webb p. 1778)

Answer 13

Squamous cell papilloma

Question 14

Which are the two most common organisms implicated in chest wall abscesses? (Brant 4th ed., p. 518)

Answer 14

Staphylococcus and Mycobacterium tuberculosis

Question 15

Indirect signs of lobar atelectasis, except?

Answer 15

ANS: Displacement of interlobar fissure

Shifting granuloma
Bronchovascular crowding
Ipsilateral diaphragm elevation

Question 16

The following are true about rounded atelectasis EXCEPT: (Brant 4th ed., p. 350)

Answer 16

ANS: The round or wedge-shaped mass forms an obtuse angle with the pleura

It develops when pleural adhesions form in the resolving phase of effusion
It may be seen in any condition associated with an exudative (proteinaceous) effusion

It is most closely associated with asbestos-related pleural disease

Question 17

This pattern refers to a network of curvilinear opacities that usually involves the lungs diffusely: (Brant 4th ed., p. 352):

Answer 17

Reticular

Question 18

According to Brant 4th ed., p. 357, the following are characteristics of an air cyst, EXCEPT:

Answer 18

ANS: thin wall <1 mm thick

most do not have a true epithelial lining
well-circumscribed intrapulmonary gas collection
wall >1 mm thick

Question 20

What is the minimum amount of fluid needed to detect pleural effusion if lateral decubitus view is used? (Brant 4th ed., p. 361):

Answer 20

5 mL

F L U I D (5 letters, 5 ML, lateral decubitus)

Question 21

Traumatic herniation of abdominal contents through a tear of the hemidiaphragm usually occurs in what location? (Brant 4th ed., p. 525)

Answer 21

left side

Question 22

Which atelectatic lung segment produces the S sign of Golden? (Brant 4th ed., p. 360)

Answer 22

Right upper lobe

Question 23

Perihilar “bat-wing” consolidation is seen most commonly in the following conditions, EXCEPT: (Webb 2nd ed., p. 37)

Answer 23

ANS: Drug injury

pulmonary edema
pneumonia
inhalation injury

Question 24

Resorption atelectasis is the same as which kind of atelectasis? (Webb 2nd ed., p. 46)

Answer 24

obstructive atelectasis

Question 25

Which is NOT listed as an indication for MR of the thorax? (Brant 4th ed., p. 327)

Answer 25

ANS: Evaluation of middle mediastinal masses

Indicated:
-Staging of lung cancer patients who can’t receive iodinated contrast
-Evaluation of aortic disease
-Evaluation of mediastinal, vascular, and chest wall invasion of lung cancer

Question 26

“Miliary” nodular parenchymal opacities of what size? (Brant 4th ed., p. 347)

Answer 26

<2 mm

Question 27

Which of the following refers to lymph nodes that are located above the horizontal line at the upper rim of the brachiocephalic vein where it ascends to the left? (Fraser p. 71)
*

Answer 27

Highest mediastinal

Question 28

The following are contents of the middle mediastinum, EXCEPT? (Fraser p. 76)

Answer 28

ANS: Descending aorta

Part of middle mediastinum:
- Brachiocephalic vein
- Phrenic nerve
- Vagus nerve

Question 29

Which of the following is FALSE regarding mediastinal lines and interfaces? (Fraser pp. 76-78)

Answer 29

ANS: As the two lungs approximate anteromedially, they are separated by two layers of pleura and intervening mediastinal adipose tissue, forming the anterior junction line.

The aortopulmonary window consists of the space between the aortic arch and the left pulmonary artery.

The normal maximal width of the right paratracheal stripe is 4 mm.

The azygoesophageal recess is formed by the contact of the right lower lobe with the esophagus and ascending portion of the azygos vein.

Question 30

Which of the following thoracic nodal stations is NOT included in the 1-2-3 pattern of lymphadenopathy in sarcoidosis? (Webb p. 751)

Answer 30

Ans: Left paratracheal

1-2-3 pattern:
Right paratracheal
Right hilar
Left hilar

Question 31

Which of the following is the most common complication of the diffuse pattern of fibrosing mediastinitis? (Webb p. 765)

Answer 31

Superior vena cava obstruction

The most common cause of this rare condition is granulomatous infection, usually secondary to Histoplasma capsulatum.

The hallmarks of chronic fibrosing mediastinitis are chronic inflammatory changes and mediastinal fibrosis.

Question 32

Which of the following best describes bronchogenic cysts? (Webb pp. 777-783)

Answer 32

Highly proteinaceous cyst content is common.

Bronchogenic cysts are foregut duplication cysts and result from abnormal development of the lung bud. They are lined by pseudostratified ciliated columnar epithelium, typical of bronchi. The cyst wall may also contain smooth muscle, mucous glands, or cartilage.

Question 33

Which of the following describes a pericardial cyst? (Webb pp. 786-788)

Answer 33

It reflects a defect in the embryogenesis of the coelomic cavity.

Pericardial cyst reflects a defect in the embryogenesis of the coelomic cavity. The wall of a pericardial cyst is composed of connective tissue and a single layer of mesothelial cells. Most patients are asymptomatic.
On plain radiographs, pericardial cysts are smooth and sharply marginated (Fig. 7.56A). Approximately 90% of pericardial cysts contact the diaphragm, with 65% occurring in the right cardiophrenic angle and 25% in the left cardiophrenic angle. In this location, they sometimes are seen to extend into the major fissure, having a lenticular shape on lateral chest films. Ten percent of pericardial cysts do not touch the diaphragm and are seen at higher levels, contiguous with the proximal aorta or pulmonary arteries.

Question 33

Imaging feature/s of hiatal hernia: (Webb pp. 808-809)

Answer 33

• Convexity of the lower aspect of the azygoesophageal recess
• Increased amount of fat surrounding the distal esophagus
• Dehiscence of the diaphragmatic crura

Hiatal hernia represents a protrusion of a portion of the stomach through the esophageal hiatus. The esophageal hiatus is an elliptical opening just to the left of the midline, corresponding superiorly to the level of the 10th thoracic vertebral body. It is margined on each side by the diaphragmatic crura. Variation in the normal appearance of the crura is common.
In patients with hiatal hernia, chest radiographs show characteristic findings of convexity of the lower aspect of the azygoesophageal interface, sometimes with a similar convexity of the preaortic recess in a retrocardiac location. Air or air and fluid may be seen in association with this convexity. On the lateral view, a retrocardiac opacity may be seen but is usually less conspicuous.
In a patient with sliding hiatal hernia, the most common CT abnormality identified is dehiscence of the diaphragmatic crura, visible as widening of the esophageal hiatus on cross- section, with projection of a portion of the stomach into the mediastinum. The width of the esophageal hiatus, defined as the distance between the medial margins of the crura, has a maximum normal value of 15 mm. Sliding hiatal hernias are frequently associated with an increase in the amount of fat surrounding the distal esophagus, secondary to herniation of omentum.

Question 34

Which of the following lesions is considered pathognomonic for von Recklinghausen disease? (Webb p. 833)

Answer 34

Plexiform neurofibroma

Plexiform neurofibroma represents an extensive fusiform or infiltrating mass along the course of the sympathetic chains or mediastinal or intercostal nerves (see Figs. 7.68 and 7.70). It is considered pathognomonic of von Recklinghausen’s disease. As with localized nerve sheath tumors, plexiform neurofibromas often appear low in attenuation compared to muscle, with CT numbers ranging from 15 to 20 HU on unenhanced scans. They are often multiple and lobulated, have ill-defined margins, and tend to surround mediastinal vessels with loss of normally visible fat planes. They can closely mimic the appearance of extensive mediastinal lymph node enlargement. Calcification and contrast enhancement can be seen.

Question 35

The following findings are consistent with extramedullary hematopoiesis in the mediastinum, EXCEPT: (Webb pp. 842-843)

Answer 35

ANS: Often multiple, bilateral, and cephalad to the 6th thoracic vertebra

• May be of homogeneous soft tissue attenuation or may show areas of fat attenuation
• Paravertebral masses in patients with severe anemia caused by inadequate production or excessive destruction of blood cells
• Well marginated
• Extramedullary hematopoiesis can result in paravertebral masses in patients with severe anemia caused by inadequate production or excessive destruction of blood cells. It can be seen in the presence of thalassemia, hereditary spherocytosis, and sickle cell anemia. These masses are of unknown origin but may arise from herniations of vertebral or rib marrow through small cortical defects or may arise from lymph nodes or elements of the reticuloendothelial system.
  Lobulated paravertebral masses, usually multiple and bilateral and caudad to the sixth thoracic vertebra, are typically seen (Fig. 7.75). They appear well marginated. On CT, the paravertebral masses are of homogeneous soft tissue attenuation (30 to 65 HU) or may show areas of fat attenuation (−50 HU), which may increase in extent after treatment.

Question 36

What is NOT a cause of pulmonary volume overload? (Brant 4th ed., p. 398)

Answer 36

Ans: mitral valve stenosis

Causes of volume overload:
ventricular septal rupture
renal failure
overhydration

Question 37

50/F at the ER 48 hours after motor vehicular crash with dyspnea and confluent ground glass opacities on x-ray. What is your diagnosis? (Brant 4th ed., p. 400)

Answer 37

fat embolism

The embolization of marrow fat to the lung is a common complication occurring 24 to 72 hours after the fracture of a long bone such as the femur. Within the lung, the fat is hydrolyzed to its component fatty acids, causing increased pulmonary capillary permeability and hemorrhagic pulmonary edema. Radiographically and on CT, confluent ground-glass and airspace opacities are seen (Fig. 12.6). The diagnosis is made by recognizing findings of systemic fat embolism (petechial rash, CNS depression) and pulmonary changes in the appropriate time period following trauma. Most patients have a mild course with minimal respiratory compromise, whereas a minority will develop progressive respiratory failure leading to death.

Question 38

40/M presents with sinus disease, renal disease, and bilateral cavitary nodules on x-ray. What is your diagnosis? (Webb 2nd ed., p. 524)

Answer 38

Wegener’s granulomatosis

• Granulomatosis with polyangiitis (GPA), formerly referred to as Wegener granulomatosis, is a systemic autoimmune disorder characterized pathologically by a necrotizing granulomatous vasculitis involving the upper and lower respiratory tracts and kidneys. The characteristic lesions in the lungs are discrete nodules or masses of granulomatous inflammation with central necrosis and cavitation. The lesions involve pulmonary vessels, accounting for the high incidence of central necrosis and for the occasional presentation with pulmonary hemorrhage. Mucosal and submucosal lesions may be present in the tracheobronchial tree and are seen almost exclusively in women.
• Most patients with GPA are middle-aged, with a slight male predominance. The respiratory tract is affected in 100% of patients, with symptoms usually dominated by sinus and nasal mucosal involvement. Pulmonary involvement may be asymptomatic or manifested by cough, dyspnea, or chest pain. Presentation with pulmonary hemorrhage and hemoptysis may mimic other pulmonary–renal syndromes such as Goodpasture syndrome and idiopathic pulmonary hemorrhage. Renal involvement usually follows involvement of the respiratory tract and is seen in almost 90% of patients.

Question 39

Which of the following is true regarding pulmonary infarcts? (Webb 2nd ed. p. 657)

Answer 39

Ans: does not exhibit air bronchograms

With some causes of consolidation, air bronchograms may not be visible. This usually occurs because of central bronchial obstruction (e.g., by cancer or mucus) or filling of bronchi in association with the underlying pathologic process. For example, pulmonary infarction often results in consolidation without air bronchograms because of blood filling the bronchi. In patients with bronchopneumonia, bronchi may be filled with mucus or pus.

Question 40

What is considered the gold standard for DVT detection? (Webb 2nd ed., p. 657)

Answer 40

contrast venography

Question 41

Which is NOT a characteristic finding in chronic pulmonary embolism? (Webb 2nd ed., 672)

Answer 41

Ans: central in location

• concentric with contrast in vessel center
• has small linear defects or “webs”
• adherent to vessel wall

CTPA is an excellent study for the evaluation of patients with suspected chronic PE, and several CT findings are specifically suggestive of chronic thromboembolic disease. Histopathologically, chronic pulmonary emboli usually are organizing thromboemboli and typically are adherent to the vessel wall. Therefore, chronic emboli are eccentric in location and usually appear as a smooth or sometimes nodular thickening of the vessel wall on CT studies (Fig. 27.15). When an artery is seen in cross section, the chronic emboli may appear to involve one wall of the vessel, may be horseshoe shaped, or may occasionally appear concentric, with contrast in the vessel center, an appearance that likely reflects recanalization
2184
of a previously occluded vessel. Chronic emboli occasionally may calcify, and the main pulmonary arteries may be dilated because of associated pulmonary hypertension. Additionally, small linear filling defects, or “webs” (Fig. 27.16), are indicative of chronic PE.

Question 42

Which of the following is FALSE regarding pulmonary arterial hypertension?

Answer 42

AOTA are true:
- Defined as resting mean pulmonary arterial pressure (mPAP) ≥ 30 mm HG with exercise
- Defined as resting mean pulmonary arterial pressure (mPAP) ≥ 25 mm HG at rest
- Its characteristic findings is dilation of the central pulmonary arteries with rapid tapering of the pulmonary vessels as they course peripherally

Question 43

23/M presents with hemoptysis, anemia, and hematuria. HRCT shows consolidation and ground-glass opacities. What is your diagnosis? (Webb 2nd ed., p. 520-521)

Answer 43

Goodpasture syndrome

Question 44

Which of the following is FALSE regarding pulmonary hypertension and its relationship with COPD? (Webb 2nd ed., p. 692-693)

Answer 44

ANS: it results from hypoxic vasoconstriction with a decrease in resistance in the pulmonary arterial vasculature
- it occurs when there is intimal thickening with a reduction in pulmonary vascular cross sectional area
- pulmonary vascular remodeling is implicated in its pathogenesis

The histopathological changes associated with pulmonary hypertension associated with COPD include pulmonary vascular remodeling, including intimal thicken- ing with a reduction in pulmonary vascular aoss sectional area.
V/Q mismatching is the primary mechanism of hypox- emia in COPD, and regional alveolar hypoxia physiologically results in hypoxic vasoconstriction and increased resistance in the pulmonary arterial vasculature.

Question 45

Which of the following is TRUE regarding tumor embolization? (Webb 2nd ed., p. 696-697)

Answer 45

As many of 25% of patients with a solid malignancy may have microemboli in the pulmonary circulation

Question 46

Which of the following is FALSE regarding parasitic embolization? (Webb 2nd ed., p. 697-698)

Answer 46

Ans: Pulmonary infarction is a common sequela

• X-rays show small nodules, representing parasitic granulomas
• Cardiopulmonary schistosomiasis most often is the result of Schistosoma mansoni
• Patients present with right heart failure, dyspnea, and cough.
  -Chest radiography in patients with parasitic embolization shows ndings consistent with pulmonary hypertension. Small nodules, representing parasitic granulomas, may be evident. Pulmonary infarction rarely is seen with parasitic embolization.

Question 47

Which is NOT an anatomic pitfall in the diagnosis of pulmonary embolism? (Webb 2nd ed., p. 672)

Answer 47

respiratory motion

pulmonary veins
lymph nodes
impacted bronchi
partial volume averaging of pulmonary arteries
pulmo arterial catheters
pulmo artery sarcoma

Question 48

A SPN encircled by a halo of ground-glass opacity is suggestive of (Brant 4th ed p.412)

Answer 48

invasive pulmonary aspergillosis

Size. Although size does not reliably discriminate benign from malignant SPNs, the larger the lesion, the greater the likelihood of malignancy. Masses exceeding 4 cm in diameter are usually malignant. However, the converse does not hold true; many pulmonary malignancies are less than 2 cm in diameter at the time of diagnosis, particularly if detected by screening chest CT. Nodules <6 mm in diameter have a less than 1% likelihood of malignancy even in high-risk patients, and, therefore, most radiologists will not recommend evaluation of such lesions unless there is a very high clinical likelihood of malignancy.

Margin (Border, Edge) Characteristics. The appearance of the margin (i.e., border or edge) of an SPN is a helpful sign in determining the nature of the lesion. The edge characteristics are best evaluated on thin-section CT, as this technique is considerably more accurate than plain radiographs. The margins of an SPN may be sharp or ill defined. A round, smooth nodule is most likely a granuloma or hamartoma, although a rare primary pulmonary malignancy such as a carcinoid tumor, adenocarcinoma, or a solitary metastasis may have a perfectly smooth margin. A notched or lobulated margin may be seen in hamartomas but malignant lesions including carcinoid tumors and some lung cancers will have a lobulated border. Pathologic examination has shown that the lobulated edge of a malignant nodule represents mounds of tumor extending into the adjacent lung. A spiculated margin is highly suspicious for malignancy (Fig. 13.1). The term corona radiata has been used to describe this appearance, in which linear densities radiate from the edge of a nodule into the adjacent lung. Pathologically, these linear radiations represent reoriented connective tissue (interlobular) septa drawn into the tumor by the cicatrizing (scarring) nature of many malignant lung tumors (Fig. 13.1C). Tumor extension from the nodule or fibrosis and edema of these connective tissue septa may thicken these linear densities. However, it has been shown that spiculation is not specific for malignancy, as benign processes that produce cicatrization can have an identical appearance. Benign lesions that have a spiculated border include lipoid pneumonia, organizing pneumonia, tuberculomas, and the mass lesions of progressive massive fibrosis in complicated silicosis. A peripherally situated pulmonary nodule may contact the costal pleura or interlobar fissure via a linear opacity known as a “pleural tail” (Fig. 13.2), which reflects pleural retraction associated with fibrosis related to the lesion and is not specific for malignancy. As with the corona radiata, the recognition of this line, while suggestive of malignancy (particularly adenocarcinoma), is not specific and may be seen in peripheral granulomas. An SPN with an ill-defined margin may be benign or malignant, with benign nodules usually reflecting a resolving inflammatory process.

The presence of small “satellite” nodules around the periphery of a dominant nodule is strongly suggestive of benign disease, particularly granulomatous infection. The identification of feeding and draining vessels emanating from the hilar aspect of an SPN is pathognomonic of a pulmonary arteriovenous malformation (AVM) (Fig. 13.3). A posttraumatic pulmonary artery pseudoaneurysm will show marked contrast enhancement and contiguity with the feeding artery on CT. The presence of a halo of ground-glass opacity encircling an SPN in an immunocompromised, neutropenic patient should suggest the diagnosis of invasive fungal infection. Finally, a nodule or mass adjacent to an area of pleural thickening with a “comet tail” of bronchi and vessels entering the hilar aspect of the mass and associated lobar volume loss is characteristic of rounded atelectasis.

Density. The density of an SPN is probably the single most important factor in characterizing the lesion as benign or indeterminate. In general, lesions that are calcified are benign. There are five patterns of calcification that when present in a solid nodule that is smooth or lobulated reliably indicates benignity. These patterns can be identified on
conventional radiography but thin-section CT is often necessary to detect and characterize the calcification. Complete, central, or peripheral rim-like calcification within an SPN is specific for a healed granuloma from tuberculosis or histoplasmosis. Concentric or laminated calcification indicates a granuloma and allows confident exclusion of neoplasm. Popcorn calcification within a nodule is diagnostic of a pulmonary hamartoma in which the cartilaginous component has calcified.

Question 49

Which of the following statements about bronchogenic carcinoma is false? (Brant 4th ed p.421)

Answer 49

The presence of a pleural effusion in patients with bronchogenic carcinoma is associated with a poor prognosis because it is synonymous with malignant pleural involvement.

it is not synonymous with malignant pleural involvement

The “CT angiogram” sign refers to the finding of enhanced PAs traversing consolidated regions which are produced by filling of the airspaces with mucoid material produced by malignant cells.

The presence of air bronchograms or bubbly lucencies within a nodule or mass or mixed solid/ground-glass attenuation is highly suggestive of an adenocarcinoma, particularly BAC

Question 50

According to the AJCC TNM staging (7th ed), when a mass is seen with tumor surrounding a main bronchus <2cm from the carina, what T is this? (Brant 4th ed p.424)

Answer 50

T3

Question 51

According to the AJCC TNM staging (7th ed), when lung cancer metastasizes to the contralateral hilar lymph nodes, what N is this?

Answer 51

N3

adapted from 8th ed.

Question 52

The doubling time refers to the time it takes for the volume of a nodule to double, which corresponds to a ___ increase in the diameter? (Brant 4th ed p.410)

Answer 52

25% (26% in 5th ed)

Question 53

Which of the following is a plain film finding specific for chest wall invasion?

Answer 53

Pleural thickening
Rib destruction

Question 54

The presence of which of the following findings suggest potential resectability of a lung mass?

Answer 54

Localized invasion of the mediastinal pleura or pericardium

Question 55

A 45/M heavy smoker underwent chest CT revealing a 8mm solitary pulmonary nodule in the left upper lobe. What is your recommendation based on the 2017 Fleischner Society Guidelines?

Answer 55

CT at 6-12 months, then at 18-24 months

Question 56

Most common carcinoma to contain central necrosis and cavitation? (Webb 3rd ed p. 360)

Answer 56

Squamous cell

Question 57

Which of the following commonly results in paraneoplastic syndromes? (Webb 3rd ed p. 366)

Answer 57

Small cell

Small cell carcinoma, a type of neuroendocrine tumor of the lung, accounts for 13% of bronchogenic carcinomas
and arises centrally within the main or lobar bronchi. These tumors are the most malignant neoplasms arising from bronchial neuroendocrine (Kulchitsky) cells and are alternatively referred to as Kulchitsky cell cancers or KCC-3. Typical carcinoid tumors (KCC-1) represent the least malignant type, with atypical carcinoid tumors (KCC-2) intermediate in aggressiveness. Small cell carcinomas exhibit a small endobronchial component invading the bronchial wall and peribronchial tissues early in the course of disease. This produces a hilar or mediastinal mass with extrinsic bronchial compression and obstruction. Invasion of the submucosal and peribronchial lymphatics leads to local lymph node enlargement (Fig. 13.12D) and hematogenous dissemination, which are almost invariable at the time of presentation. Microscopically, these malignant cells are tightly clustered with nuclei molded together because of the scant amount of cytoplasm. This lesion is distinguished from carcinoid tumor histologically by the presence of mitoses. Electron microscopy and immunocytochemistry demonstrate the presence of intracytoplasmic neurosecretory granules.

Question 58

On CT scan of a patient, there is a large hilar mass with pronounced mediastinal lymphadenopathy and peribronchial invasion. What is the most likely histopathology? (Webb 3rd ed p. 367)

Answer 58

Small cell

Question 59

Which of the following is most often associated with the “pleural tail” sign? (Webb 3rd ed p. 965)

Answer 59

Adenocarcinoma

Question 60

The following etiologies commonly result in calcified pulmonary metastases, EXCEPT: (Webb 3rd ed p. 502)

Answer 60

Renal cell carcinoma

Calcified pulmonary mets:
Mucinous adenocarcinoma
Thyroid carcinoma
Osteogenic sarcoma

Calcification of metastases occurs most commonly with osteogenic sarcoma, chondrosarcoma, synovial sarcoma, thyroid carcinoma, and mucinous adenocarcinoma (Fig. 5.5). Calcification may be dense, particularly with osteogenic sarcoma, mimicking a granuloma. Calcification may persist following successful chemotherapy despite resolution of the tumor.

Question 61

Which of the following lesions is likely malignant? (Webb 3rd ed p. 992)

Answer 61

Cavity with wall measuring more than 15mm

SPN measuring 2.5cm, and which contains fat
Mass within a cavity that moves with gravity
Air-fluid level in a cavitary SPN

Question 62

Which is NOT true about pulmonary edema in children? (Brant 4th ed., p. 1133)

Answer 62

ANS: It occurs when pulmonary arterial pressures are leveled because of left-sided myocardial failure.

Below are true:
- The most common cause in children is acute glomerulonephritis.
- It can occur in hypoplastic left heart syndrome.
- A noncardiogenic cause is increased intracranial pressure.

Question 63

In children, which of the following does NOT usually present with interstitial lung disease that predominates in the lower lobes? (Brant 4th ed., p. 1135)

Answer 63

Ans: chronic asthma

tuberous sclerosis
connective tissue disease
primary interstitial pneumonitis

Question 64

Which lung lobe is NOT commonly involved in congenital lobar hyperinflation/congenital lobar emphysema? (Brant 4th ed., p. 1139)

Answer 64

left lower lobe

right upper lobe
left upper lobe
middle lob

Question 65

Which is NOT TRUE regarding surfactant deficiency disease? (Brant 4th ed., 1144-1145)

Answer 65

Ans: Classically, infants present with lungs that are granular in pattern and large in volume.

small lungs, finely granular, w. air bronchograms

It occasionally occurs in full-term infants of diabetic moms.

Pneumothorax and pneumomediastinum are common complications of positive pressure ventilation.

Question 66

Which is true regarding meconium aspiration syndrome? (Brant 4th ed., p. 1148) . Resultant hypoxia can lead to ___

Answer 66

persistent fetal circulation

Question 67

Lobar pneumonia (Brant 4th ed., p. 435). inflammatory exudate begins with the ___ airspaces

Answer 67

distal airspaces

air bronchograms are common
spreads via pores of Kohn and canals of Lambert
significant volume loss is unusual

Question 68

Which is NOT TRUE regarding S. aureus pneumonia? (Brant 4th ed., p. 436)

Answer 68

ans: Air bronchograms are commonly seen

bcoz inflammatory exudate fills the airways, air bg are rarely seen

Empyema is a common sequela
Typically produces a bronchopneumonia
Pneumatocele is common in children

Staphylococcus aureus pneumonia is most common in hospitalized and debilitated patients. It may also develop following hematogenous spread to the lung in patients with endocarditis or indwelling catheters and in intravenous drug users. Community-acquired infection may complicate influenza or other viral pneumonias.
S aureus typically produces a bronchopneumonia and appears radiographically as patchy opacities (Fig. 16.3). In severe cases, the opacities may become confluent to produce lobar opacification. Because the inflammatory exudate fills the airways, air bronchograms are rarely seen. In adults, the process is often bilateral and may be complicated by abscess formation in 25% to 75% of patients. In patients who develop pulmonary infection from hematogenous seeding, one sees multiple bilateral poorly defined nodular opacities that even- tually become more sharply defined and cavitate. Parapneu- monic effusion and empyema are common. Pneumatocele formation is common in children and may lead to pneumotho- rax. Pneumatoceles may be distinguished from abscesses by their thin walls, rapid change in size, and tendency to develop during the late phase of infection.Air bronchograms are commonly seen

Question 69

What is NOT a common radiographic finding of Pseudomonas aeruginosa pneumonia? (Webb 2nd ed., p. 387)

Answer 69

lobar pneumonia

cavitation, bronchopneumonia patten
tree-in-bud or centrilobular

Chest radiographs show a pattern typical of bronchopneumonia, including segmental, often multifocal, patchy consolidation that favors the lower lobes. Pleural effusions may occur, as may empyema. Cavita- tion may also be seen (see Fig. 12-9). ‘free-in-bud or cen- trilobular nodules may be seen on HRCT (see Fig. 10-28C in Chapter 10). The pattern of P. aeruginosa infection is insufficiently specific to distinguish it from other causes of bronchopneumonia.

Question 70

What is the term used to refer to a combination of lung parenchymal and lymph node Mycobacterium tuberculosis infection? (Webb 2nd ed., p. 391)

Answer 70

Ranke complex

Question 71

What is NOT a common finding in primary tuberculosis? (Webb 2nd ed., p. 391)

Answer 71

Miliary pattern

Air-space consolidation of an entire lobe
No radiologic abnormalities
Right lung is more commonly affected than the left

Question 72

What is the earliest chest radiographic manifestation of P. jiroveci infection? (Webb 2nd ed., p. 413)

Answer 72

bilateral perihilar ground-glass opacity

Question 73

The imaging hallmark of this disease is excessive airway collapse on expiration. (Brant p. 491)

Answer 73

Tracheobronchomalacia

Question 74

Which is FALSE about tracheal and bronchial injury? (Brant p. 492)

Answer 74

Penetrating tracheal injuries usually involve the distal trachea

usually involve the cervical trachea

Exhibits the “fallen lung” sign
Diagnosis is suggested by presence of pneumothorax that fails to respond to chest tube drainage.
Horizontal laceration parallel to the tracheobronchial cartilage is the most common form of injury.

Question 75

. Cystic bronchial dilatation interrupted by focal areas of narrowing (Brant p. 494)

Answer 75

Varicose

Question 76

T or F

Flattening and depression of the hemidiaphragms and increased retrosternal airspace are seen more frequently in centrilobular emphysema than panlobular emphysema. True or False? (Brant p. 499)

Answer 76

False

Question 77

Considered the fundamental unit of lung structure because it is the smallest anatomic unit that can be clearly identified on HRCT and assessment of distribution of abnormalities within it can be helpful in the differential diagnosis of lung disease. (Fraser p. 12)

Answer 77

Secondary pulmonary lobule

Question 78

Lung disease exhibiting concentric lower lobe ground-glass opacity without honeycombing and with subpleural sparing (Webb p. 1462)

Answer 78

Nonspecific interstitial pneumonia

Question 79

Lung disease exhibiting honeycombing with a basal and subpleural predominance in the absence of a known disease or exposure. (Webb p. 1462)

Answer 79

Usual interstitial pneumonia/Idiopathic pulmonary fibrosis

Question 80

Autoimmune disorder characterized by necrotizing granulomatous vasculitis involving the upper and lower respiratory tracts and kidneys. The characteristic lung lesions are discrete nodules or masses with central necrosis and cavitation. Involvement of pulmonary vessels accounts for occasional presentation of pulmonary hemorrhage. (Brant p. 479)

Answer 80

Wegener Granulomatosis

Question 81

Geographic ground glass opacities superimposed upon thickened interlobular and intralobular septa or the “crazy paving” pattern. (Brant p. 484)

Answer 81

Pulmonary alveolar proteinosis

Question 82

Which is FALSE about saber-sheath trachea? (Webb pp. 1795-1802)

Answer 82

characterized by marked decrease in sagittal diameter of the intrathoracic trachea associated with an increase in its coronal diameter

dec coronal, inc sagittal

The ff are true:
during forced expiration, CT demonstrates further inward bowing of the tracheal walls
the main bronchi are of normal size
almost always associated with COPD

Question 83

Characterized by development of cartilaginous and osseous nodules within the submucosa of the tracheal and bronchial walls. Nodules tend to be localized to submucosa directly associated with the tracheal cartilage, sparing the posterior tracheal membrane. (Webb p. 1817)

Answer 83

Tracheobronchopathia osteochondroplastica

Question 84

Which is not part of the triad of Kartagener syndrome? (Brant p. 496)

Answer 84

ANS: high concentration of chloride on sweat test

bronchiectasis
sinusitis
situs inversus

Question 85

Answer 85

CHEST WALL LIPOMA

Question 86

Answer 86

LUFTSICHEL SIGN

Question 87

Answer 87

ATOLL SIGN
REVERSE HALO SIGN

Question 88

DIAGNOSIS

DIAGNOSIS

Answer 88

TUBEROUS SCLEROSIS
LYMPHANGIOLEIOMYOMATOSIS
RENAL ANGIOMYOLIPOMA

Question 89

KIND OF EMPHYSEMA

Answer 89

CENTRILOBULAR EMPHYSEMA

Question 90

Diagnosis

Answer 90

MOUNIER-KUHN SYNDROME
TRACHEOBRONCHOMEGALY

Question 91

Answer 91

KLEBSIELLA

Question 92

Answer 92

CONGENITAL DIAPHRAGMATIC HERNIA
MORGAGNI HERNIA

Question 93

Premature infant. Diagnosis?

Answer 93

BRONCHOPULMONARY DYSPLASIA

Question 94

DIAGNOSIS

Answer 94

PANLOBULAR EMPHYSEMA

Question 95

Answer 95

PULMONARY ARTERIAL HYPERTENSION

Question 97

13. What is the name of the pointed structures?

Answer 97

KERLEY LINES

Question 98

BENIGN OR MALIGNANT?

Answer 98

BENIGN

Question 99

WHAT SIGN?

Answer 99

HALO SIGN

Represents hemorrhage
angioinvasive aspergilosis
lung adenoCA

Question 100

what sign is depicted?

Answer 100

CT ANGIOGRAM SIGN

represents vessel traversing airless consolidated lung; seen also in lung adenoCA, mets)

Question 101

Answer 101

Feeding vessel sign

represents vessel leading to mass (e.g. septic emboli, pulmo infarct)

Question 102

Diagnosis

Answer 102

Achalasia

esophageal stricture?

Question 103

Diagnosis?

Answer 103

Mature teratoma

Question 104

Nodal station

Answer 104

7 (subcarinal)