CR Chest Fair Game Flashcards by Armando Saenz

Case 103 - Fleischner Low Risk

= 4 mm

No Followup Needed

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Case 103 - Fleischner Low Risk

>4 mm - 6 mm

CT at 12 mo

If no change no further fu needed

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Case 103 - Fleischner Low Risk

>6 - 8 mm

CT at 6-12 months

Then 18-24 months if no change

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Case 103 - Fleischner High Risk

= 4 mm

CT at 12 mo

If no change no further f/u

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Case 103 - Fleischner High Risk

>4 - 6 mm

CT at 6 - 12 months
then
18-24 months if no change

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Case 103 - Fleischner High Risk

>6 - 8 mm

CT at 3 - 6 months
then
9-12 months AND 24 months if no change

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Case 103 - Fleischner High Risk

>8 mm

CT at 3, 9, and 24 months
or
PET vs Bx

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Case 104

4 Causes of Tracheal Stenosis

Intubation Injury
Malignancy
TB
Wegners Granulomatosis
Amyloidosis

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Case 105

Causes of Thymic Hyperplasia

Myasthenia Gravis
Steroids or chemo
Scleroderma
Hyperthyroidism - Grave's Dz
Hyperplasia
Rheumatoid Arthritis
Red Cell Aplasia

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Case 105

How do you distinguish between Thymic hyperplasia and Neoplasia?

MRI using chemical shift artifact

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Case 106
SPN - Which is most likely malignant?
Solid Nodule
Ground-glass Nodule
Semi-solid Nodule of mixed attenuation (ground glass and solid)

Semi-solid Nodule of mixed attenuation

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Case 106

What manifests as a solid nodule with a halo of ground glass?

BAC
Invasive Aspergillosis
Candidiasis
Cytomegalovirus

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Case 106

In which clinical setting is Invasive Aspirgillosis most likely to occur?

Severely neutropenic patient

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Case 106

BAC is a subtype of which cancer cell type?

Adenocarcinoma

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Case 52

Five tumors that may affect central airways

Lung CA
Hamartoma
Carcinoid
Mucoepidermoid Carcinoma
Endobronchial mets

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Case 52
T of TNM - For centrally obstructing neoplasm
Hilar but not all lung?
Entire lung?

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Case 53

What organ systems are affected in Wegner’s Granulomatosis?

Lungs

Kidneys

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Case 53

Define Wegener’s Granulomatosis

Necrotizing Vasculitis involving the upper respiratory tract, lungs, and kidneys

Limited form of the disease is confined to lungs

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Case 53

Thoracic Manifestations of Wegener’s Granulomatosis

Multiple Lung Nodules / Masses
Well Defined
Cavitation
Feeding Vessels
Peripheral Distribution

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Case 54

Multiple poorly defined lung nodules in immunosuppressed patient?

Fungal Pneumonia

Invasive Aspergillus

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Case 54

CT halo sign?

Ground glass surrounding a nodule indicating hemorrhage

Early sign in the course of infection with Aspergillus

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Case 54

Most common fungal infection to affect immunosuppressed patients?

Pulmonary Aspergillosis

Potentially lethal
May undergo cavitation

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Case 55

LAM v. EG

LAM EG
Thin uniform cysts Irregular bizzare
Diffuse Spares CP angles
Pneumothorax/Chylothorax Nodules
Nonsmoker Smoker

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Case 55

Name two infiltrative lung diseases that are associated with a cystic pattern

LAM

Eosinophilic Granuloma - Langerhan’s Cell Histiocytosis

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Case 55 | Name two pleural complications of LAM

Chylothorax | Pneumothorax

Case 55 | Describe the typical demographic features of LAM

Reproductive age female (35 yo avg) | Nonsmoker

Case 56 | Most likely cause of focal consolidation in an HIV-positive patient?

Community Acquired Bacterial Pneumonia

Case 55 | Differences in cysts between LAM vs LCH

LAM - smooth cysts - regular and uniform LCH - irregular / bizarre cysts AND - nodules which can cavitate - Spares the Costophrenic Angles

Case 56 | Second most common cause of focal consolidation in an HIV-positive patient?

Case 56 | How often does PCP present as a focal consolidation on an HIV-positive patient?

10%

Case 56 | Are recurrent bacterial pneumonias an AIDS-defining illness?

Yes

Case 57 | Low density nodes with peripheral enhancement?

Case 57 | Lymph node enlargement is most common in primary or post-primary TB?

Primary TB

Case 57 | Primary TB - is LN enlargement more common in pediatric or adult patients?

Pediatric

Case 57 | HIV-positive pt with TB - Are enlarged mediastinal LNs encountered more commonly in CD4 counts above or below 200/mm?

Below

Case 58 | HIV-positive patient with bilateral perihilar ground glass densities

Pneumocystis jiroveci pneumonia - PCP

Case 59 | Name four benign causes of calcified LNs

TB Histoplasmosis Sarcoidosis Silicosis

Case 59 | Neoplasm with ossified lymph nodes

Osteosarcoma

Case 60 | Two infections that can result in rapidly growing nodules in non-AIDS immunosuppressed patients

Fungal | Septic Infarcts

Case 60 | What organism is most closely associated with septic infarcts?

Staph aureus

Case 60 | Three common sources of septic infarcts

Tricuspid Endocarditis Indwelling Catheters Prosthetic Devices

Case 60 | List four features of septic infarcts

Poorly defined nodules that cavitate Wedge Shaped Peripheral and Basilar Feeding Vessel

Case 61 | Four radiographic signs of bronchopleural fistula

Space fails to fill with fluid Abrupt decrease in air-fluid level New air in previously opacified space Contralateral shift of the mediastinum

Case 62 | Right Apical Tumor - most common cell type?

Squamous Cell Carcinoma

Case 62 | Name four absolute contraindications to surgical resection of superior sulcus tumors

Invasion of more than 50% of a vertebral body Brachial Plexus invasion above T1 Esophageal Invasion Tracheal invasion

Case 63 | Irregular shaped cysts with some scattered nodules

Langerhan's Cell Histiocytosis - 90% smokers - spares lung bases and CP angles

Case 64 | Reticulonodular interstitial densities - three possible diagnosis

Drug toxicity Lymphangetic carcinomatosis Atypical Infection

Case 64 | Malignancies commonly associated with lymphangitic carcinomatosis

Breast Lung Stomach Colon

Case 64 | Unilateral lymphangitic carcinomatosis

Lung CA

Case 65 | Right apical mass with satellite nodules

Reactivation TB

Case 65 | Satellite nodules - infection vs malignancy

Infection

Case 65 | Most common sites for post-primary TB in the lung?

Apical and posterior segments of the upper lobes and superior segments of the lower lobes

Case 67 | Fatty diffuse mediastinal widening

Mediastinal Lipomatosis

Case 67 | Three risk factors for developing mediastinal lipomatosis

Obesity Cushing's Syndrome Steroids

Case 68 | Azygous continuation of the SVC - associated extravascular abnormality

Polysplenia

Case 68 | Causes of Azygous Vein Enlargement

Vena Caval Obstruction Tricuspid insufficiency Right Sided Heart Failure

Case 69 | What value is considered positive for pulmonary nodule enhancement?

> 15 HU is concerning for CA (specificity 58%)

Case 70 | Diaphragmatic rupture - most common on L or R

Left

Case 70 | Two most common causes of diaphragmatic rupture

Blunt Trauma | Penetrating Injury

Case 70 | Diaphragmatic hernia - what is the most common organ herniated?

Stomach

Case 70 | Signs of Diaphragmatic Rupture

``` NGT in the thorax Elevated hemidiaphragm Loss of normal diaphragm dome shape Changing Diaph levels on serial CxR Contralateral mediastinal shift Left pleural effusion ```

Case 71 Sternoclavicular dislocation - Most common - ant vs post

Posterior

Case 71 | Complications of posterior sternoclavicular joint dislocation

Injury to - brachiocephalic / subclavian veins - trachea - esophagus

Case 72 | Causes of unilateral absent perfusion on VQ Scan

``` Ascending Aortic Aneurysm Hilar Mass Dissection Pneumonectomy PA Sarcoma PA Hypoplasia / Agenesis ```

Case 72 | Causes of Ascending Aortic Aneurysm

Connective Tissue Disorders (Marfan's and Ehlers-Danlos) Syphilis Cystic Medial Necrosis

Case 73 | Two complications of over inflated tracheostomy tube cuff

Tracheal Stricture Tracheomalacia Tracheal Rupture Tracheoesophageal fistula

Case 73 | Two types of fistulas that may occur as a tracheostomy tube complication

Tracheoesophageal | Tracheoarterial

Case 74 | Characteristics of Rounded Atelectasis

``` Subpleural Round / Oval Sharply Marginated Posterior Lower Lobes Abuts Pleural Thickening ```

Case 75 | Four causes of upper zone distribution of chronic infiltrative lung disease

``` Cystic Fibrosis Sarcoid Silicosis Berylliosis Langerhan's CH Coal Workers Pneumoconiosis Ankylosing Spondylitis ```

Case 75 | Upper zone distribution with reticular and nodular pattern

Sarcoid | LCH

Case 75 | Irregular bronchial dilation associated with pulmonary fiborisis

Traction bronchiectasis

Case 75 | Laboratory test elevated in patients with sarcoidosis

Elevated Angiotensin-converting enzyme levels (ACE)

Case 76 | Two entities associated with an ascending aortic aneurysm

Cystic Medial Necrosis - Marfan's - Ehlers-Danlos) Syphilis

Case 76 | What is the difference between a true and false aneurysm?

True - intact aortic wall | False - disrupted aortic wall

Case 77 | Centrally obstructing mass containing calcification

Carcinoid

Case 77 | Are carcinoids benign or malignant?

Malignant

Case 77 | Nuclear medicine studies for carcinoid?

Octreotide

Case 77 | What percentage of carcinoids demonstrate calcification on CT?

30%

Case 77 | Four characteristics of Carcinoid

``` Central (80%) Lobulated Calcification (30%) Near bifurcations Octreotide Scan ```

Case 78 | Esophageal perforation due to repeated episodes of vomiting

Boerhaave's Syndrome

Case 78 | Three causes of esophageal perforation

Iatrogenic Impacted foreign body Obstructing neoplasm Trauma

Case 79 | HIV-positive patient with parahilar masses

Kaposi's Sarcoma

Case 79 | Most commonly involved organ system by Kaposi's Sarcoma?

Skin

Case 79 | Is Kaposi's sarcoma (KS) gallium-avid?

Case 80 | Define bulla

- Sharply demarcated airspace - Measures more than1 cm - Well defined wall measuring less than 1 mm

Case 80 | Define bleb

``` Small - Less than 1 cm Gas space within - Visceral pleura - Subpleural lung ```

Case 80 | Three potential complications of bullae

Pneumothorax Infection Hemorrhage

Case 81 | Name 5 endobronchial Metastases

``` Thyroid Breast Kidney Colon Melanoma ```

Case 83 | Pneumonia with a diffuse reticulonodular pattern

Varicella Zoster Pneumonia

Case 83 | Overall incidence of pneumonia in patients with chickenpox?

15%

Case 83 | Pregnant women - higher or lower incidence of VZ pneumonia?

Higher

Case 83 | Typical appearance of healed varicella pneumonia

Multiple diffuse discrete pulmonary calcifications

Case 84 | Four causes of unilateral enlarged apical cap

``` Abscess Lung CA Lymphoma Extrapleural Hematoma Extrapleural Metastasis Radiation Fibrosis ```

Case 85 | Type of emphysema most closely associated with cigarette smoking

Centrilobular Upper lobes

Case 86 | How does drug toxicity present in the lungs?

Reticular interstitial opacities and ground glass densities

Case 86 | What percentage of patients receiving bleomycin develop pulmonary toxicity?

4 %

Case 86 | Does simultaneous chest radiation therapy increase or decrease the risk of bleomycin pulmonary toxicity?

Increase

Case 86 In a patient with bleomycin toxicity would you expect the patient's diffusing capacity of carbon monoxide to be increased or decreased?

Decreased

Case 87 HIV positive patient - which fungal infection is likely to present with pulmonary nodules pleural effusion and lymph node enlargement?

Cryptococcus

Case 87 | Which organ system is most commonly affected by cryptococcus?

Central Nervous System

Case 87 | Besides CNS - which other organ systems are most commonly involved in disseminated Cryptococcal infection?

Bone and skin

Case 88 | TNM Lung Cancer - Define N specifications

``` N0 - No mets N1 - Ipsilateal peripheral interlobar - Ipsilateral Hilar-interlobar N2 - Ipsilateral Mediastinal N3 - Supraclavicular Nodes - Contralateral Anything ```

Case 89 | Most common cause of SVC syndrome?

Malignancy - Lung CA

Case 89 | One common benign cause of SVC syndrome

Long term intravenous devices | Fibrosing mediastinitis

Case 89 | Three mechanisms by which the SVC may become obstructed

Extrinsic Compression Direct Invasion Intraluminal Thrombus

Case 89 | Typical Symptoms with SVC Obstruction

Edema of the face and neck Headache Visual disturbances Reduced level of conciousness

Case 89 | Diagnosis of SVC Obstruction requires what two things?

Decreased or Absent contrast in the SVC | Opacification of collateral vessels

Case 90 | Periosteal reaction in association with pulmonary disease

Hypertrophic Pulmonary Osteoarthropathy (HPOA)

Case 90 | Is HPOA symptomatic?

Yes

Case 92 | How is hemophilia genetically transmitted?

X-linked recessive - transmitted by females but primarily affects males

Case 92 | Name potential complications of intramuscular hemorrhage

``` Joint Contracture Ischemic Myopathy Neuropathy Pressure necrosis of adjacent bone Pseudotumor formation ```

Case 93 | Two benign features of lytic bone lesions

Well circumscribed | Sclerotic Margins

Case 93 | Lytic rib lesion with benign features - name two likely causes

``` Enchondroma Fibrous Dysplasia ABC Non-ossifying Fibroma *LCH ```

Case 93 | Chronic infiltrative lung disease and lucent bone lesions

LCH

Case 93 | Primary neoplasms frequently associated with lytic bone mets

Lung Breast Kidney Thyroid

Case 93 | McCune-Albright Syndrome

Polyostotic fibrous dysplasia Cafe au lait skin lesions Precocious Puberty

Case 94 | Dressler's Syndrome

The development of pericardial and pleural effusions 2 to 10 weeks after an MI

Case 95 | Three classifications of bronchiectasis

Cylindrical Varicose Cystic

Case 95 | Name three congenital or developmental disorders associated with bronchiectasis

``` Cystic Fibrosis Yellow Nail Synd Kartagner's Mounier-Kuhn Synd Young's Syndrome Williams-Campbelll ```

Case 96 | Name causes of thoracic esophageal dysmotility

Achalasia Amyloidosis Scleroderma Drugs Chaga's Dz

Case 97 | Atypical cavitary infection from SW United States

Coccidiomycosis

Case 97 What is the typical pattern associated with disseminated coccidioidomycosis infection? Cavities - initial or chronic form of this infection?

Multiple small nodules Chronic

Case 98 | Define ground glass opacity

Hazy increased opacity of lungs with preservation of bronchial and vascular margin visibility

Case 98 | Name two technical features that are necessary components of HRCT imaging

``` Thin collimation (1-2 mm) High Spatial Frequency reconstruction algorithm ```

Case 99 Retrosternal densities Most likely cause?

Lymphadenopathy

Case 99 | Most common site of enlarged nodes in patients with breast CA

Axilla

Case 99 | Medial breast lymphatics drain in to?

Internal mammary lymph nodes

Case 100 | Complications of TTNB

Pneumothorax Seeding the Bx Track Chest Tube Air Embolism Hemoptysis

Case 101 | Four entities associated with mucoid impaction and mucocele formation

Allergic Broncho-pulmonary Aspergillosis (ABPA) Obstructing Endobronchial Tumor Congenital Bronchial Atresia Cystic Fibrosis

Case 101 | Name 6 congenital conditions that affect the bronchi

``` Congenital Bronchiectasis (Cystic Fibrosis, W.C. Synd) Bronchial Isomerism Syndrome Bronchial Atresia Supernumerary Bronchus Pig Bronchus Cardiac Bronchus ```

Case 101 | Which anatomic structures enable collateral air drift to occur in the lungs?

Interalveolar pores of Kohn | Canals of Lambert

Case 101 | Give four possible etiologies of a tubular opacity on imaging studies

Mucocele / Mucoid Impaction AVM PAVPR ( partial anomalous pulmonary venous return) Pulmonary Varix

Case 102 | Centrilobular ground glass opacities DDx

Hypersensitivity Pneumonitis Bronchiolitis RB-ILD PCP PLCH

Case 102 | What anatomic structures are located in the central core of the secondary pulmonary lobule?

Lobular Bronchiole Pulmonary Artery Peribronchovascular Lymphatics

Case 102 | Seven pulmonary diseases associated with smoking

COPD DIP (Desquamative) Lung CA Chronic Bronchitis PLCH Respiratory Bronchiolitis RB-ILD

Case 102 | What type of immune reaction is associated with hypersensitivity pneumonitis?

Type IV

Case 103 - Fleischner Low Risk | > 8 mm

CT at 3, 9, 24 months or PET vs Bx