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CHEST Flashcards

1
Q
  • Granuloma - Neoplasm (bronchogenic carcinoima, solitary met) - Hamartoma = Round pneumonia (under 8yo) = AVM
A

Solitary Pulmonary Nodule

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2
Q
  • Mets
  • Granulomas (TB or fungal)
  • Septic emboli
    = Wegener’s
    = Rheumatoid
A

Multiple Pulmonary Nodules

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3
Q
  • TB
  • Fungal disease
  • Sqaumous cell carcinoma
    = Pyogenic infection (abscess or septic emboli)
    = Wegener’s
    = Rheumatoid arthritis
A

Cavitary Pulmonary Nodule

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4
Q
  • TB - Fungal disease - Mets = Pneumoconioses = Healed Varcicella
A

Milary Pulmonary Nodule

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5
Q
  • Infectious bronchiolitis (MAC, TB) - Hypersensitivity pneumonitits - Endobronchial spread of tumor = RB-ILD = Pneumoconioses
A

Centrilobular Pulmonary Nodules

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6
Q
  • Emphysema - LAM - LCH/EG = Pneumocystis pneumonia = LIP
A

Cystic Lung Disease

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7
Q
  • Idiopathic pulmonary fibrosis/UIP - Collagen vascular dz (scleroderma) - Asbestos-related lung dz = drug toxicity
A

Lower Lobe Interstitial Disease

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8
Q
  • TB - Sarcoidosis - Cystic Fibrosis = Pneumoconioses = LCH
A

Upper Lobe Interstitial Disease

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9
Q
  • Chest wall abnormality (Polan, mastectomy) - Swyer-James - Acute asthma = Airway obstruction = PE = Pneumothorax
A

Hyperlucent Lung

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10
Q
  • Lymphoma - Thymic lesion - Thyroid lesion = Germ cell neoplasm (teratoma)
A

Anterior Mediastinal Mass

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11
Q
  • Lymphadenopathy - Vascular abnormality (aneurysm) - Congenital cyst / bronchogenic cyst = hiatal hernia
A

Middle Medistinal Mass

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12
Q
  • Neurogenic tumor - Lymphoma - Developmental cyst (neuroenteric cyst) = extramedullary hematopoiesis = mediastinal hematoma
A

Posterior Mediastinal Mass

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13
Q
  • Cryptogenic Organizing Pneumonia - Pulmonary Alveolar Proteinosis - Bronchioloalveolar Cell Carcinoma [BAC] = Chronic Eosinophilic Pneumonia = Lipoid Pneumonia
A

Chronic Airspace Disease

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14
Q
  • Cryptogenic Organizing Pneumonia - Eosinophilic Pneumonia - Pulmonary Infarction = Pulmonary Contusion = Alveolar Sarcoidosis
A

Peripheral Airspace Disease

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15
Q
  • Pulmonary edema - Atypical infection - Pulmonary hemorrhage = ARDS = Alveolar proteinosis = Vasculitis
A

Ground Glass Opacification

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16
Q
  • Infection - Lymphoma - Sarcoidosis = Mets = Pneumoconioses
A

Mediastinal/Hilar lymphadenopathy

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17
Q
  • Asbestos related pleural disease - Fibrothorax (prior infex or hemorrhage) - Iatrogenic (pleurodesis)
A

Calcified Pleural Disease

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18
Q
  • Postinfectious (bacterial, TB, MAC) - Cystic Fibrosis - ABPA = Obstructive lesion/mass = Ciliary dyskinesia
A

Bronchiectasis

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19
Q
  • Sarcoidosis - Lymphangitic spread of tumor - Pneumoconioses = Lymphoproliferative disorder
A

Perilymphatic Pulmonary Nodules

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20
Q
  • Pleural mets - Empyema - Mesothelioma = Fibrous tumor of the pleura = Fibrothorax
A

Pleural Based Mass

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21
Q
  • PCP - TB - Fungal infection = Invasive aspergillosis = Kaposi Sarcoma = Pulmonary lymphoma
A

Parenchymal Disease in an HIV patient

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22
Q
  • True LV aneurysm - False LV aneurysm - Pericardial cyst/ mass = Calcified pericarditis
A

Abnormal left ventricular contour

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23
Q
  • Thrombus - Mets - Benign Neoplasm (myxoma, rhabdomyoma) = Malignant neoplasm (sarcoma, lymphoma)
A

Cardiac mass

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24
Q
  • Infarction/scar - Myocarditis - Cardiac mass = Infiltrative disease (amyloid, granulomatous)
A

Delayed myocardial enhancement

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25
Q
  • Lipoma - Lipomatous hypertrophy of the interatrial septum - Arrhythmogenic RV dysplasia
A

Cardiac wall fatty deposit

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26
Q
  • Lymphangitic carcinomatosis - lymphoma - sarcoid - pulmonary edema
A

Unilateral interstitial lung disease

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27
Q
  • Histo - Healed varicella - silicosis
A

Multiple diffuse calcified nodules

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28
Q
  • Sarcoid (upper lobe) - EG (upper lobe) - UIP (lower lobe, idiopathic) - Asbestosis (lower lobe) - Pneumoconiosis (upper lobes) - Scleroderma (lower lobe)
A

Honeycombing

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29
Q
  • ABPA (asthmatics) - Noninvasive (normal people, fungus ball) - Semi invasive (mild immunosuppressed) - Invasive (very compromised, ill defined pulm nodules)
A

4 types of Asprergillus

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30
Q
  • PAP - BAC - lipoid pneumonia - Drug induced pneumonitis
A

Crazy Paving

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31
Q
  • COP - sarcoid - BAC - Eosinophilic pneumonia
A

Peripheral ground glass opacification

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32
Q
  1. Thymus (thymoma, carcinoma, thymolipoma) 2. Germ cell neoplasm (teratoma) 3. Lymphoma 4. Throid (goiter, cancer) 5. Vascular abnormality (aneurysm)
A

Anterior Mediastinal Mass

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33
Q
  1. Infection (fungal, bacterial) 2. Wegener’s ganulomatosis 3. Septic emboli 4. Cavitary Mets 5. Rheumatoid Nodules 6. Pulmonary lacerations
A

Multiple cavitary lesions

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34
Q
  1. Edema 2. Hemorrhage 3. Infection (PCP) 4. Hypersensitivity Pneumonitis 5. Drug Toxcicity/Inhalation
A

Ground Glass Opacities - Acute

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35
Q
  1. BAC 2. NSIP 3. LIP
A

Ground Glass Opacities - Chronic

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36
Q
  1. Neoplasm (squamous, adnoid cystic, mucoepidermoid) 2. Papillomatosis 3. Tracheopathica Osteoplastica 4. Saroidosis, Amyloidosis, Relapsing Polychondritis
A

Endotracheal mass

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37
Q
  1. Mesothelioma 2. Pleural Mets 3. Fibrous tumor of pleura 4. Lipoma 5. Empyema/loculated effusion 6. Infection / empyema necessitans
A

Pleual Mass

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38
Q
  1. Esophageal injury/rupture 2. Pulmonary/tracheal trauma 3. Rupture of bleb, asthma, severe coughing 4. Barotrauma 5. Surgery 6. Retropharyngeal infection
A

Pneumomediastinum causes

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39
Q
  1. UIP / IPF 2. CVD (scleroderma, rheumatoid) 3. Aspiration 4. Asbestosis 5. Durg toxicity (methotrexate, chemo, busulfan)
A

Basilar Fibrosis

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40
Q
  1. Sarcoidosis 2. Lymphoma 3. Mets 4. Small cell lung cancer 5. Infections (TB) 6. Castleman’s Dz
A

Bilateral hilar adenonopathy

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41
Q
  1. Miliary TB / Histo 2. Hematogenous mets (thyroid, renal) 3. Silicosis 4. EG
A

Small nodules, random distribution

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42
Q
  1. Neruogenic tumor (schwannoma, neurofibroma, paraganglioma, ganglioneuroma) 2. Hematoma 3. Abscess (Pott’s dz) 4. Vascular (aortic aneurysm) 5. Extramedullary hematopoesis
A

Posterior Mediastial Mass

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43
Q
  1. Cystic Fibrosis 2. Kartagener’s / Ciliary Dyskinesia 3. Chronic aspiration 4. Chroinic infection 5. Inhalation injury
A

Bronchiectasis

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44
Q
  1. Maligancy (primary and mets) 2. Hamartoma 3. AVM 4. Infection 5. Fluid/effusion 6. Round atelectasis (a/w asbestos exposure)
A

Solitary Lung Mass

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45
Q
  1. Esophagus (mass, tic, hiatal hernia) 2. Varicies 3. Foregut cyst 4. Lymphadenopathy 5. Pericardial mass/ cyst 6. LV pseudoanerysm 7. Aortic or PA aneurysm
A

Middle Mediastinal Mass

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46
Q
  1. Edema 2. Hemorrhage / Contusion 3. Infection 4. Drug toxicity 5. Hypersensitivity Pneumontis
A

Bilateral Patchy Opacities - Acute

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47
Q
  1. BAC 2. Sarcoidosis 3. COP / BOOP 4. Eosinophilic Pneumonia 5. PAP 6. NSIP
A

Bilateral Patchy Opacities - Non-Acute

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48
Q
  • Azygous continuation of IVC - Obstruction of vena cava - Tricuspid insufficiency - Rt sided heart failure
A

Causes of azygous vein enlargement

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49
Q
  • Pulmonary embolism - Extrinsic compression of PA (mass, aortic aneurysm [Ehlor-Danlos, Marfan’s, syphilis]) - Aortic dissection
A

Causes of unilateral absent perfusion on VQ scan

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50
Q
  • silicosis - sarcoidosis - Coal worker’s pneumoconisosis - ankylosing spondylitis - EG - cystic fibrosis
A

Upper Lung Chronic Infiltrative Disease

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51
Q
  • Cystic medial necrosis (marfan’s, Ehlers-Danlos) - atherosclerosis - syphilis
A

Causes of ascending aortic aneurysms [>4cm]

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52
Q
  • kidney - melanoma - thyroid - breast - colon
A

Common extrathoracic sites with endobronchial mets

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53
Q
  • radiation fibrosis - mediastinal lipomatosis - vascular abnormalites (coarc)
A

Bilaterally enlarged apical caps

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54
Q
  • Bronchogenic carcinoma - lymphoma - extrapleural hematoma - abscess - radiation fibrosis
A

Unilateral apical cap

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55
Q

Cryptococcus

A

In an HIV + patient, what fungal infection presents with pulmonary nodules, pleural effusion, and lymph node enlargement?

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56
Q
  • maligancy - cystic fibrosis - IPF - localized fibrous lesions of the pleura
A

Disorders that are associated with Hypertrophic Pulmonary Osteoarthropathy

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57
Q

Cylindrical Varicoid Cystic/Saccular

A

Three types of bronchiectasis (Reid classification)

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58
Q

Cystic Fibrosis Williams-Campbell Immotile cilia syndrome Mounier-Kuhn Primary hypogammaglobulinemia

A

Congenital disorders associated with bronchiectasis

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59
Q
  • Loffler’s syndrome - Chronic eosinophilic pneumonia - BOOP - pulmonary infarcts - vasculitides
A

Peripheral distribution of consolidation

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60
Q
  1. centrilobular 2. paraseptal 3. panlobular 4. paracicatricial
A

4 types of emphysema

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61
Q

Alpha-1-antitrypsin Ritalin lung IV methylphenidate

A

Panlobular emphysema with basilar predominance

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62
Q
  • mosaic perfusion - bronchial dilation - air trapping
A

CT findings of bronchiolitis obliterans

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63
Q
  • bone marrow txplant - viral infections - toxic inhalation - rheumatoid arthritis - lung txplant - IBD
A

Conditions associated with bronchilitis obliterans

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64
Q
  1. curvilinear subpleural lines 2. thickened septal lines 3. subpleural dependent density 4. parenchymal bands 5. honeycombing
A

5 CT findings of asbestosis

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65
Q

ground glass opacification with smooth septal thickening in a geographic distribution

A

Define crazy paving

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66
Q
  • BOOP - Loffler’s syndrome - chronic eosinophilic pneumonia - pulmonary infarcts - vasculitidies
A

Peripheral pattern of consilidation

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67
Q
  • Left to right shunt (Vein of Galen, hemangioendothelioma) - Coarctation - Hypoplastic left heart - narrow proximal Aorta, MV, and LV - Arrhythmia - Cardiomyopathy
A

CHF in a newborn

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68
Q
  • Hypersensitivity pneumonitis - Sarcoid - Acute on chronic PE - GVHD/CVD (BO and OP)
A

Head Cheese (air trapping, normal lung, GGO)

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69
Q

Think small airways disease - BO - Asthma

A

Mosaic Attenuation with air traping

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70
Q
  • Chronic PE (pulmonary HTN and enlarged RVH) - Vasculitis - Fibrosing mediastinitis (ST around aorta, RVH, RVE)
A

Mosaic attenuation with no air trapping

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71
Q
  • TOF - Ebsteins - Severe pulmonary stenosis - Tricuspid atresia
A

Neonate with CHD with decreased pulmonary vascularity

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72
Q
  • D-transposition - Truncus arteriosis - TAPVR - VSD - ASD - PDA
A

Neonate with CHD and increased pulmonary vascularity

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73
Q
  • hypoplastic L heart - coarcation - ?TAPVR
A

Neonate with CHD and pulmonary venous HTN

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74
Q
  • Neurogenic - ARDS - Near drowning - Re-expansion pulmonary edema - Acute inhalational injury
A

Noncardiogenic edema

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75
Q
  • Pericardial effusion - oreo cookie sign - Bicuspid aortic valve, aortic stenosis - Coarctation - figure of 3 sign, rib notching (ddx NF) - Extrathoracic shunt - Vein of galen, hemangioendothelioma - Cardiomyopathy - infiltrating (sarcoid,amyloid,HOCM) - Cardiomyopathy - ischemic/infarction - Kawasaki - coronary artery aneurysms - Cor tritriatrium
A

Acyanotic, no shunt vascularity, big heart, +/- edema

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76
Q

Obstructive, Relaxation, Adhesive, Cicatricial

A

Types of Atelectasis

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77
Q

Crescent of air on frontal CXR, interface between aorta and hyperexpanded superior segment of LLL

A

Luftsichel sign

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78
Q

Diffuse cysts , round in shape, thin walled, diffuse, female childbearing age, assoc with tuberous sclerosis 1%

A

Lymphangiomyomatosis findings and association

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79
Q

RUL atelectasis, usually due to obstructing mass

A

Golden’s S sign

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80
Q

LLL atelectasis with downward shift of hilar structures causing flattening of left heart border and cardiac rotation

A

Flat waist sign

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81
Q

1) abnormal adjacent pleura (effusion or pleural thickening/plaque); 2) peripheral, touching pleura; 3) round or elliptical; 4) volume loss in lobe; 5) comet tail sign (pulmonary vessels and bronchi leading to opacity)

A

Signs of round atelectasis

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82
Q

Pneumonia (atypical in GGO such as viral or PJP) Pulmonary hemorrhage/edema ARDS

A

Ddx of acute consolidation/GGO

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83
Q

-Mucinous adenocarcinoma -Organizing pneumonia -Chronic eosinophilic pneumonia GGO add Idiopathic pneumonia Hypersensitivity pneumonitis Alveolar proteinosis

A

Ddx of chronic consolidation/GGO

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84
Q

Pulmonary hemorrhage Pulmonary edema - cardiogenic PJP Alveolar proteinosis

A

Ddx of GGO in central distribution

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85
Q

Organizing pneumonia Chronic eosinophilic pneumonia Atypical pneumonia Pulmonary edema - noncardiogenic

A

DDx for peripheral consolidation/GGO

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86
Q

Smooth - pulmonary edema/hemorrhage, Alveolar proteinosis, Atypical pneumonia Nodular - Sarcoid, lymphangitic carcinomatosis

A

Interlobular septal thickening types and ddx

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87
Q

Alveolar proteinosis PJP Organizing pneumonia Mucinous adenocarcinoma Lipoid pneumonia ARDS Pulmonary hemorrhage

A

Ddx for crazy paving

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88
Q

Subpleural sparing –Infectious - endobronchial TB or MAI, bronchopneumonia, atypical PNA –Inflammatory - HSP, RB-ILD, diffuse panbronchiolitis, silicosis, hot tub lung (rxn to atypical mycobacterium like HSP)

A

Ddx of Centrilobular pulmonary nodules

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89
Q

Sarcoid Pneumoconiosis Lymphangitic carcinomatosis

A

Ddx of perilymphatic nodules

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90
Q

Fungal Miliary TB

A

Interstitial lung disease, nodules, acute

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91
Q

Silicosis Sarcoidosis LCH Lymphangitic carcinomatosis

A

Interstitial lung disease, nodular, chronic

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92
Q

Silicosis Sarcoid Treated lymphoma

A

Eggshell calcifications in lungs

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93
Q

Interstitial edema Atypical pneumonia (viral, PJP)

A

Interstitial,lung disease, reticular, acute

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94
Q

Fibrosis Emphysema Cystic lung dz Bronchiectasis

A

Interstitial lung disease, reticular, chronic

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95
Q

Sarcoid Chronic HSP Cystic fibrosis Prior TB Ankylosing spondylitis XRT Silicosis

A

Fibrosis, upper lobe distribution

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96
Q

UIP, NSIP Connective tissue disorders with UIP-like findings Chronic aspiration End stage asbestosis

A

Fibrosis, lower lobe distribution

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97
Q

Lymphangitic carcinomatosis Lymphoma Kaposi’s sarcoma Amyloid - rare

A

Interstitial lung disease, septal lines, chronic

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98
Q

Pulmonary edema Atypical infections

A

Interstitial lung disease, septal lines, acute (Kerley B lines)

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99
Q

Mycobacterium TB or atypical mycobacterium, bacterial or aspiration pneumonia, airway invasive aspergillus

A

Tree in bud nodules

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100
Q

Hematogenous metasteses, septic emboli, pulmonary LCH

A

Random nodules

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101
Q

Disseminated TB, fungal or hematogenous mets

A

Miliary nodules

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102
Q

Solitary - primary bronchogenic carcinoma (cavitary adenocarcinoma or squamous cell), TB (upper lobe) Multiple - septic emboli, vasculitis, mets (squamous cell or uterine)

A

Cavitary lesion, solitary and multiple

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103
Q

Solitary - bulla, bleb, pneumatocoele Multiple - lymphangiomyomatosis, emphysema, pulmonary LCH, diffuse cystic Bronchiectasis, PJP pneumonia, lymphoid interstitial pneumonia

A

Lung cysts , solitary and multiple

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104
Q

Ground glass attenuation surrounding consolidation. Ddx angioinvasive aspegillosis, hemorrhage met, Wegeners granulomatosis, Kaposi’s sarcoma, viral infection

A

Halo sign in pulmonary

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105
Q

Relapsing polychondritis - usu involves ears and nose in middle age female Tracheobrochopathi osteochondroplastica - nodular with calcifications

A

Tracheal thickening, diffuse, sparing of posterior trachea

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106
Q

TB - smooth long segment Amyloid - nodular +/- calcifications Wegeners granulomatosis - subglottic stenosis Sarcoid - hilar LAD, differing presentations

A

Tracheal thickening, diffuse, circumferential

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107
Q

Apical, posterior, anterior

A

RUL segments?

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108
Q

Lateral and medial

A

RML segments?

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109
Q

Superior, Lateral, Anterior, Posterior, Medial

A

RLL and LLL segments?

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110
Q

Apical posterior. Anterior. Superior lingula. Inferior lingula.

A

LUL segments.

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111
Q
A

**In lower lobes, medial and anterior are anterior, posterior and lateral are posterior

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112
Q

RUL from RML. Fine horizontal line.

A

Minor fissure?

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113
Q

1%. RUL apical or posterior segments are encased in their own parietal and visceral pleura

A

Azygos lobe?

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114
Q

Subsegmental atelectasis. Dont see them in obstructive atelectasis because airways are obstructed of course.

A

In which type of atelectasis would you expect to see air bronchograms?

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115
Q

Obstruction of small peripheral bronchi usually due to secretions

A

Subsegmental atelectasis?

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116
Q
A

**Obstructive atelectasis happens more quickly in patients breathing supplemental oxygen because its absorbed from the alveoli quicker than nitrogen. Obstructive atelectasis happens when oxygen from air is absorbed by blood and not replaced.

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117
Q
A

**In general obstructive atelectasis is associated with volume loss, but in critically ill ICU patients, there may be rapid transudation of fluid into obstructed alveoli, causing superimposed consolidation

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118
Q

This is what is seen adjacent to a mass or pleural effusion causing mass effect

A

Relaxation atlectasis?

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119
Q

Lack of surfactant. RDS. ARDS.

A

Adhesive atelectasis?

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120
Q

Volume loss from architectural distortion of lung parenchyma by fibrosis

A

Cicatrical atelectasis?

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121
Q

Mucus plugging

A

Acute lobar atelectasis?

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122
Q

Obstructing central tumor must be ruled out

A

Lobar atelectasis in an outpatient?

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123
Q

Luftsichel sign. Crescent of air on the frontal radiograph representing the interface between the aorta and the hyperexpanded superior segment of LLL

A

What sign in LUL atelectasis?

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124
Q

Reverse S sign of Golden.

A

Sign in RUL collapse?

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125
Q

Peridiaphragmatic triangular opacity caused by diaphragmatic traction from an inferior accessory fissure or an inferior pulmonary ligament

A

Juxtraphrenic peak sign?

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126
Q

Heart rotates and the L hilum is pulled down.

A

What do you see in LLL collapse?

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127
Q

Flat waist sign describes flattening of the L heart border as a result of downward shift of hilar structures

A

What sign in LLL collapse?

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128
Q
A

**RLL collapse is a mirror image of LLL collapse

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129
Q

You may only seen loss of R heart border.

A

RML atelectasis?

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130
Q

Focal atelectasis with a round morphology, always associated with an adjacent pleural abnormality

A

Round atelectasis?

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131
Q

All five have to met. Adjacent pleura has to be abnormal. Opacity must be peripheral and in contact with pleura. Must be round or elliptical. Volume loss in affected lobe. Pulmonary vessels and bronchi leading into the opacity must be curved causing comet tail

A

Diagnostic criteria for round atelectasis?

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132
Q

Centrilobular artery and central bronchus.

A

Center of each secondary pulmonary lobule?

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133
Q

Pulmonary veins and lymphatics

A

Periphery of each pulmonary lobule?

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134
Q

Between 1-2.5 cm

A

Size of SPL?

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135
Q
A

**Only call ground glass on CT

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136
Q

Complete filling of the affected alveoli with a liquidlike substance- Blood, pus, water, or cells

A

Histology of consolidation?

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137
Q
A

**Can’t see pulmonary vessels through the consolidatoin on unenhnaced CT, but you can with ground glass opacification (GGO)

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138
Q

Pneumonia. Pulmonary Hemorrhage. ARDS. Pulmonary edema.

A

Differenential of acute consolidation?

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139
Q

BAC. Organizing pneumonia. Chronic eosinophilic pneumonia.

A

Differential of chronic consolidation?

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140
Q

Upper lobes

A

Distribution of chronic eosinophilic pneumonia?

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141
Q

Incomplete filling of alveoli (blood, pus, water, or cells). Alveolar wall thickneing, or reduced aeration.

A

Histology of ground glass opacification?

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142
Q

Edema. Pna (Atypical more common). Pulm hemorrhage. ARDS.

A

Differential of acute GGO?

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143
Q

BAC. Organizing pneumonia. Chronic eosinophilic pneumonia. Idiopathic pneumonias. HP (subacute phase). Alveolar proteinosis.

A

Chronic GGO differential?

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144
Q

Edema. Alveolar hemorrhage. Pneumocystis Jiroveci. Alveolar proteinosis.

A

Central distribution of GGO?

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145
Q

Organizing pna. Chronic eosinophilic (upper lobes). Atypical or viral pna. Edema (noncardiac, cardiac will be central)

A

Peripheral consolidation or GGO?

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146
Q

Edema

A

By far, most common cause of smooth interlobular septal thickening?

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147
Q

Edema. PAP. Pulm hemorrhage. Atypical pna. (Same diff as central GGO)

A

Diff for smooth interlobular septal thickening?

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148
Q

Lymphangitic carcinomatosis. Sarcoidosis.

A

Nodular, irregular, or assymetric septal thickening?

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149
Q

Interlobular septal thickening with superimposed GGO

A

Crazy paving?

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150
Q

Filling of alveoli with proeinaceous material and septal thickening caused by lymphatics taking up the same material

A

Why does PAP cause crazy paving?

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151
Q

PAP. Pneumocystic Jiroveci. Organizing pna. BAC (mucinous). Lipoid pneumonia. ARDS. Pulm Hemorrhage.

A

Differential for crazy paving? (7)

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152
Q
A

**Centrilobular nodules never extend to the pleural surface

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153
Q

Endobronchial spread of TB or atypical mycobacteria. Bronchonpneumonia. Atypical pneumonia (esp. mycoplasma)

A

Infectious causes of centrilobular nodules?

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154
Q

HSP and RB ILD are most common. Otehrwise Hot tub lung, diffuse panbronchiolitis, and silicosis.

A

Inflammatory causes of centrilobular nodules?

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155
Q

Chronic inflammatory disorder characterized by lymphoid hyperplasia of the walls of respiratory bronchioles, usually patients are Asian.

A

Diffuse panbronchiolitis?

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156
Q

Type III

A

What type of hypersensitivity reaction is HSP?

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157
Q

Subpleural. Peribronchovascular. Septal.

A

Three locations of perilymphatic nodules?

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158
Q

Sarcoid.

A

Most common cause of perilymphatic nodules?

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159
Q

Sarcoid. Confluent perilymphatic nodules.

A

Galaxy sign?

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160
Q

Pneumoconioses and lymphangitic carcinomatosis.

A

Other causes of perilymphatic nodules?

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161
Q

Mets. Septic emboli. Pulmonary LCH.

A

Random nodule distribution?

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162
Q

Diseminated TB. Diseminated fungal infection. Diseminated mets.

A

Miliary pattern of nodules?

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163
Q
A

**Most effusions associated with pneumonia are not empyemas but instead are a sterile effusion caused by increaed capillary permeability

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164
Q
A

**Treatment of BPF is very contraversial and individualized

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165
Q
A

**Miliary TB can be primary or reactivation TB

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166
Q
A

**Normal CT rules out P Jiroveci but it can hide in a normal chest radiograph

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167
Q

Impacted bronchioles, nodules are the impacted terminal bronchioles.

A

What are the linear branching structures in the tree in bud pattern? The nodules?

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168
Q

Small airways infection

A

Tree in bud are almost always associated with what?

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169
Q

Mycobacteria. Bacterial pna. Aspiration pna. Airway invasive aspergillosis

A

Diff for tree in bud nodules?

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170
Q

Under 4 mm will be benign and over 15 mm will be malignant

A

Wall thickness for definite benign or malignant cavitary lesions?

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171
Q

Cancer or infection

A

Solitary cavitary lesion is almost always what?

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172
Q

Carcinoma (SCC or adno, usually SCC). TB (Upper lobe cavitation). Septic emboli. Vasculitis (Wegeners). Metastases.

A

Diff for cavitary lesions?

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173
Q

LAM. Emphysema (upper lobe in a smoker). Pulmonary LCH (cysts and nodules in upper lungs). Diffuse cystic bronchiectasis. Pneumocystis jiroveci. LIP

A

Diff for multiple lung cysts?

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174
Q

Bulla is big, larger than 1 cm, occupies at least 30% of volume of the thorax. Bleb is an air filled structure contiguous with pleura less than 1 cm

A

Bulla vs bleb?

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175
Q

IPF. End stage asbestosis. NSIP.

A

Diff for lower lobe fibrotic changes?

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176
Q

Collagen vascular disease or drug reaction.

A

NSIP usually associated with what?

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177
Q

Cellular and fibrotic.

A

Two types of NSIP?

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178
Q

NO

A

Honeycombing in NSIP?

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179
Q

Fibrotic

A

Which type of NSIP causes basilar fibrosis?

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180
Q

End stage sarcoidosis. Chronic hypersensitivity pneumonitis. End stage silicosis.

A

Upper lobe firbosis differential?

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181
Q

Mycoplasma. Viral. Chlamydia.

A

Types of pneumonia which affect young otherwise healthy patients?

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182
Q

Elderly smokers. Severe infections

A

Who gets legionella?

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183
Q

Alcoholics and aspirators

A

Who gets klebsiella?

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184
Q

Voluminous inflammatory exudates causing the bulging fissure sign.

A

Klebsiella leads to what?

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185
Q

MRSA and resistent gram negatives including pseudomonas

A

Most important pathogens in HAP?

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186
Q

Usually polymicrobial but pseudomonas and acinetobacter are useful

A

Pathogens in VAP?

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187
Q

Patchy consolidation with poorly defined airspace opacities usually involving several lobes. Usually S Aureus.

A

What is bronchopneumonia?

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188
Q

Inflammatory cells in the interstitial tissues of the alveolar septa. Atypical agents.

A

Interstitial pneumonia?

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189
Q

Children. Incomplete pohrs of Kohn. S. Pneumonia.

A

What causes round pneumonia?

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190
Q

Necrosis or sloughing of a pulmonary segment or lobe, severe manifestation of pulmonary abscess.

A

Pulmonary gangrene?

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191
Q

1- Free flowing exudative effusion- treat with needle aspiration or simple drain. 2- Development of fibrous strands- Large bore chest tube and fibrinolytic therapy. 3- Fluid becomes solid and jelly like- Requires surgery.

A

3 Stages of Empyema?

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192
Q
A

**Most effusions associated with pneumonia are not empyemas but instead are a sterile effusion caused by increaed capillary permeability

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193
Q

Surgery. More rare causes are lung abscess, empyemia, trauma.

A

Most common cause of bronchopleural fistula?

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194
Q

New or increasing gas in a pleural effusion.

A

Imaging of BPF?

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195
Q
A

**Treatment of BPF is very contraversial and individualized

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196
Q

Extension of empyema to chest wall, usually due to TB. Can also be caused by Nocardia and Actinomyces

A

Empyema necessitans?

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197
Q

Contained disease. Primary TB.

A

Initial exposure to TB can lead to what two clinical outcomes?

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198
Q

90%. Results in calcified granulomas and/or calcified hilar lymph nodes. Normal immune patients will sequester the bacilli with a caseating granuloma.

A

Describe contained TB?

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199
Q

Host cannot contain the organism- Seen in immunocompromised and children

A

Describe primary TB?

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200
Q

15%

A

What percentage of primary TB have normal radiographs?

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201
Q

Ill defined consolidation. Pleural effusion. Lymphadenopathy. Miliary disease.

A

4 Imaging features of pulmonary primary TB?

202
Q

Lower lobes and RML.

A

Most common lobes for primary TB?

203
Q

Initial focus of parenchymal infection.

A

Ghon Focus?

204
Q

Ghon focus and lymphadenopathy

A

Ranke complex?

205
Q

Rare in primary TB. Common in reactivation TB.

A

Which TB gets cavitation?

206
Q

Low attenuation centrally and peripheral enhancement.

A

Adeonpathy in TB?

207
Q

Primary. Rare in post primary.

A

Which TB gets adenopathy?

208
Q

Upper lobe apical and posterior segments.

A

Where does reactivation TB usually occur?

209
Q

Cavitation and lack of adenopathy. Focal upper lobe consolidation and endobronchial spread (Tree in bud) is common.

A

Reactivation TB in an immunocompetent patient?

210
Q

Low attenuation adenopathy. May mimic immune reconstitution syndrome seen in HIV patients.

A

Reactivation TB in an immunocompromised patient?

211
Q

Well defined rounded opacity in the upper lobes

A

Tuberculoma?

212
Q

Apical scarring with upper lobe volume loss and superior hilar retraction.

A

Healed TB?

213
Q

Containment of initial infection by a delayed hypersensitivity response.

A

Calcified granulomas signify what?

214
Q
A

**Miliary TB can be primary or reactivation TB

215
Q

Bronchiectasis and tree in bud nodules in the RML or lingula.

A

Classic radiographic findings of Lady Windermere syndrome?

216
Q

Elderly woman with cough, low grade fever and weight loss

A

Clinical presentation of Lady Windermere syndrome?

217
Q

MAI. M. Kansasii

A

Organisms in Lady Windermere syndrome?

218
Q

Hypersensitivity pneumonitis in response to atypical mycobacteria which are often found in hot tubs. Patient is otherwise healthy, no active infection. Imaging is similar to other causes of HP with centrilobular nodules.

A

What is hot tub lung?

219
Q

Fibrosing mediastinitis, infection of lymph nodes leading to pulmonary venous obstruction, bronchial stenosis, and pulmonary artery stenosis.

A

Rare complication of histoplasmosis?

220
Q

TB- Upper lobe fibrocavitary consolidation

A

Chronic histoplasmosis can mimic what?

221
Q

Bacterial pna. Consider TB if CD4 count is low.

A

Focal airspace opacity in an immunocompromised patient?

222
Q

CD4 less than 200

A

Who gets pneumocystic jiroveci?

223
Q

Bilateral perihilar airspace opacities with peripheral sparing.

A

Classic radiographic findings of P Jiroveci?

224
Q

Perihilar GGO sometimes with crazy paving.

A

Classic CT of P Jiroveci?

225
Q
A

**Normal CT rules out P Jiroveci but it can hide in a normal chest radiograph

226
Q

Upper lobe pneumotoceles which may predispose to pneumothorax or pneumomediastinum.

A

P Jiroveci has a propensity to lead to what?

227
Q

Cryptococcus

A

Most common fungal infection in AIDS patients?

228
Q

Cryptococcus meningitis

A

Pulmonary infection with cryptococcus usually coexists with what?

229
Q

Less than 100

A

CD4 in cryptococcus?

230
Q

Wide range: GGO, Focal consolidation, cavitating nodules, miliary diseaes, lymphadenopathy, effusions

A

Imaging of cryptococcus?

231
Q

Individuals with abnormal immunity or pre-existing pulmonary disease

A

Aspergillus only affects who?

232
Q

ABPA, Aspergilloma (Saprophytic), Semi invasive. Airway invasive. Angioinvasive.

A

Types of aspergillus infection?

233
Q

Hypersensitivity reaction to aspergillus in patients with long standing asthma

A

What is allergic bronchopulmonary aspergillosis and who gets it?

234
Q

Recurrent wheezing, low grade fever, cough, sputum production. Sputum contains fragments of aspergillus hyphae.

A

Presentation of ABPA?

235
Q

Upper lobe bronchiectasis and mucoid impaction which can be high attenuation or even calcified

A

Key finding on CT of ABPA?

236
Q

Finger in glove

A

Combination of mucoid impaction within bronchiectatic airways represents what sign?

237
Q

An aspergilloma develops in a pre-existing cavity.

A

What is saprophytic aspergillosis?

238
Q
A

**Imaging of patient in different positions causes the aspergilloma to move

239
Q

TB and sarcoid.

A

Most common causes of a pre-existing cavity?

240
Q

Hemoptysis

A

Most common symptom of aspergilloma?

241
Q

Crescent of air outlines the mycetoma against the wall of the cavity.

A

Monod sign?

242
Q

Necrotizing granulomatous inflammation (analogous in pathology to reactivation tb) in response to chronic aspergillus infection.

A

What is semi-invasive aspergillosis?

243
Q

Debilated, diabetic, alcoholic, and COPD patients

A

Who gets semi-invasive aspergillosis?

244
Q

Segmental areas of consolidation, often with cavitatoin and pleural thickening, which progress slowly over months or years

A

CT of semi-invasive aspergillosis?

245
Q

Infection deep to the airway epithelial cells

A

What is airway invasive aspergillosis?

246
Q

Only the immunocompromised, including neutropenic and AIDS patients

A

Who gets airway invasive aspergillosis?

247
Q

From bronchiolitis to bronchopneumonia

A

Spectrum of clinical disease in airway invasive aspergillosis?

248
Q

Centrilobular and tree in bud nodules. Also bronchopneumonia which is indistinguishable from other causes of bronchopneumonia

A

CT findings of airway invasive aspergillosis?

249
Q

Aggressive infection characterized by invasion and occlusion of arterioles and smaller pulmonary arteries by fungal hyphae.

A

What is angioinvasive aspergillosis?

250
Q

Severely immunocompromised patients, including patients on chemotherapy, stem cell or solid organ trasplant recipients, and in AIDS

A

Who gets angioinvasive aspergillosis?

251
Q

Represents a crescent of air from retraction of infarcted lung. Good prognostic sign indicating patient is in recovery phase.

A

Air cresent sign in angioinvasive aspergillosis?

252
Q

Dilated lymphatic channels radiating from hila, clinically insignificant

A

What do Kerley A lines represent?

253
Q

Radiate from periphery- Thickened interlobular septa

A

Kerley B lines?

254
Q

Vascular redistribution (increased caliber of the upper lobe vessels compared to lower lobe vessels). Interstitial edema. Alveolar edema (Pleural effusions and cardimegaly are usually present)

A

3 stages of pulmonary edema radiographically?

255
Q

Intrathoracic- Patchy. Nonthoracic- Diffuse.

A

GGO in intrathoracic causes of edema vs non thoracic causes?

256
Q

Aggressive thoracentesis- reexpansion of lung in a state of collapse for more than 3 days

A

When does reexpasion pulmonary edema occur?

257
Q

Transverse width of the upper mediastinum

A

Vascular pedicle?

258
Q

Interface of the SVC and R mainstem bronchus.

A

Right border of vascular pedicle?

259
Q

Lateral border of the takeoff of the subclavian from the aorta

A

L border of the vascular pedicle?

260
Q

Less than 58 mm

A

Normal vascular pedicle width?

261
Q
A

**Vascular pedicle widths of 63 and 70 have been proposed as cutoffs for increased pulmonary capillary wedge pressure

262
Q
A

**ET Tube can be slightly lower in situations with low pulmonary compliance like ARDS to reduce barotrauma

263
Q

1% of patients. Increased risk of venous perforation and thrombosis

A

Look at pics of azygous malposition of catheter, what risks? What percentage of patients have azygous malposition.

264
Q

Rupture or pseudoanerysm. Also intracardiac catheter knot and arrythmias are other complications of swan ganz catheters

A

Risks of Swan Ganz distal to proximal interlobar pulmonary artery? General risks of Swan Ganz.

265
Q

80-90%

A

Tobacco is thought to cause what percentage of lung cancers?

266
Q
A

**Asbestos increases lung ca risk by 5 and is synergistic with smoking

267
Q
A

**Pulmonary fibrosis increases lung ca risk by 10

268
Q
A

**Scarring also increases risk

269
Q

GG nodule

A

More likely malignant, solid or gg nodule?

270
Q

Central. Laminar. Diffuse.

A

What types of calcification are benign?

271
Q

Hamartoma

A

What nodules have popcorn calcification?

272
Q

Non round is usually benign

A

Shape of pulmonary nodule and correlation with ca?

273
Q

Infection

A

Clustering of nodules suggests?

274
Q

18% of malignancy.

A

Nodule .8-3cm?

275
Q

Very high chance of malignancy

A

Nodules over 3 cm?

276
Q

Irregular edge or spiculated margin

A

Margins which are concerning?

277
Q

26%

A

Doubling in volume corresponds to what increase in diameter?

278
Q
A

**Decrease in size of a suspicious nodule isn’t sufficient to diagnose benignity, can occur with collpase of aerated alveoli or necrosis

279
Q

Small cell

A

Histology of lung ca with the worst prognosis?

280
Q

Adneocarcinoma

A

Most common histological subtype of lung ca?

281
Q

Peripheral

A

Adenocarcinoma, central or peripheral?

282
Q

TTF-1 (Thyroid transcription factor). Positive in adenocarcinoma and negative in pulmonary mets

A

Pathologic marker of adenocarcinoma of the lung?

283
Q

Main lobar or segmental bronchi. Causes symptoms early due to bronchial obstruction.

A

Majority of SCC arise from where?

284
Q

BAC. Spreading of malignant cells using the alveolar walls as a scaffold

A

Lepidic growth?

285
Q

Most other types of lung cancer. Cancer growth by invasion and destruction of lung parenchyma.

A

Hilic growth?

286
Q

Negative

A

BAC on PET?

287
Q
A

**New classification of BAC- Going to ignore this

288
Q

Nonmucinous

A

Better prognosis, nonmucinous or mucinous BAC?

289
Q

Solid or gg nodule with air bronchograms

A

Imaging of nonmucinous BAC?

290
Q

Chronic consolidation.

A

Imaging of mucinous BAC?

291
Q

Describes prominent appearance of enhancing pulmonary vessels seen in low attenuation mucin rich consolidation of mucinous BAC

A

CT angiogram sign?

292
Q

Small cell (after adeno and scc)

A

Third most common histologic subypte of lung cancer?

293
Q

Neuroendocrine

A

In small cells, neoplastic cells are of what origin?

294
Q

Smoking

A

Small cell associated with what?

295
Q

Central bronchi with invasion through the bronchial wall, typically presenting as a large hilar or perihilar mass.

A

Where dose small cell tend to occur?

296
Q
A

**Small cell is considered disemminated disease, rarely amenable to surgery

297
Q
A

**Large cell is a wastebasket diagnosis for tumors which aren’t squamous, adenocarcinoma, or small cell

298
Q

Smoking

A

Large cell associated with what?

299
Q

Periphery as a large mass

A

Where do large cell carcinomas usually occur?

300
Q

Endobronchial mass distal to the carina which may cause obstructive atelectasis. Up to 20% of cases present as a pulmonary nodule

A

Common presentation of carcnoid?

301
Q

Typical- without mets has an excellent prognosis (92% survival over 5 years). Atypical has a worse prognosis and arises in periphery.

A

Describe two subtypes of carcinoid?

302
Q

DIPNECH- Extremely uncommon precursor lesion to typical carcinoid tumor, characterized by mutiple foci of neurondocrine hyperplasia or tumorlets (Carcinoid foci less than 5 mm) and bronchiolitis obliterans

A

What is diffuse idiopathic pulmonary neuroendocrine cell hyperplasia?

303
Q

Adenocarcinoma, including BAC

A

50% of cancrs presenting as a solitary pulmonary nodule is what?

304
Q

SCC and Small cell

A

Hilar mass is a common presentation of which lung cancers?

305
Q
A

**Tapered bronchus is highly specific for lung cancer

306
Q

Lung ca occuring in the lung apex

A

What is a superior sulcus tumor?

307
Q

Type of superior sulcus tumor with involvement of the sympathetic ganglia causing Horner syndrome

A

What is a pancoast tumor?

308
Q

Ipsilateral ptosis, miosis, anhidrosis

A

Horner syndrome?

309
Q

T3

A

What stage is a superior sulcus tumor?

310
Q

Diffuse spread of neoplasm through the pulmonary lymphatics, typically seen in late stage disease. Nodular interlobular septal thickening, usually asymmetric

A

What is lymphangitic carcinomatosis?

311
Q

M1a- meaning it precludes curative resection. Have to do cytologic evaluation to be sure.

A

What stage is a malignant effusion?

312
Q

Early stages up to IIB and sometimes IIIA. Can do neoadjuvant or adjuvant chemo and radiotherapy also.

A

Surgery is performed for what stages of lung cancer?

313
Q

Contralteral or supraclavicular lymph nodes.

A

What makes a tumor IIIb or unresectable?

314
Q
A

**Skipped lung cancer staging. Probably need to review later?

315
Q

WHO Class 1 entities

A

When can you use pulmonary arterial hypertension instead of pulmonary hypertension?

316
Q

Pulmonary arterial systolic pressure greater than 25 at rest or 30 during exercise.

A

Definition of pulmonary arterial hypertension?

317
Q

When pulmonary capillary wedge pressure is greater than 18

A

When are elevated pulmonary venous pressures present?

318
Q

Chronic thromboembolic disease, chronic respiratory disease, chronic heart disease, idipathic causes

A

Causes of pulmonary hypertension?

319
Q

Pre-capillary and Post-capillary.

A

Most common classification of pulmonary hypertension?

320
Q

Causes clear up to the pulmonary parenchyma.

A

Precapillary is what?

321
Q

Problems with pulmonary veins or pulmonary venous pressure.

A

Postcapillary is what?

322
Q

Pulmonary arterial hypertension. Pulmonary venous hypertension. Pulmonary hypertension associated with chronic hypoxemia. Pulmonary hypertension due to thromboembolic disease. Pulmonary hypertension due to miscellaneous disorders.

A

5 classes of pulmonary hypertension according to WHO?

323
Q

Primary (Idiopathic or familial). Congenital L to R shunts. Pulmonary venous or capillary involvement such as pulmonary venoocclusive disease and pulmonary capillary hemangiomatosis

A

Causes of grade 1 pulmonary hypertension?

324
Q

L sided heart disease.

A

Causes of grade 2 pulmonary hypertension?

325
Q

Sarcoid, compression of vessels, etc.

A

Causes of grade 5 pulmonary hypertension?

326
Q

Pulmonary artery calcifications

A

Pathognominic for pulmonary artery hypertension?

327
Q

Mosaic attenuation due to perfusion abnormalities

A

Lungs in pulmonary hypertension?

328
Q

Confirms that a hilar mass is in fact a pulmonary artery. There is a convergence of hilar pulmonary artery branches into an enlarged pulmonary artery

A

Hilum convergence sign?

329
Q

Visualization of hilar vessels thorugh a mass- indicates that a mass is actually present.

A

Hilum overlay sign?

330
Q

Anterior mediastinum, never middle.

A

Where is mass in hilum overlay sign?

331
Q

Enlarged centrally. Taper distally.

A

Imaging of pulmonary arteries in pulmonary hypertension?

332
Q

In wall of muscular arteries in pulmonary hypertension- Focal disruption of the elastic lamina by an obstructing plexus of endothelial channels. Relative paucity of prostacyclins and nitric oxide expressed by endothelial cells

A

Plexiform lesion?

333
Q

Fibrotic obliteration of the pulmonary veins and venules.

A

Pulmonary veno-occlusive disease?

334
Q

May be idiopathic but is associated with pregnancy, drugs, and bone marrow transplant

A

Associations of pulmonary veno-occlusive disease?

335
Q

Pulmonary arterial enlargement. Pulmonary edema and gg centrilobular nodules are often present

A

Imaging of pulmonary veno-occlusive disease?

336
Q

Surgical thromboendartectomy (similar to carotid endarterectomy)

A

Treatment of chronic thromboembolic pulmonary hypertension?

337
Q

Histoplasmosis and TB

A

Most common cause of fibrosing mediastinitis?

338
Q

Increased mediastinal soft tissue often with calcified lymph nodes due to prior granulomatous infection

A

Imaging of fibrosing mediastinitis?

339
Q

Widening of pulmonary arteries due to clot

A

Fleishner sign?

340
Q

Peripheral wedge shaped opacity representing pulmonary infarct.

A

Hamptoms hump?

341
Q

Regional oligemia in lung distal to pulmonary artery thrombus

A

Westermark sign?

342
Q

Form alveolar wall and participate in gas exchange

A

Type 1 pneumocytes?

343
Q

Produce surfactant, which prevents atelectasis

A

Type 2 pneumocytes?

344
Q

2-4 years

A

Mean survival of interstitial pulmonary fibrosis

345
Q

AIP

A

Only interstitial pneumonia with a worse prognosis than pulmonary fibrosis?

346
Q

IPF

A

Clinical syndrome of UIP?

347
Q

Collagen vascular disease (RA more than scleroderma). Drug injury. Asbestosis.

A

Other triggers of lung injury that may result in a UIP pattern?

348
Q

Less fibrotic change in NSIP

A

NSIP vs UIP histology

349
Q

NSIP responds to steroids

A

Treatment difference between NSIP and UIP?

350
Q

NSIP

A

Most common pulmonary manifestation in patients with collagen vascular disase?

351
Q

Ground glass opacities, nearly always bilateral

A

Important imaging feature of NSIP?

352
Q

Features GGO with fine reticulation and traction bronchiectasis

A

Fibrotic NSIP appearance?

353
Q

Fibrotic

A

Which NSIP has worse prognosis?

354
Q

GGO without much fibrotic changes

A

Cellular NSIP appearance?

355
Q

Fibrotic

A

Which NSIP is more common?

356
Q

Sparing of immediate subpleural lung

A

Very specific but uncommon finding in NSIP?

357
Q

Cryptogenic organizing pneumonia- Clinical syndrome of organizing pneumonia without known cause

A

What is COP?

358
Q
A

**COP used to be called BOOP

359
Q

Responds to steroids with a good prognosis, may resolve completely, although recurrences are common

A

Treatment and prognosis of COP?

360
Q

Granulation tissue polyps that fill the distal airway and alveoli

A

Pathologic pattern of OP?

361
Q

Mixed consolidation and ground glass opacities in a peripheral and peribronchovascular distribution

362
Q

Reverse halo or Atoll sign- Central lucency surrounded by a GG halo

A

What sign is specific for COP?

363
Q

Halo sign- Invasive aspergillus

A

Central opacity with peripheral GG?

364
Q

Smoking

A

RB-ILD associated with what?

365
Q

Pigmented macrophages are found in respiratory bronchioles

A

Pathological finding in RB-ILD?

366
Q

Centrilobular nodules and patchy GGO.

A

Key imaging findings of RB-ILD?

367
Q

More random in RB-ILD where it is more peripheral in NSIP

A

Distribution of GGO in RB-ILD vs NSIP?

368
Q
A

**RB-ILD and DIP represent a continous spectrum of smoking related lung disease

369
Q

In DIP, the brown pigmented macrophages also extend into the alveoli

A

Pathology of RB-ILD vs DIP?

370
Q

Diffuse basal predominant patchy or subpleural GGO, more extensive than RB-ILD. A few cysts may also be present although predominant abnormality is GGO

A

Imaging of DIP?

371
Q

Sjogrens, HIV

A

LIP is very rare, associated with what?

372
Q

DIffuse infiltration of the interstitium by lymphocytes and other immune cells, with resultant distortion of the avleoli.

A

Histology of LIP?

373
Q

Diffuse or lower lobe predominant GGO with scattered thin walled perivascular cysts, thought to be due to air trapping from peribronchiolar cellular debris

A

Imaging of LIP?

374
Q

PTX

A

LIP may be complicated by what in advanced disease?

375
Q

DAD- Diffuse alveolar damage.

A

AIP is synonomous with what?

376
Q

Clinical syndrome of ARDS

A

What is AIP?

377
Q

Surfactant destruction

A

Primary cause of AIP?

378
Q

Early (Exudative) and chronic (Organizing)

A

Two phases of AIP?

379
Q

Acute, subacute, chronic

A

Phases of HP?

380
Q

Inflammatory exudate filling the alveoli, manifests on imaging as groundglass or consolidation. Small, ill defined centrilobular nodules.

381
Q

Centrilobular GG nodules. Mosaic attenuation

A

Subacute HP?

382
Q

Describes combination of patchy GG and areas of lucency due to mosaic perfusion or air trapping

A

Head cheese sign?

383
Q
A

**Abnormalities of HP involve entire axial cross section of lung

384
Q

Upper lobe predominant pulmonary fibrosis superimposed on findings of subacute and acute HP

A

Chronic HP?

385
Q

Can be seen in upper lobes but is uncommon.

A

Honeycombing in HP?

386
Q

Pneumoconiosis is due to inorganic dust inhalation where HP is organic dust inhalation

A

Pneumoconioses vs HP?

387
Q

Silicosis and coal workers pneumoconiosis

A

Two most common pneumoconioses?

388
Q
A

**Findings of CWP and Silicosis are indistinguishable

389
Q

Miners, from inhalation of silica dust

A

Who gets silicosis?

390
Q

Inhalation of coal dust

A

CWP is due to what?

391
Q

Upper lobe predominant centilobular and subpleural nodules

A

Most characteristic finding of uncomplicated disease in silicosis and CWP?

392
Q

Silicosis. Less commonly CWP

A

Eggshell lymph node calcifications?

393
Q

Large conglomerate masses (Progressive massive fibrosis)

A

Complications of silicosis or CWP?

394
Q

TB

A

Both silicosis and CWP have increased risk of?

395
Q

RA and either CWP (more common) or silicosis- represents necrobiotic rheumatoid nodules superimposed on the smaller centrilobualr and subleural nodules of the pneumoconiosis.

A

Caplan syndrome?

396
Q

Pulmonary fibrosis with a UIP pathology

A

End stage asbestosis?

397
Q

Lower lobes, the asbestos fibers are too large to be removed by the alveolar macrophages and lymphatic system

A

Upper or lower lobes for asbestosis? Why?

398
Q

Pleural thickening and plaques (May or may not be calcified).

A

Clue to asbestos exposure?

399
Q
A

**Even though pleural plaques are due to asbestos exposure, they are not a component of asbestosis, do not lead to fibrosis, and are usually asymptomatic

400
Q
A

**Eosinophilic lung disease is a spectrum of diseases that feature accumulation of eosinophils in the pulmonary airspaces and interstitium

401
Q

Also called Loeffler syndrome- Transient and migratory areas of focal consolidation, with an elevated eosinophilic count in the peripheral smear

A

Simple pulmonary eosinophilia?

402
Q
A

**Identical appearance to eosinophilia can be seen with parasites and drugs but simple pulmonary eosinophilia is reserved for idiopathic causes

403
Q

Peripheral with upper lobe predominance- pattern can remain unchanged for months.

A

Consolidation in chronic eosinophlic pneumonia?

404
Q

Steroids- Responds rapidly

A

Treatment of chronic eosinophilic pneumonia?

405
Q

Systemic small vessel disease associated with asthma and peripheral eosinophilia

A

Churg Strauss?

406
Q

p ANCA

A

What is positive in Churg Strauss?

407
Q

Varied, most common appearance is peripheral consolidation or GG

A

Imaging findings of Churg Strauss?

408
Q

p ANCA. Most common cuase of pulmonary hemorrhage with renal failure

A

Microscopic polyangiitis is most common cause of what? What is positive?

409
Q

Cnetral predominant GG representing hemorrhage

A

Imaging of microscopic polyangiitis?

410
Q

Sinusitis, lung involvement, and renal insufficiency

A

Triad of Wegeners?

411
Q

c ANCA

A

Lab tests specific for Wegeners?

412
Q

Nasopharyngeal and eustachian tube obstruction. Involvement of trachea and bronchi is common, leading to airway stenosis

A

Upper airways in Wegeners?

413
Q

Multiple cavitary nodules which don’t respond to abx. Intra-cavitary fluid level suggests superimposed infection

A

Lungs in Wegeners? Superimposed infection?

414
Q
A

**Drugs can elicit numerous pulmonary responses

415
Q

40%

A

What percentage of patients develop radiographic abnormalities after external radiotherapy?

416
Q

Early stage of radiation injury, can occur within one month of radiotherapy, most severe 3-4 months after treatment. GG centered on radiation port, but can extend out of radiation port

A

Radiation pneumonitis?

417
Q

Late stage of radiation injury. Fibrosis becomes apparent 6-12 months after therapy. Key imaging finding is distribution of fibrosis and traction bronchiectasis within the radiation port, but may extend out of the port

A

Radiation fibrosis?

418
Q

Pulmonary fibrosis with honeycombing, slight upper lobe predominance

A

Pulmonary sarcoidosis may progress to what in lungs?

419
Q

Radiographs only- 0 Normal radiograph. 1- Hilar or mediastinal adenopathy only. 2- Adenopathy with lung changes 3- Lung w/o adenopathy. 4- Endstage fibrosis

A

Staging of sarcoid?

420
Q

Symmetric addenopathy with stippled or egg shell calcification in up to 50%

A

Most common radiographic finding in sarcoid?

421
Q

Right paratracheal, R hilar, L hilar- Completely encircles trachea on lateral- donut sign

A

Where is adenopathy in sarcoid?

422
Q

Upper lobe predominant perilymphatic nodules of variable sizes representing sarcoid granulomas

A

In addition to lymphadenopathy, most common ct finding in sarcoid?

423
Q
A

May see superimposed GGO in sarcoid

424
Q

Mosaic perfusion due to air trapping

A

Bronchial involvement of sarcoid?

425
Q

Smoking- Nearly 100% association

A

Pulmonary LCH associated with?

426
Q

PTX

A

How may pumonary LCH present?

427
Q

Diabetes insipidus from inflammation of pituitary stalk (hypophysitis), lucent bone lesions, skin involvement.

A

What other associated findings may be seen with pulmonary LCH?

428
Q

LCH. Malignancy. TB. Fungal. Sarcoid. Gaucher.

A

Differential for dz affecting bone and lung?

429
Q

Rare, but may resemple DIP

A

Gaucher in lungs?

430
Q

Nodules associated with airways, as they progress they will cavitate and resultant irregular cysts predominate

A

First detectable abnormality and progression in LCH?

431
Q

Smoking cessation is critical. Responds to steroids.

A

Treatment of pulmonary LCH?

432
Q

Upper lobe predominant cysts and irregular peribronchovascular nodules both sparing the costophrenic sulci

A

So overall findings in LCH?

433
Q

In PAP, there are no effusions and the heart is normal in size

A

PAP vs pulmonary edema?

434
Q

Superimposed infection, especially with nocardia

A

Patients with PAP are susceptible to what?

435
Q

Bronchialveolar lavage

A

Treatment of PAP?

436
Q

1%

A

What percentage of TS patients have LAM?

437
Q

Women of child-bearing age

A

Almost all cases of sporadic LAM are in what patients?

438
Q

Estrogen

A

Some cases of LAM respond to what?

439
Q

PTX, Chylous effusion

A

LAM is associated with what two things?

440
Q

Cysts are round and regular and affect all five lobes where LCH is just upper lobe

A

Cysts in LAM vs LCH?

441
Q

Prevascular superiorly and precardiac inferiorly (Precardiac is only a potential space)

A

Two compartments in anterior mediastinum?

442
Q
A

**Bascially all of the mediastinal structures are in the middle mediastinum including the phrenic, vagus, and recurrent laryngeal nerve

443
Q

Posterior trachea and posterior pericardium

A

Anterior border of the posterior mediastinum?

444
Q

Formed by four laters of pleura at the anterior junction of the R and L lungs. Projections over the superior 2/3 of the sternum.

A

Anterior junction line?

445
Q

Anterior mediastinal mass

A

Abnormal convexity or displacement of the anterior junction line?

446
Q

Four layers of pleura, seen projection through the trachea on frontal view, more superior than the anterior junction line.

A

Posterior junction line?

447
Q

Posterior

A

Which extend more superiorly, posterior or anterior lungs?

448
Q

Posterior mediastinal mass

A

Abnormal convexity or displacement of the posterior junction line?

449
Q

Formed by two layers of pleura where the medial aspect of each lung abuts the lateral wall of the trachea and intervening mediastinal fat

A

Right and Left paratracheal stripes?

450
Q

Usually pleural thickening, although a paratracheal or tracheal mass can be the cause

A

Thickening of the R paratracheal stripe?

451
Q

Same diff as on the R except add mediastinal hematoma in setting of trauma

A

Thickening of the L paratracheal stripe?

452
Q

Only interface seen on lateral view, representing interface of posterior wall of trachea with two pleural layers of the medial right lung

A

Posterior tracheal stripe?

453
Q

Mach effect

A

Why do we see R and L paraspinal lines?

454
Q

2 layers of pleura abutting the posterior mediastinum

A

What forms the paraspinal lines?

455
Q

Posterior mediastinal mass

A

Paraspinal line abnormality?

456
Q

Interface formed by contact of the posteromedial RLL and retrocardiac mediastinum. Extends from the subcarinal region to the diaphragm inferiorly

A

Azygoesophageal recess?

457
Q

Esophageal mass, hiatal hernia, L atrial enlargement and adenopathy

A

Distortion of the azygoesophageal recess?

458
Q

Lymph nodes (most common cause of AP abnormality). L Phrenic nerve. Recurrent laryngeal nerve. L vagus nerve. Ligamentum arteriosum. L bronchial arteries

A

What lives in the AP window?

459
Q

Anterior mediastinal mass, RV dilatation, Pulmonary artery enlargement

A

Obliteration of the retrosternal clear space?

460
Q

Emphysema

A

Increase in retrosternal clear space?

461
Q

From the L superior intercostal vein, not usually seen on radiography. It may be dilated in SVC obstruction as a collateral.

A

Aortic nipple?

462
Q

Normal posterior junction line because ant junction line isn’t always seen

A

Easiest way to infer an anterior mediastinal mass on cxr?

463
Q

Thymic epithelial neoplasm. Germ cell tumor. Thyroid lesion if it extends above thoracic inlet. Lymphoma.

A

Anterior mediastinal mass diff dx?

464
Q

Thymoma. Middle aged to older individuals, 45-60.

A

Most common primary tumor of the anterior mediastinum? Who gets it?

465
Q

33%. 10%

A

What percentage of thymoma patients have MG? Other way around.

466
Q

MG. Red cell aplasia. Hypogammaglobulinemia. Paraneoplastic syndromes. Malignancies such as lymphoma and thyroid cancer.

A

Thymomas are associated with what other diseases?

467
Q

Whether capsule is intact

A

Invasive and non invasive thymoma?

468
Q

30%. May invade adjacent structures.

A

What percentage of thymomas are invasive?

469
Q

Phrenic nerve invasion

A

Thymoma with L hemidiaphragm elevation?

470
Q

Drop mets along pleural and pericardial surfaces. Hematogenous mets are very rare.

A

Where does invasive thymoma spread?

471
Q
A

**Thymomas are classfied into A, AB, B1, B2, B3, C, with C being the worst

472
Q

Thymic carcinoma. Thymic carcinoid. Thymic cyst. Thymolipoma.

A

Other less common thymic lesions?

473
Q

Histologically malignant. Aggressive. Hematogenous mets. Poor prognosis.

A

Thymic carcinoma characteristics?

474
Q

Metastatic pattern.

A

Distinguishing between thymic carcinoma and thymoma on CT?

475
Q

ACTH, causing Cushing syndrome

A

50% of thymic carcinoids secrete and cause what?

476
Q

MEN 1 and 2

A

Thymic carcinoid is associated with what?

477
Q

Indistinguishable from thymoma and thymic carcinoma.

A

Imaging of thymic carcinoid?

478
Q

Preoperative Indium 111 Octreotide.

A

If carcinoid is suspected, what imaging?

479
Q

Radiation therapy, AIDS, Congenital

A

Thymic cyst often caused by what?

480
Q

Remnants of the thymopharyngeal duct

A

When thymic cysts are congenital they arise from what?

481
Q

Anterior mediastinum

A

Congenital thymic cyst may occur anywhere along the descent of the course of the thymus from neck but usually occur where?

482
Q

Benign fat containing lesion with interspersed soft tissue. Can become really large and drape over the mediastinum.

A

Characteristics of a thymolipoma?

483
Q

Males

A

Malignant germ cell tumor- which gender?

484
Q

Fat fluid level. Not commonly seen.

A

What is specific for a teratoma?

485
Q

Teratoma

A

Most common anterior mediastinal germ cell tumor?

486
Q
A

**Aorta is in posterior mediastinum, posterior mediastinal mass would silhouette the aorta

487
Q

Seminoma

A

What is most common malignant mediastinal germ cell tumor?

488
Q

Obscuration of the superior border of the mass implying mass is in continuity with the soft tissues of the neck

A

Cervicothoracic sign?

489
Q

Continuity with the superior thyroid obviously

A

Key to diagnosing a thyroid lesion as an anterior mediastinal mass?

490
Q
A

**Calcification is rare in untreated lymphoma.

491
Q

Hodgkins

A

Lymphoma most commonly in thorax?

492
Q

Usually happens in CWP and silicosis. Less commonly in sarcoid, but sarcoid is more common.

A

Egg shell calcification?

493
Q

TB. Can also be seen in fungal infection, metastatic disease and sometimes lymphoma

A

Low attenuation lymph nodes should raise concern for what?

494
Q

Castleman disease. Sarcoid. TB. Vascular mets.

A

Avid lymph node enhancement?

495
Q

Angiofollicular lymph node hyperplasia- cause of highly vascular thoracic lymph node enlargement, uncertain etiology.

A

What is castleman disease?

496
Q

Children. Surgical resection.

A

Who gets localized Castlemen and what is cure?

497
Q

Older patients or AIDS patients.

A

Who gets multicentric Castleman disease?

498
Q

Systemic illness including fever, anemia, lymphoma. Treat with chemo.

A

Symptoms of multicentric Castlemans? Treatment?

499
Q

Avidly enhancing lymphadenopathy

A

Key imaging feature of Castemans?

500
Q

R cardiophrenic angle. Cystic lesion abuts pericardium, can change shape.

A

Most common location of pericardial cyst? Appearnce.

MSK CORE (5 decks)

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