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Chest > CR Chest Challenge > Flashcards

CR Chest Challenge Flashcards

1
Q

Case 107

Photographic negative of pulmonary edema

A

Chronic Eosinophilic Pneumonia

RRx - Steroids
Asthma Correlation - 50%

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2
Q

Case 107

Three entities that typically present with a peripheral distribution of consolidation

A 
Chronic Eosinophilic Pneumonia
Cryptogenic Organizing Pneumonia (COP)
Loffler's Syndrome
Pulmonary Infarcts
Vasculitides
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3
Q

Case 108

Most common location for a paratracheal air cyst

A

Right posterolateral wall at the level of the thoracic inlet

Tracheal Diverticulum

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4
Q 
Case 110
Mediastinitis
Retrosternal fluid 
--> highly sensitive?
--> specific in early post operative period?
A
  • Yes
  • No
    • Specificity of retrosternal fluid for mediastinitis increases after POD 14
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5
Q

Case 111

What type of organism is most commonly responsible for nosocomial pneumonia?

A

Gram Negative

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6
Q

Case 111

Term used to describe cavitary pneumonia associated with intravacitary sloughed lung

A

Pulmonary Gangrene

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7
Q

Case 111

Organism most closely associated with pulmonary gangrene?

A

Klebsiella - not specific.. also Strep, TB, Mucormycetes

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8
Q

Case 112

Four types of emphysema

A

Centrilobular (upper lobes) Paraseptal

Panlobular (lower lobes) Paracicatrical

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9
Q

Case 112

Two causes of panlobular emphysema

A

Alpha1-antitrypsin (AAT) deficiency

IV injection of methylphenidate (Ritalin)

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10
Q

Case 113

Three CT findings of Obliterative Bronchiolitis

A

Mosaic Perfusion
Bronchial Dilitation
Air Trapping

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11
Q

Case 113

Four diseases or conditions that may be associated with OB

A

Bone Marrow Transplant RA
Viral Infections Lung Transplant
Toxic Fume Inhalation IBD

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12
Q

Case 113

Hallmark features of Obliterative Bronchiolitis

A

Mosaic pattern of attenuation

Air Trapping

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13
Q

Case 113

What distinguishes small airways dz from pulmonary vascular dz?

A

Air Trapping –> small airways dz

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14
Q

Case 114

Multiple pulmonary masses s/p hysterectomy

A

Metastatic Leiomyoma

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15
Q

Case 114

Slow growing pulmonary metastasis

A

Metastatic Leiomyoma
Thyroid CA
Salivary Gland Tumors

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16
Q

Case 114

Fast growing pulmonary metastasis

A

Sarcoma
Melanoma
Germ Cell Neoplasms

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17
Q

Case 115

Linear opacity coursing parallel to the pleural surface

A

Subpleural curvilinear line

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18
Q

Case 115

Linear opacity coursing perpendicular to the pleural surface?

A

Parenchymal bands

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19
Q

Case 115

Subpleural curvilinear lines and parenchymal bands are associated with what chronic infiltrative lung dz?

A

Asbestosis

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20
Q

Case 115

Findings in Asbestosis

A 
**Thickened Septal Lines
Subpleural curvilinear lines
Parenchymal Bands
Subpleural Dependant Density
Honeycombing
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21
Q 
Case 116
What is post-pneumonectomy Syndrome?
Why do patients get dyspnea?
Is this most common after left or right pneumonectomy?
Treatment?
A

Herniation of the contralateral lung in to the resected lung cavity
Compression of the lower lobe bronchus by vascular structures
Most commonly on the right
Surgical repositioning - saline prosthesis in cavity
* RARE*

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22
Q

Case 117

What is Mounier-Kuhn Syndrome?

A

Congenital tracheobronchomegaly w/ recurrent infections

  • Atrophy or absence of elastic fibers and thin muscular mucosa
  • Tracheal Diverticula
  • Ineffective coughing mechanism
  • Pooling of secretions
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23
Q

Case 117

Radiologic definition of tracheomegaly?

A

Coronal tracheal diameter of

  • > 25 mm in men
  • > 21 mm in women
  • measured 2 cm above the aortic arch
  • on standard PA radiograph
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24
Q

Case 118

Most common cause of central bronchiectasis?

A

ABPA - Aspergillosis

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25
Q

Case 118

Findings associated with ABPA

A

Mucoid impaction
Recurrent Atelectasis
Patchy Consolidation
- Asthmatics are predisposed

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26
Q

Case 119

Crazy-paving

A

Ground-glass opacity with superimposed smooth septal thickening in a patchy or geographic distribution

  • Aleveolar Proteinosis
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27
Q

Case 119

Three pulmonary infections that may complicate PAP

A

Nocardia
Aspergillus
Mucormycetes

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28
Q 
Case 119
How is PAP Diagnosed?
Treated?
Cause?
Typically Patient?
A

PAS-positive proteinaceous material
Brochoalveolar lavage (BAL)
Unknown
Men - 4th and 5th decade

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29
Q

Case 120

Define Tracheomalacia

A

Excessive pliability and collapsibility of the trachea secondary to weakness of the tracheal walls and supporting cartilages

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30
Q

Case 120
Primary (congenital) tracheomalasia patients primarily lack?

Which phase of respiration collapses the trachea?

A

Cartilage

Expiration - lunate trachea

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31
Q

Case 120
Tracheomalacia
Congenital Causes?

Acquired Causes?

A

Congenital deficiency of cartilage

Prior intubation / COPD / Trauma / Infection / Goiter

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32
Q

Case 121
Two most common cell types of primary malignant tracheal neoplasms

How much tracheal stenosis before patients are symptomatic

A

Adenoid Cystic Carcinoma - better prognosis
Squamous Cell Carcinoma - smokers, male, poor prognosis

75% narrowing

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33
Q

Case 122

Two most common causes of tubular opacities in the lung

A

Mucoid Impaction

AVM

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34
Q

Case 122
Two entities commonly associated with mucoid impaction

Most common cell type of NSCLC to present as an endobronchial lesion

A

ABPA and Cystic Fibrosis

Squamous Cell CA

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35
Q

Case 122

In bronchial obstruction, how does the adjacent lung remain aerated?

A

Collateral air drift

  • Pores of Kohn
  • Canals of Lambertt
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36
Q 
Case 123
Localized Fibrous Tumors of the Pleura
Benign?
Asbestos?
What skeletal abnormality is associated?
T1 and T2 signal intensity of fibrous tumors?
A

No
No - 60% benign / 40% malignant - most curable by surgical resection
Hypertrophic Osteoarthropathy - Episodic Hypoglycemia
Low T1 and Low T2

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37
Q

Case 124
Heart Transplant
Pulmonary nodule - infection or neoplasm?
Two organisms causing majority of infectious nodules in these pts
Non-infectious etiology

A

Infection
Aspergillus (2 months) and Nocardia (5 months)
Post-transpland lymphoproliferative disorder (2-6% occurence)

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38
Q

Case 125

Causes of PAH

A

Left to Right Shunt
Chronic PE
Mitral Valve Dz

39
Q

Case 126

Neoplastic causes of endobronchial lesion

A

Carcinoid Lung CA
Hamartoma Lipoma
Mucoepidermoid Tumor Lymphoma
Endobronchial Mets

40
Q

Case 126

Endobronchial Lesion and gastric wall thickening

A

Lymphoma

Breast Cancer

41
Q

Case 126

Causes of complete lung atelectasis

A

Main stem intubation
Obstructing mucous plug
Obstructing Neoplasm
Foreign Body

42
Q

Case 127

Neoplasms that result in a fine nodular pattern of metastasis

A

Thyroid
Melanoma
Renal Cell
Breast and Pancreas (Adenocarcinomas)

43
Q

Case 127

Neoplasms that may result in calcified mets

A

Thyroid Colon
Breast Sarcoma
Ovary Treated Mets

44
Q

Case 127

Non-neoplastic causes of fine nodular pattern

A

Healed VZ Pneumonia
Healed Histoplasmosis
Silicosis

45
Q

Case 128

Enhancing mediastinal LN

A

Castleman’s Dz
- Angiofollicular LN Hyperplasia
- Hyaline Vascular is more common subtype
- Plasma Cell most commonly associated with clinical manifestations
- May develop Lymphoma
Hypervascular Mets

46
Q

Case 128

Hypervascular mets

A

Renal Cell
Thyroid
Melanoma
Carcinoid

47
Q

Case 129
Spin Echo / Gradient Echo
- Anatomy - Black Blood
- Luminal Flow - White Blood

A

Spin Echo - Black Blood / excellent for anatomy

Gradient Echo - White Blood / evaluate luminal flow

48
Q

Case 130

Relapsing Polychondritis

A

Rare inflammatory disease that affects cartilages
Auricular 90%
Respiratory 50%

49
Q

Case 130

Entities with diffuse tracheobronchial narrowing

A

Wegner’s Relapsing Polychondritis
Sarcoidosis Tracheopathia (spares post wall)
Amyloidosis Osteochondroplastica (spares post wall)
Infection Saber sheath trachea

50
Q 
Case 131
Swyer-James Syndrome
Cause
CxR Findings
HRCT Findings
A
  • Acute viral infection in early childhood prevents development of lung
  • Unilateral hyperlucent lung / Reduced vascularity
  • Dec lung attenuation / Bronchiectasis / Air Trapping
  • Variant of postinfectious OB
51
Q 
Case 132
Nontuberculous mycobacterial infection (NTMB)
Causes
Demographics
Imaging characteristics
A

Mycobacterium avium Complex (MAC) and Myco Kansasii
Older men - COPD, hemoptysis
Older women - no COPD or hemoptysis, RML and Lingula
Cylindrical bronchiectasis / multiple tiny nodules / tree in bud

52
Q 
Case 133
Cardiac Bronchus
Where does it arise?
Symptoms?
Treatment?
A

Bronchus Intermedius
Recurrent infections / hemoptysis / cough / dyspnea
Surgical Resection in symptomatic patients

53
Q 
Case 134
Aberrant Right Subclavian Arthery (ARSA)
Prevalence?
Swallowing difficulty?
Associated acquired aortic abnormality?
A

Last branch from arch coursing L->R behind esophagus & trachea
1%
Dysphagia lusoria
Aortic Dissection - Stanford A surgical / Stanford B medical

54
Q 
Case 135
Interlobar Sequestration
Describe
Most common type
Most common side
Diagnosis
A

Aberrant lung tissue w/o normal connection to bronchial tree
Supplied by systemic artery
Intralobar most common - contained within the substance of the lung
Extralobar - contained within its own pleural envelope - syst ven drain
Left side most common / Posterior basal segment
Identification of systemic arterial supply confirms the diagnosis

55
Q

Case 136

Three early postoperative complications of lung transplantation

A

Reperfusion Edema
Acute Rejection
Infection- most common / cytomegalovirus (CMV)

56
Q

Case 138

Three disease entities that manifest as diffuse ground glass on CT

A

Hypersensitivity Pneumonitis
Atypical Infection (PCP, CMV)
Pulmonary Edema
Pulmonary Hemorrhage

57
Q

Case 138

Difference between ground glass and consolidation on CT

A

GG does not obscure underlying lung structures

58
Q

Case 138
Name seven Idiopathic Interstitial Pneumonias recognized by the American Thoracic Society (ATS) and the European Respiratory Society (ERS)

A 
IPF - Idiopathic Pulmonary Fibrosis
NSIP - Nonspecific IP
COP - Cryptogenic Organizing Pneumonia
AIP - Acute IP
RB-ILD - Respiratory Bronchiolitis-ILD
DIP - Desquamative IP
LIP - Lymphocytic IP
59
Q

Case 139

Cardiogenic causes of pulmonary edema associated with pregnancy

A

Preeclampsia
Peripartum Cardiomyopathy
- Last month of pregnancy
- or first 6 months following delivery

60
Q

Case 139

Non-cardiogenic causes of pulmonary edema in pregancy

A

Tocolytic Therapy

Amniotic Fluid Embolism

61
Q

Case 139
Is pregnancy associated with increased incidence of PE?

Why are pregnant patients at increased risk for community-acquired pneumonias?

A

Yes

Depression in cell mediated immunity

62
Q

Case 139
Preeclampsia -

Eclampsia -

A

Hypertention / Edema / Proteinuria

Seizures

63
Q

Case 140

Fat attenuation mass in the interatrial septum

A

Lipomatous Hypertrophy of the Interatrial Septum (LHIS)

  • 50% association with mediastinal lipomatosis
  • Brown / Fetal fat (PET +)
  • May rarely cause arrhythmias but mainly benign
64
Q

Case 141

Oligemia distal to an obstructing embolus

A

Westermark’s Sign

65
Q

Case 142

Disorder most closely associated with a basilar distribution of panlobular emphysema?

A

Alpha1-antitrypsin Deficiency (AAT)

  • Bronchiectasis
  • Autosomal Recessive
  • Cirrhosis
66
Q

Case 143

Cryptogenic Organizing Pneuonia

A

Peripheral patchy foci of consolidation
Peribronchovascular foci of consolidation

  • Reverse halo sign
67
Q

Case 145
Anterior mediastinal cyst

Anterior mediastinal mass ddx that contains solid and cystic elements

A

Thymic Cyst

Thymoma / Hodgkin’s / Germ Cell Tumors

68
Q

Case 145

Most common cause of thymic mass

A

Thymoma

69
Q

Case 145

Thymic mass with solid and cystic components

A

Thymoma
Hodgkin’s
Germ Cell Tumors

70
Q

Case 147

Hyperdense liver and pulmonary nodules

A

Amiodarone toxicity

  • used to treat arrhythmias
  • incidence is 5 - 20%
71
Q

Case 148

Multiple small nodules with peribronchovascular distribution

A

Sarcoidosis - ++ symmetrical hilar lymph node involvement
Lymphangitic Carcinomatosis
Lymphoma
Kaposi’s Sarcoma

72
Q

Case 149

Saphenous Vein Graft Aneurysm Following CABG

A

Most serious complication is dehiscence

73
Q

Case 150

Most common type of pulmonary infection to occur in HIV patients. Pneumocystis, bacterial, or mycobacterial?

A

Bacterial

74
Q

Case 151

Renal transplant patient presents with low grade fever and nonproductive cough

A

CMV

75
Q

Case 151

Is PCP a common opportunistic infection in transplant recipients?

A

No

76
Q

Case 151

What are the microscopic features of CMV?

A

Cellular enlargement

Intra-nuclear inclusion bodies

77
Q

Case 152

Pulmonary Venoocclusive Disease Triad

A

Severe PAH
Pulmonary Edema
Normal pulmonary venous wedge pressure

78
Q

Case 152
Pulmonary Venoocclusive Disease (PVOD)
Describe

A

Disorder characterized by obstruction of the pulmonary veins and venules by intimal fibrosis

Etiology unknown
Diagnosis requires biopsy

79
Q

Case 153

Multiple tracheal masses

A

Papillomatosis - HPV

Amyloid
- Nodules low signal on T1 and T2

80
Q

Case 154

Five causes of tracheal stenosis

A

Trauma Amyloidosis
Infection COPD
Sarcoid Relapsing Polychondritis
Wegner’s Tracheobronchopathia

81
Q

Case 154

Tracheal stenosis vs Tracheomalasia

A

Focal Narrowing

Excessive Collapsability during expiration

82
Q

Case 154

Idiopathic Tracheal Stenosis - more common in men or women?

A

Middle aged women

Treatment - surgery

83
Q

Case 156
Mosaic Pattern of Lung Attenuation
Secondary to Small Airways Disease
How can you differentiate pulm vasc dz from small airways dz?

A

Geographically marginated areas of low attenuation
Compare number and size of vessels
- Similar –> increased attenuation areas are abnormal
- Reduced –> low attenuation areas are abnormal
Obtain expiratory CT images –> small airways will show air trapping

84
Q

Case 157

Cyst within a cyst

A

Echinococcus

85
Q

Case 157

What is the significance of a Meniscus or crescent sign

A

Impending cyst ruprture

86
Q

Case 159

Entities associated with conglomerate masses in the upper lung zones

A

Sarcoid Coal Workers Pneumoconiosis
Silicosis Berylliosis
TB

87
Q

Case 161
Inhalational Anthrax Infection
Imaging Findings

A

CxR - mediastinal widening, hilar enlargement, pleural effusions
- Hilar LNs and pleural effusions rapidly enlarge

88
Q

Case 162

Two diseases that manifest as ground-glass opacity and cysts

A

PCP

LIP - Lymphocytic Interstitial Pneumonia

89
Q

Case 163

Three smoking related interstitial lung diseases

A

PLCH
DIP
RB-ILD

90
Q

Case 163
What is DIP?
DDx?

A

Desquamative Interstitial Pneumonia
- rare interstitial pneumonia that occurs almost exclusively in cigarette smokers
- no honeycombing
DDx - PLCH, RB-ILD

91
Q

Case 164

Indications for pleurodesis?

A

Intractable pleural effusions

Recurrent pneumothorax

92
Q

Case 164

What agent is used to perform PET imaging?

A

F18-Fluorodeoxyglucose

93
Q

Case 164

What is more common mets or mesothelioma?

A

Mets

94
Q

Case 164

What is latency period btwn asbestos and mesothelioma?

A

30 to 40 yrs

Chest (3 decks)

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