Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AJT CORE > CORE - Chest > Flashcards

CORE - Chest Flashcards

1
Q

Right or left ribs project more posteriorly on lateral chest x-ray

A

right ribs project more posteriorly (also slightly magnified); by convention lateral view is obtained with left side against the detector

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

“Black hole” on lateral chest x-ray

A

L mainstem bronchus (or LUL); left PA is both posterior and superior, right PA is anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Normal posterior wall thickness of bronchus intermedius

A

<3 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Raider’s triangle

A

a.k.a. retrotracheal space; anterior border is posterior trachea, posterior border is vertebral column

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Opacity in Raider’s triangle

A

aberrant SCA (right or left), double aortic arch, substernal goiter, esophageal diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most anterior and superior cardiac valves

A

tricuspid is most anterior, pulmonic is most superior; mitral valve is larger in size than the aortic valve (if two prosthetic valves are seen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

“Pointy” part of mechanical cardiac valves point toward or away from the direction of blood flow?

A

toward the direction of blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Valve that would have a pacemaker wire running through it

A

tricuspid valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Number of pleural layers in azygous fissure

A

4 layers of pleura; azygous vein displaced laterally during development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

More anterior of the major fissures on lateral chest x-ray

A

right major fissure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Flat waist sign

A

LLL collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Segments of RUL (3) and LUL (4)

A

RUL = anterior, posterior, apical; LUL = anterior, apical-posterior, superior lingular, inferior lingular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Inferior border of superior mediastinum

A

sterno-manubrial junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Posterior border of anterior mediastinum

A

pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Contents of middle mediastinum

A

heart, pericardium, tracheal bifurcation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mediastinal compartment containing thoracic duct

A

posterior mediastinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pig bronchus + associations

A

bronchus arises directly from trachea (prior to bifurcation); classically refers to RUL bronchus; assoc. with pulmonary sling and TEF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Most common anatomic variant of pulmonary veins

A

separate vein draining RML; typically only upper and lower pulmonary veins for each lung (4 total)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Findings in proximal interruption of the pulmonary artery

A

small hemithorax, oligemia (relative to other lung); distal vessels are present; occurs on side opposite of aortic arch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Proximal interruption of the pulmonary artery associations

A

PDA; interrupted left PA is also assoc. with ToF and truncus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Location of mediastinal findings above the clavicles

A

posterior mediastinum (“cervicothoracic sign”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hilum overlay sign

A

vessels seen through hilar mass => mass is either in anterior or posterior mediastinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Most common cause of pneumonia in normal patients and AIDS patients

A

S. pneumo for both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Bioterrorism + mediastinal widening

A

anthrax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

“Bulging fissure”

A

Klebsiella; classically in alcoholics and aspirators; h/o “currant jelly” sputum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Patients who get pseudomonas pneumonia

A

vented ICU patients, CF and primary ciliary dyskinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Most common complication of aspiration

A

empyema (which can develop a bronchopleural fistula)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Infection associated with chest wall invasion and/or rib osteomyelitis

A

actinomyces; post-dental procedure, may also have mandibular osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pulmonary findings post-BMT

A

<30 days = edema, hemorrhage, ARDS, aspergillosis; 30-90 days = PCP, CMV; >90 days = COP, bronchiolitis obliterans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Timing of GVHD affecting lungs (post-BMT)

A

> 100 days; manifests as bronchiolitis obliterans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Pulmonary infections with CD4 >200

A

bacterial infections, TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Pulmonary infections with CD4 <200

A

PCP, atypical mycobacterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Pulmonary infections with CD4 <100

A

CMV, disseminated fungal, mycobacterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Chronic airspace opacity in AIDS patient

A

consider AIDS lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

AIDS patient with CD4 <100 and GGO (PCP isn’t an option on this multiple choice question)

A

CMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Hypervascular lymph nodes (AIDS patient)

A

Castleman disease, Kaposi sarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Ranke complex

A

Ghon focus + ipsilateral calcified hilar node; represents healed primary TB; Ghon focus = calcified caseating granuloma (tuberculoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Primary TB in peds and immunocompromised patients

A

consolidation, effusion, lymphadenopathy; cavitation is uncommon; lymph nodes demonstrate central low density

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Post-primary TB

A

a.k.a. reactivation TB; cavitary lesion in upper lobe(s); lymphadenopathy uncommon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Miliary TB

A

represents hematogenous dissemination; can occur in primary or reactivation TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Patient with TB and AIDS started on HAART, now doing worse

A

immune reconstitution inflammatory syndrome (IRIS); treatment is steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

MAC infection (cavitary form)

A

thin-walled cavitary lesion(s) in upper lobe with fibrosis, +/- tree-in-bud nodules in other areas (endobronchial spread); seen in COPD, CF, immunocompromised patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Hot tub lung

A

hypersensitivity pneumonitis in response to mycobacteria; no active infection; UL GGO + centrilobular nodules; occurs in otherwise health patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Infection with propensity to invade mediastinum, pleura, or chest wall

A

mucormycosis; actinomyces may also invade chest wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Timing of CMV in patients post-BMT

A

30-90 days; occurs due to reactivation of latent infection or from CMV-infected marrow products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

SARS findings

A

lower lobe predominant GGO; SARS = severe acute respiratory syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Diffusely scattered small calcified lung nodules

A

healed varicella; occurs most commonly in immunocompromised adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Feeding vessel sign DDx

A

hematogenous mets, septic emboli, pulmonary infarcts, invasive aspergillosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Bacteria implicated in Lemierre syndrome

A

Fusobacterium necrophorum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

USPSTF recommendations for lung cancer screening

A

low dose CT for asymptomatic adults 55-80 y/o with a 30 pack-year history and who currently smoke (or quit within 15 years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Size cutoff for a solitary pulmonary nodule

A

<3 cm (>3 cm = mass)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Most suspicious SPN calcification pattern

A

eccentric calcification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

SPN findings suggestive of malignancy

A

spiculated margins, air bronchogram through nodule (AIS), part-solid part-GGO nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

SPN morphology (most to least suspicious)

A

part-solid part-GGO > pure GGO > pure solid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

GGO nodule on PET

A

cold suggests malignancy, hot suggests infection; SPN should be >1 cm to evaluate on PET

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Paraneoplastic syndromes associated with lung cancer

A

PTH in SCC; SIADH, ACTH, limbic encephalitis, and Lambert-Eaton in small cell lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Most common type of lung cancer

A

adenocarcinoma; also most common type to present as SPN; assoc. with pulmonary fibrosis and smoking (less than SCC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Well-differentiated adenocarcinoma with lepidic growth

A

AAH/AIS/invasive mucinous adenocarcinoma (a.k.a. BAC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Chronic consolidation DDx

A

endobronchial tumor (post-obstructive), mucinous BAC, lymphoma, organzing pneumonia, eosinophilic pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

BAC on PET

A

cold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Stage of lung cancer that is unresectable

A

stage 3B or higher (see ‘SPECIAL - Staging’ notes for more info)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Radiation changes (lungs)

A

early (1-3 months) = geographic GGO; late = bronchiectasis, fibrosis, consolidation, volume loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Increasing air in pneumonectomy cavity (post-op)

A

bronchopleural fistula; should become progressively more fluid-filled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Xenon in pneumonectomy cavity on V/Q scan

A

bronchopleural fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

“Cannonball mets”

A

RCC or choriocarcinoma mets (classically)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Most common cause of unilateral lymphangitic carcinomatosis

A

bronchogenic carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Heart valves affected by endobronchial carcinoid

A

mitral and aortic valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Most common tracheal malignancy + 2nd most common

A

SCC > adenoid cystic carcinoma; both generally arise in lower trachea; ACC is NOT assoc. with smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Primary pulmonary lymphoma

A

defined as lack of extra-thoracic involvement for 3 months; usually NHL (80% are MALT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Secondary pulmonary lymphoma - NHL vs. HL

A

NHL is 80-90% of secondary pulmonary lymphoma, but HL more commonly involves the lungs; NHL often occurs in the absence of mediastinal disease (unlike HL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Timing of pulmonary PTLD

A

usually occurs within 1 year; typically B-cell type (assoc. with EBV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

AIDS patient with lung nodules, pleural effusions, lymphadenopathy

A

AIDS lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

AIDS lymphoma

A

high-grade NHL, assoc. with EBV; CD4 <100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Most common lung tumor in AIDS patients

A

Kaposi sarcoma > AIDS lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Bloody pleural effusion in AIDS patient

A

Kaposi sarcoma; CD4 <200 for Kaposi’s; most common hepatic neoplasm in AIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Pulmonary lesion with “popcorn calcification”

A

hamartoma; often with intra-lesional fat; may be PET hot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Most common location for bronchial atresia

A

apical-posterior segment of LUL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Finger-in-glove DDx

A

ABPA, bronchial atresia, bronchial carcinoid, bronchogenic carcinoma, CF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Indication to treat pulmonary AVM

A

afferent vessel >3 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Left SVC drainage

A

coronary sinus; rarely to LA (resulting in right-to-left shunt)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Extralobar sequestration associations

A

CCAM, CDH, vertebral anomalies, congenital heart disease, pulmonary hypoplasia; extralobar type is less common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Potential complication of CCAM

A

malignant transformation to pleuopulmonary blastoma and rhabdomyosarcoma; treatment of CCAM is excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

CCAM with a systemic arterial feeding vessel

A

sequestration (NOT CCAM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Lung disease(s) that spare costophrenic angles

A

pulmonary LCH, hypersensitivity pneumonitis

85
Q

Cystic lung disease with thin-walled oval cysts

A

Birt-Hogg-Dube; also get skin stuff and RCCs/oncocytomas

86
Q

LIP associations

A

Sjogren’s, HIV, RA, SLE, Castleman’s; LIP in peds => think HIV

87
Q

Increased size of the retrosternal clear space

A

empyshema

88
Q

Causes of panlobular emphysema

A

a.k.a. panacinar emphysema; alpha-1 antitrypsin, Swyer-James, ritalin lung

89
Q

Central dot sign

A

centrilobular emphysema; most common type; upper lobe predominant

90
Q

Paraseptal emphysema findings

A

subpleural distribution; 1 row of cysts thick (vs. honeycombing which is 2-3 rows thick)

91
Q

Main PA greater than aorta in size in the setting of emphysema

A

assoc. with worse outcomes; represents pulmonary HTN due to COPD

92
Q

Vanishing lung syndrome

A

a.k.a. idiopathic giant bullous emphysema; occupies >1/3 of hemithorax by definition; young males usually

93
Q

Vanishing lung syndrome associations

A

alpha-1 antitrypsin, Marfan’s, Ehlers-Danlos

94
Q

Pattern of nodularity in pneumoconioses

A

centrilobular and/or perilymphatic

95
Q

Asbestosis (definition)

A

fibrotic changes assoc. with asbestos exposure; UIP-esque changes + pleural thickening

96
Q

Earliest pleural-based phenomenon associated with asbestos exposure

A

pleural effusion (lag time of 5 years); pleural plaques and mesothelioma have a lag time of >20 years

97
Q

Cavitary upper lobe lesion in the setting of silicosis

A

suspect TB; PMF can also cavitate

98
Q

Pattern of nodularity with subpleural sparing

A

centrilobular

99
Q

Upper lobe fibrosis DDx

A

end-stage sarcoidosis, chronic HSP, end-stage silicosis, ankylosing spondylitis

100
Q

Lower lobe fibrosis DDx

A

IPF, NSIP (fibrotic form), end-stage asbestosis, rheumatoid arthritis, scleroderma

101
Q

Occupational history of working on aircraft or space shuttles

A

Berylliosis; hilar adenopathy + upper lobe reticular opacities

102
Q

Findings in talcosis

A

GGO, micronodules, +/- PMF

103
Q

Consolidation vs. GGO

A

consolidation obscures vessels, GGO does not

104
Q

Centrilobular nodules DDx

A

endobronchial spread of infection (pneumonia, TB), HSP, RB-ILD, silicosis; “airway stuff”

105
Q

Perilymphatic nodules DDx

A

sarcoidosis, pneumoconioses, lymphangitic carcinomatosis

106
Q

RB-ILD findings

A

GGO + centrilobular nodules; typically upper lobe predominant; RB-ILD = RB + clinical symptoms

107
Q

DIP findings

A

lower lobe predominant GGO (more extensive than RB-ILD); +/- small cysts

108
Q

Most common interstitial lung disease

A

UIP/IPF

109
Q

“Heterogeneous histology”

A

UIP/IPF

110
Q

NSIP subtypes

A

cellular (GGO only) and fibrotic (GGO + traction bronchiectasis + reticulation); posterior lower lobes with subpleural sparing; Tx is steroids

111
Q

Biochemical markers in sarcoidosis

A

elevated ACE, hypercalcemia

112
Q

Stage 2 of sarcoidosis

A

lymphadenopathy + parenchymal disease; stage 1 is only nodes, stage 3 is only parenchymal, stage 4 is fibrosis; based on x-ray

113
Q

Stage of CHF: cephalization of vessels, big heart

A

stage 1 (redistribution); PCWP 13-18 mmHg

114
Q

Stage of CHF: peribronchial cuffing, Kerley B lines

A

stage 2 (interstitial edema); PCWP 19-25 mmHg

115
Q

Stage of CHF: airspace opacity, pleural effusion

A

stage 3 (alveolar edema); PCWP >25 mmHg

116
Q

Most common cause of right heart failure

A

left heart failure; other causes include chronic PE and tricuspid regurgitation

117
Q

Cause of hyperacute rejection following lung transplant

A

HLA and ABO antigen mismatch; massive homogeneous infiltration

118
Q

Time frame for acute rejection following lung transplant

A

8 days to 2 months; GGO + interlobular septal thickening; treatment is steroids

119
Q

Findings in chronic lung transplant rejection

A

bronchiolitis obliterans (bronchiectasis, air trapping, bronchial wall thickening); affects 50% at 5 years; may progress to fibrosis

120
Q

Organizing pneumonia in lung transplants

A

seen in both acute and chronic rejection (more common in acute); treatment is steroids

121
Q

Air trapping in a lung transplant at or after 6 months

A

chronic rejection

122
Q

Most common recurrent primary disease after lung transplant

A

sarcoidosis

123
Q

Increased infection risk related to PAP

A

Nocardia

124
Q

PAP in a child <1 y/o

A

assoc. with alymphoplasia

125
Q

Most common type of lipoid pneumonia

A

endogenous; due to a post-obstructive process (e.g. cancer)

126
Q

Atoll sign

A

a.k.a. reverse halo sign; organizing pneumonia; may be secondary to infection, drug reaction, inhalation, acute/chronic rejection; treatment is steroids

127
Q

Peripheral GGO or consolidation DDx

A

organizing pneumonia, chronic eosinophilic pneumonia, non-cardiogenic pulmonary edema, atypical/viral pneumonia

128
Q

Phase of HSP with patchy GGO, centrilobular nodules, and air trapping

A

subacute

129
Q

Findings of chronic HSP

A

subacute findings + fibrosis

130
Q

Causes of focal tracheal stenosis

A

post-intubation/tracheostomy, Behcet’s, Crohn’s

131
Q

Circumferential tracheal thickening with calcifications

A

amyloidosis

132
Q

Kartagener syndrome

A

primary ciliary dyskinesia + situs inversus; 50% of PCD patients have Kartagener’s

133
Q

Tracheal diameter >3 cm

A

Mounier-Kuhn (a.k.a. tracheobronchomegaly); normal tracheal size is <2.5 cm

134
Q

Air trapping on CT (no additional findings)

A

bronchiolitis, often viral or asthma in kids; may see assoc. centrilobular nodules; consider RB in smokers and chronic rejection in lung transplants

135
Q

Follicular bronchiolitis associations + findings

A

Sjogren’s, RA, HIV; lower lobe predominant ground-glass centrilobular nodules +/- tree-in-bud nodules

136
Q

Constrictive bronchiolitis

A

a.k.a. bronchiolitis obliterans; bronchiectasis, air trapping, bronchial wall thickening, GGO

137
Q

Causes of bronchiolitis obliterans

A

post-viral, inhalational, post-transplant, drug-induced, Swyer-James

138
Q

Findings in ankylosing spondylitis

A

upper lobe fibrosis and bullous changes

139
Q

Pulmonary manifestations of RA

A

lower lobe fibrosis; presence of rheumatoid nodules help distinguish from UIP; may see pleural thickening and/or effusion

140
Q

Upper lobe lung nodules in a coal miner with RA

A

Caplan syndrome

141
Q

“Shrinking lung”

A

progressive volume seen in SLE; involves both lungs; may also see pleural and pericardial effusions

142
Q

Shortness of breath when sitting up

A

hepatopulmonary syndrome; arteriovenous shunting seen in cirrhosis; dilated subpleural vessels in peripheral lower lobes; uptake in brain and kidneys on Tc-99m MAA

143
Q

Goodpasture syndrome findings

A

patchy GGO and/or consolidation; may progress to fibrosis; h/o hemoptysis

144
Q

Pleural calcification DDx

A

abestos-related plaques, old hemorrhage, old infection/TB, extra-skeletal osteosarcoma

145
Q

Pleural mass with extension into pulmonary fissure

A

suggestive of mesothelioma; most common pleural malignancy (lipoma is the most common benign pleural tumor)

146
Q

Fibrous tumor of the pleural associations

A

hypoglycemia, hypertrophic osteoarthropathy; 20% are malignant; 6th-7th decade

147
Q

Most common pleural mets

A

lung cancer (adenocarcinoma most commonly) > breast > lymphoma; pleural effusion is the most common manifestation

148
Q

Volume of pleural effusion to be visible on frontal and lateral x-rays

A

175 cc for frontal and 75 cc for lateral

149
Q

Lateralization of diaphragmatic peak

A

subpulmonic effusion (between lung base and diaphragm)

150
Q

Most common pathogens associated with empyema necessitans

A

TB > actinomyces; “BATMAN”

151
Q

Most common location of traumatic diaphragmatic hernia (not congenital)

A

left-side also (liver is protective)

152
Q

Paradoxial movement of diaphragm on sniff test

A

diaphragmatic paralysis; hemidiaphragm is elevated on inspiration and does not change on expiration; must consider malignancy causing phrenic nerve compression (arises from C3-5 nerve roots)

153
Q

Elevated hemidiaphragm with negative sniff test

A

eventration (congenital weakening); DDx is diaphragmatic paralysis, diaphragmatic hernia, subpulmonic effusion

154
Q

Pancoast tumor definition

A

superior sulcus tumor + Pancoast syndrome (shoulder pain, hand pain/atrophy, Horner syndrome); most commonly SCC

155
Q

Reasons for superior sulcus tumor unresectability

A

C8 or higher brachial plexus involvement, diaphragmatic paralysis, >50% vertebral body involvement, distant nodes or mets

156
Q

Multiple pleural lesions with slurred speech, double vision, and arm weakness

A

thymoma with drop mets (in the setting of myasthenia gravis)

157
Q

Thymoma vs. thymic carcinoma

A

lymphadenopathy and mets are more common in thymic carcinoma

158
Q

Thymoma associations

A

myasthenia gravis, pure red cell aplasia, hypogammaglobulinemia

159
Q

Anterior mediastinal soft tissue mass DDx

A

thymic hyperplasia, thymoma, thymic carcinoma, malignant germ cell tumor, lymphoma

160
Q

Thymic hyperplasia vs. thymic malignancy (MR)

A

thymic hyperplasia demonstrates signal dropout on out-of-phase (thymic malignancies do not)

161
Q

Most common mediastinal germ cell tumor

A

teratoma (cystic +/- fat and calcs); seminoma is homogeneous, NSGCTs are heterogeneous; all assoc. with Klinefelter’s

162
Q

Causes of fibrosing mediastinitis

A

histoplasmosis, TB, radiation, sarcoidosis

163
Q

Anterior mediastinal mass with calcification(s) DDx

A

teratoma, treated lymphoma, thymoma, thymic carcinoma

164
Q

Aortic nipple

A

left superior intercostal vein

165
Q

Fissure separating medial-basal segment from other lower lobe segments

A

inferior accessory fissure; more common on right

166
Q

Fissure separating superior segment from other lower lobe segments

A

superior accessory fissure

167
Q

Thoracic duct course

A

arises from cisterna chyli (L1) => passes through aortic hiatus => crosses midline at T5 (right-to-left) => empties into LSCV/LIJV

168
Q

Size limit for bleb vs. bulla

A

bleb is <1 cm, bulla is >1 cm; giant bulla occupies >30% of hemithorax

169
Q

Westermark sign

A

regional oligemia (due to PE)

170
Q

Fleischner sign

A

enlarged pulmonary artery (due to PE)

171
Q

Pulmonary artery aneurysm DDx

A

iatrogenic, Behcet’s, chronic PE

172
Q

Recurrent thrombophlebitis + pulmonary artery aneurysms

A

Hughes-Stovin syndrome (vasculitis); aneurysms may rupture

173
Q

Rasmussen aneurysm seen in primary or post-primary TB?

A

post-primary (reactivation); pseudoaneurysm (not a true aneurysm)

174
Q

Signs of pulmonary hypertension

A

> 25 mmHg (pulmonary artery); PA >29 mm or larger than the aorta, mural calcifications, RV diltation and/or hypertrophy

175
Q

Causes of secondary pulmonary hypertension

A

chronic PE, cor pulmonale (emphysema/asthma/CF), left heart failure, mitral valve stenosis, pulmonary veno-occlusive disease

176
Q

Location of tracheobronchial injury (trauma)

A

within 2 cm of carina; injury close to the carina causes pneumomediastinum rather than pneumothorax

177
Q

Criteria for flail chest

A

≥3 segmental rib fractures or >5 adjacent rib fractures; “paradoxical motion of chest wall with breathing”

178
Q

Persistent fluid collection after chest tube placement (trauma)

A

extra-pleural hematoma; look for displaced extra-pleural fat

179
Q

Timing of pulmonary contusion

A

appears within 6 hours, disappears in 72 hours; represents alveolar hemorrhage without alveolar disruption

180
Q

Most common site of aortic injury (trauma)

A

isthmus > root > diaphragm

181
Q

Altered mental status, rash, and shortness of breath (trauma)

A

fat emboli (classically 1-2 days after fracture); GGO in lungs (looks like edema); may not see pulmonary artery filling defects

182
Q

Abrupt bend in tip of a central line near cavo-atrial junction

A

terminates in azygous vein

183
Q

Central line on left side of heart

A

left-sided/duplicated SVC or arterial placement

184
Q

Ideal endotracheal tube positioning

A

5 cm from carina; neck flexion => tip moves caudal; neck extension => tip moves cephalad

185
Q

Function of IABP

A

decrease LV afterload, increase myocardial perfusion; should be just below origin of LSCA

186
Q

ACR Appropriateness Criteria: suspicion for metastatic disease

A

CXR

187
Q

ACR Appropriateness Criteria: patients on mechanical ventilation

A

daily CXR

188
Q

ACR Appropriateness Criteria: chest pain with high suspicion for aortic dissection

A

CXR

189
Q

PMF assocations

A

silicosis, CWP, talcosis, sarcoidosis

190
Q

Frozen hemithorax

A

mesothelioma; lack of expected contralateral mediastinal shift with massive pleural effusion

191
Q

Hemorrhagic lymph nodes

A

anthrax; mediastinal widening also

192
Q

Tulip bulb aorta

A

annulo-aortic ectasia (Marfan’s, Ehlers-Danlos)

193
Q

Reverse batwing pulmonary opacities

A

chronic eosinophilic pneumonia; high serum eosinophils, normal BAL eosinophils

194
Q

Migratory pulmonary consolidations

A

pulmonary eosinophilia (Loeffler syndrome); normal serum eosinophils, high BAL eosinophils

195
Q

Angiofollicular lymph node hyperplasia

A

a.k.a. Castleman disease

196
Q

Location of acute HSP

A

lower lobe predilection, patchy GGO

197
Q

Erdheim-Chester syndrome

A

classic triad of osteosclerosis + perirenal soft tissue + pleural or diffuse septal thickening; may see GGO and centrilobular nodules

198
Q

Normal relationship of bronchi and PAs

A

right bronchus is eparterial (bronchus above artery); left bronchus is hyparterial (bronchus below artery) then anterior to the left PA

199
Q

Relationship of PAs to trachea on lateral chest x-ray

A

right PA is anterior to the trachea, left PA is posterior to the trachea

200
Q

Which hilum is higher on a frontal radiograph?

A

left

201
Q

Lenticular subscapular soft tissue mass with fatty streaks

A

elastofibroma; seen in elderly patients; biopsy unnecessary with classic appearance; resection is curative

202
Q

Amiodarone toxicity

A

peripheral consolidations +/- interstitial fibrosis; treatment discontinue + steroids

203
Q

Wandering vein

A

single vein collects all pulmonary venous return from a lung and drains to LA

204
Q

Scimitar syndrome associations

A

pulmonary hypoplasia, ASD, horseshoe lung, absence/interruption of IVC, systemic arterial supply to right lung

205
Q

Thymic carcinoid association

A

MEN1; most commonly assoc. hormonal syndrome is Cushing’s

206
Q

p-ANCA vasculitides

A

Churg-Strauss, PAN; Goodpasture’s is non-ANCA

207
Q

Increased risk of pneumothorax in lung biopsy

A

lesion size <2 cm, depth >4 cm, COPD, non-perpendicular pleural entry site, multiple pleural punctures

208
Q

Lower lobe segments - right and left

A

right = PALMS; left = SLAP (anteromedial)

209
Q

Intermediate probability for PE with negative D-dimer - NEXT STEP

A

CXR; if intermediate probability + positive D-dimer => CTA or CXR; pregnant patients with suspicion for PE should start with CXR

AJT CORE (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions