Chest

Question 0

Pulmonary renal syndromes (haemorrhage + nephritis)

Answer 0

• Goodpasture syndrome (anti-GBM positive)
• Wegener disease (ANCA positive; nodules are
more common than ASD)
• SLE
• Henoch-Schönlein purpura
• Polyarteritis nodosa
• Penicillamine hypersensitivity

Question 1

Solitary pulmonary nodule

Answer 1

Granulomatous: tuberculoma, histoplasmoma, cryptococcus, coccidiodomycosis

Malignant: lung cancer, solitary metastasis

Benign: carcinoid, hamartoma

Infectious/inflammatory: pneumonia, hydatid, rounded atelectasis, Wegener’s, sarcoid, organising pneumonia

Congenital: sequestration, bronchogenic cyst, intrapulmonary lymph node

Vascular: haematoma, AVM

Question 2

Causes of ARDS

Answer 2

• Massive pneumonia
• Trauma
• Shock
• Sepsis
• Pancreatitis
• Drug overdose
• Near-drowning
• Aspiration

Question 3

Chronic airspace disease

Answer 3

Tumors
• Bronchioalveolar carcinoma • Lymphoma

Inflammation
• Tuberculosis, fungus
• Eosinophilic pneumonia
• Pneumonitis, BOOP/COP
• Alveolar sarcoid (mimics ASD)

Other causes
• Alveolar proteinosis
• Pulmonary hemorrhage
• Lipoid pneumonia, chronic aspiration

Question 4

Multiple pulmonary nodules

Answer 4

Metastases

Abscesses (pyogenic e.g. Staph, Klebsiella; immunocompromised e.g. Nocardia, Legionella)

Infectious: TB, fungus, aspergillosis, histoplasmosis

Inflammatory: sarcoidosis, rheumatoid nodules, silicosis,

Wegener’s, necrotising vasculitis, histiocytosis

Question 5

Miliary pattern

Answer 5

Hematogenous infection: TB, histoplasmosis
Metastases: thyroid, melanoma, breast, choriocarcinoma
Eosinophilic granuloma
Silicosis
Sarcoid

Question 6

Calcified lung nodules, > 1mm

Answer 6

Metastases
- Medullary thyroid cancer, mucinous or osteogenic metastases

Infection

• Previous varicella pneumonia
• Histoplasmosis, coccidioidomycosis, TB

Parasites
- Schistosomiasis

Other
- Silicosis, CWP

Question 7

Calcified lung nodules, < 1mm

Answer 7

Alveolar microlithiasis
Chronic pulmonary venous hypertension
“Metastatic” calcification from severe renal
disease

Question 8

Cavitating lesion

Answer 8

Abscess
• Pyogenic: Staphylococcus > Klebsiella > Streptococcus
• Immunocompromised: Legionella, Nocardia

Cavitated tumor
• SCC (primary SCC > head and neck SCC > sarcoma metastases)
• Sarcoma
• Lymphoma
• TCC of the bladder

Cavitated granulomatous mass (often multiple)
• Fungus: Aspergillus, coccidioidomycosis (thin
wall)
• TB
• Sarcoid, Wegener disease, rheumatoid nodules
• Necrotizing granulomatous vasculitis

Cavitated posttraumatic hematoma

Question 9

Small cystic disease

Answer 9

• Eosinophilic granuloma
• Lymphangioleiomyomatosis
• Cystic form of PCP
• Honeycombing in any end-stage interstitial
disease
• LIP

Question 10

Interstitial disease

Answer 10

Fluid

• Pulmonary edema
• Venous obstruction (thrombosis)

Inflammation

• Infectious (interstitial pneumonias)
• Viral
• Granulomatous (TB, fungal) PCP

Idiopathic

• IPF
• Sarcoid

Collagen vascular disease

• RA
• Scleroderma
• Ankylosing spondylitis

Extrinsic agents

• Pneumoconiosis (asbestos, silicosis, CWP)
• Drugs

Tumor
• Interstitial tumors: Eosinophilic granuloma
• Lymphangitic tumor spread
• Desmoplastic reaction to tumor

Proteinaceous material

Question 11

Crazy paving

Answer 11

Pulmonary alveolar proteinosis
ARDS
PCP
Lipoid pneumonia
Hemorrhage
Bronchoalveolar carcinoma (BAC)
Pulmonary edema

Question 12

Focal pulmonary haemorrhage

Answer 12

PE
Trauma (contusion)
AVM
Cancer (BAC)

Question 13

Diffuse pulmonary haemorrhage

Answer 13

Wegener
Goodpasture (resolves in days to weeks, can result in fibrosis)
Idiopathic (children)
Bone marrow transplant

Question 14

Peripheral ground glass opacity and consolidation

Answer 14

COP
Infarcts
Septic emboli
Collagen vascular disease
Contusion
DIP
Drug toxicity
Eosinophilic pneumonia
Fibrosis
Sarcoidosis

Question 15

Honeycombing on HRCT

Answer 15

UIP (idiopathic pulmonary fibrosis)
Scleroderma/RA
Asbestosis
Chronic hypersensitivity pneumonitis
Sarcoidosis
Silicosis
EG
Drug toxicity: bleomycin

Question 16

Diseases spreading along bronchovascular bundle

Answer 16

Sarcoidosis
Lymphoma
Lymphangitic spread of tumor
TB
Kaposi sarcoma

Question 17

Hyperlucent lung

Answer 17

Airways

• Obstruction of airways (air trapping)
• Emphysema, bullae
• Large airway obstruction: asthma, mucus plug Small airway obstruction (bronchioli): Swyer-James syndrome (bronchiolitis obliterans)
• Compensatory hyperexpansion of residual lung after: surgical lobectomy, chronic lobar collapse
• Cysts
• Congenital: Hypogenetic lung syndrome, congenital lobar emphysema

Vascular (hyperlucency caused by oligemia)

• PE
• Pulmonary artery stenosis

Chest wall abnormalities

• Mastectomy
• Poland syndrome (congenital absence of pectoralis muscle)

Pleural
- Pneumothorax

Question 18

Small lung

Answer 18

Hypogenetic lung syndrome
Agenesis of pulmonary artery
Chronic atelectasis
Bronchiolitis obliterans (Swyer-James syndrome)

Question 19

Bronchiectasis

Answer 19

Postinfectious (most common)
• Any childhood infection
• Recurrent aspiration
• ABPA: central bronchiectasis
• Chronic granulomatous infection
• Pertussis

Bronchial obstruction
• Neoplasm
• Foreign body

Congenital
• Cystic fibrosis (abnormal secretions)
• Bronchial cartilage deficiency: Campbell syndrome
• Abnormal mucociliary transport: Kartagener
syndrome

Question 20

Upper lobe bronchiectasis

Answer 20

• Cystic fibrosis
• TB
• Radiation
• ABPA (most commonly central)
• Mounier-Kuhn syndrome
• Agammaglobulinemia
• Kartagener syndrome

Question 21

Calcified pleural plaques

Answer 21

• Tuberculosis (usually diffuse plaques)
• Asbestos-related plaques (usually focal plaques)
• Fluid (empyema, hematoma)
• Talc

Question 22

Elevated hemidiaphragm

Answer 22

Phrenic nerve paralysis • Tumor • Surgery
Immobility because of pain • Rib fractures
Pleuritis, pneumonia
PE
Abdominal masses, subphrenic collection, abscess
Diaphragmatic hernia
Pleural tumors
Subpulmonic effusion (apparent elevation of hemidiaphragm)

Question 23

Lower lobe bronchiectasis

Answer 23

Post infective
Aspiration
Hypogammaglobulinemia
Bronchiolitis obliterans (post transplant)