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
Case 118 | Findings associated with ABPA
Mucoid impaction Recurrent Atelectasis Patchy Consolidation - Asthmatics are predisposed
26
Case 119 | Crazy-paving
Ground-glass opacity with superimposed smooth septal thickening in a patchy or geographic distribution - Aleveolar Proteinosis
27
Case 119 | Three pulmonary infections that may complicate PAP
Nocardia Aspergillus Mucormycetes
28
``` Case 119 How is PAP Diagnosed? Treated? Cause? Typically Patient? ```
PAS-positive proteinaceous material Brochoalveolar lavage (BAL) Unknown Men - 4th and 5th decade
29
Case 120 | Define Tracheomalacia
Excessive pliability and collapsibility of the trachea secondary to weakness of the tracheal walls and supporting cartilages
30
Case 120 Primary (congenital) tracheomalasia patients primarily lack? Which phase of respiration collapses the trachea?
Cartilage Expiration - lunate trachea
31
Case 120 Tracheomalacia Congenital Causes? Acquired Causes?
Congenital deficiency of cartilage Prior intubation / COPD / Trauma / Infection / Goiter
32
Case 121 Two most common cell types of primary malignant tracheal neoplasms How much tracheal stenosis before patients are symptomatic
Adenoid Cystic Carcinoma - better prognosis Squamous Cell Carcinoma - smokers, male, poor prognosis 75% narrowing
33
Case 122 | Two most common causes of tubular opacities in the lung
Mucoid Impaction AVM
34
Case 122 Two entities commonly associated with mucoid impaction Most common cell type of NSCLC to present as an endobronchial lesion
ABPA and Cystic Fibrosis Squamous Cell CA
35
Case 122 | In bronchial obstruction, how does the adjacent lung remain aerated?
Collateral air drift - Pores of Kohn - Canals of Lambertt
36
``` Case 123 Localized Fibrous Tumors of the Pleura Benign? Asbestos? What skeletal abnormality is associated? T1 and T2 signal intensity of fibrous tumors? ```
No No - 60% benign / 40% malignant - most curable by surgical resection Hypertrophic Osteoarthropathy - Episodic Hypoglycemia Low T1 and Low T2
37
Case 124 Heart Transplant Pulmonary nodule - infection or neoplasm? Two organisms causing majority of infectious nodules in these pts Non-infectious etiology
Infection Aspergillus (2 months) and Nocardia (5 months) Post-transpland lymphoproliferative disorder (2-6% occurence)
38
Case 125 | Causes of PAH
Left to Right Shunt Chronic PE Mitral Valve Dz
39
Case 126 | Neoplastic causes of endobronchial lesion
Carcinoid Lung CA Hamartoma Lipoma Mucoepidermoid Tumor Lymphoma Endobronchial Mets
40
Case 126 | Endobronchial Lesion and gastric wall thickening
Lymphoma | Breast Cancer
41
Case 126 | Causes of complete lung atelectasis
Main stem intubation Obstructing mucous plug Obstructing Neoplasm Foreign Body
42
Case 127 | Neoplasms that result in a fine nodular pattern of metastasis
Thyroid Melanoma Renal Cell Breast and Pancreas (Adenocarcinomas)
43
Case 127 | Neoplasms that may result in calcified mets
Thyroid Colon Breast Sarcoma Ovary Treated Mets
44
Case 127 | Non-neoplastic causes of fine nodular pattern
Healed VZ Pneumonia Healed Histoplasmosis Silicosis
45
Case 128 | Enhancing mediastinal LN
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
Case 128 | Hypervascular mets
Renal Cell Thyroid Melanoma Carcinoid
47
Case 129 Spin Echo / Gradient Echo - Anatomy - Black Blood - Luminal Flow - White Blood
Spin Echo - Black Blood / excellent for anatomy Gradient Echo - White Blood / evaluate luminal flow
48
Case 130 | Relapsing Polychondritis
Rare inflammatory disease that affects cartilages Auricular 90% Respiratory 50%
49
Case 130 | Entities with diffuse tracheobronchial narrowing
Wegner's Relapsing Polychondritis Sarcoidosis Tracheopathia (spares post wall) Amyloidosis Osteochondroplastica (spares post wall) Infection Saber sheath trachea
50
``` Case 131 Swyer-James Syndrome Cause CxR Findings HRCT Findings ```
- 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
``` Case 132 Nontuberculous mycobacterial infection (NTMB) Causes Demographics Imaging characteristics ```
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
``` Case 133 Cardiac Bronchus Where does it arise? Symptoms? Treatment? ```
Bronchus Intermedius Recurrent infections / hemoptysis / cough / dyspnea Surgical Resection in symptomatic patients
53
``` Case 134 Aberrant Right Subclavian Arthery (ARSA) Prevalence? Swallowing difficulty? Associated acquired aortic abnormality? ```
Last branch from arch coursing L->R behind esophagus & trachea 1% Dysphagia lusoria Aortic Dissection - Stanford A surgical / Stanford B medical
54
``` Case 135 Interlobar Sequestration Describe Most common type Most common side Diagnosis ```
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
Case 136 | Three early postoperative complications of lung transplantation
Reperfusion Edema Acute Rejection Infection- most common / cytomegalovirus (CMV)
56
Case 138 | Three disease entities that manifest as diffuse ground glass on CT
Hypersensitivity Pneumonitis Atypical Infection (PCP, CMV) Pulmonary Edema Pulmonary Hemorrhage
57
Case 138 | Difference between ground glass and consolidation on CT
GG does not obscure underlying lung structures
58
Case 138 Name seven Idiopathic Interstitial Pneumonias recognized by the American Thoracic Society (ATS) and the European Respiratory Society (ERS)
``` 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
Case 139 | Cardiogenic causes of pulmonary edema associated with pregnancy
Preeclampsia Peripartum Cardiomyopathy - Last month of pregnancy - or first 6 months following delivery
60
Case 139 | Non-cardiogenic causes of pulmonary edema in pregancy
Tocolytic Therapy | Amniotic Fluid Embolism
61
Case 139 Is pregnancy associated with increased incidence of PE? Why are pregnant patients at increased risk for community-acquired pneumonias?
Yes Depression in cell mediated immunity
62
Case 139 Preeclampsia - Eclampsia -
Hypertention / Edema / Proteinuria Seizures
63
Case 140 | Fat attenuation mass in the interatrial septum
Lipomatous Hypertrophy of the Interatrial Septum (LHIS) - 50% association with mediastinal lipomatosis - Brown / Fetal fat (PET +) - May rarely cause arrhythmias but mainly benign
64
Case 141 | Oligemia distal to an obstructing embolus
Westermark's Sign
65
Case 142 | Disorder most closely associated with a basilar distribution of panlobular emphysema?
Alpha1-antitrypsin Deficiency (AAT) - Bronchiectasis - Autosomal Recessive - Cirrhosis
66
Case 143 | Cryptogenic Organizing Pneuonia
Peripheral patchy foci of consolidation Peribronchovascular foci of consolidation - Reverse halo sign
67
Case 145 Anterior mediastinal cyst Anterior mediastinal mass ddx that contains solid and cystic elements
Thymic Cyst Thymoma / Hodgkin's / Germ Cell Tumors
68
Case 145 | Most common cause of thymic mass
Thymoma
69
Case 145 | Thymic mass with solid and cystic components
Thymoma Hodgkin's Germ Cell Tumors
70
Case 147 | Hyperdense liver and pulmonary nodules
Amiodarone toxicity - used to treat arrhythmias - incidence is 5 - 20%
71
Case 148 | Multiple small nodules with peribronchovascular distribution
Sarcoidosis - ++ symmetrical hilar lymph node involvement Lymphangitic Carcinomatosis Lymphoma Kaposi's Sarcoma
72
Case 149 | Saphenous Vein Graft Aneurysm Following CABG
Most serious complication is dehiscence
73
Case 150 | Most common type of pulmonary infection to occur in HIV patients. Pneumocystis, bacterial, or mycobacterial?
Bacterial
74
Case 151 | Renal transplant patient presents with low grade fever and nonproductive cough
CMV
75
Case 151 | Is PCP a common opportunistic infection in transplant recipients?
No
76
Case 151 | What are the microscopic features of CMV?
Cellular enlargement | Intra-nuclear inclusion bodies
77
Case 152 | Pulmonary Venoocclusive Disease Triad
Severe PAH Pulmonary Edema Normal pulmonary venous wedge pressure
78
Case 152 Pulmonary Venoocclusive Disease (PVOD) Describe
Disorder characterized by obstruction of the pulmonary veins and venules by intimal fibrosis Etiology unknown Diagnosis requires biopsy
79
Case 153 | Multiple tracheal masses
Papillomatosis - HPV Amyloid - Nodules low signal on T1 and T2
80
Case 154 | Five causes of tracheal stenosis
Trauma Amyloidosis Infection COPD Sarcoid Relapsing Polychondritis Wegner's Tracheobronchopathia
81
Case 154 | Tracheal stenosis vs Tracheomalasia
Focal Narrowing | Excessive Collapsability during expiration
82
Case 154 | Idiopathic Tracheal Stenosis - more common in men or women?
Middle aged women Treatment - surgery
83
Case 156 Mosaic Pattern of Lung Attenuation Secondary to Small Airways Disease How can you differentiate pulm vasc dz from small airways dz?
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
Case 157 | Cyst within a cyst
Echinococcus
85
Case 157 | What is the significance of a Meniscus or crescent sign
Impending cyst ruprture
86
Case 159 | Entities associated with conglomerate masses in the upper lung zones
Sarcoid Coal Workers Pneumoconiosis Silicosis Berylliosis TB
87
Case 161 Inhalational Anthrax Infection Imaging Findings
CxR - mediastinal widening, hilar enlargement, pleural effusions - Hilar LNs and pleural effusions rapidly enlarge
88
Case 162 | Two diseases that manifest as ground-glass opacity and cysts
PCP | LIP - Lymphocytic Interstitial Pneumonia
89
Case 163 | Three smoking related interstitial lung diseases
PLCH DIP RB-ILD
90
Case 163 What is DIP? DDx?
Desquamative Interstitial Pneumonia - rare interstitial pneumonia that occurs almost exclusively in cigarette smokers - no honeycombing DDx - PLCH, RB-ILD
91
Case 164 | Indications for pleurodesis?
Intractable pleural effusions | Recurrent pneumothorax
92
Case 164 | What agent is used to perform PET imaging?
F18-Fluorodeoxyglucose
93
Case 164 | What is more common mets or mesothelioma?
Mets
94
Case 164 | What is latency period btwn asbestos and mesothelioma?
30 to 40 yrs