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CR Chest Fair Game Flashcards

1
Q

Case 103 - Fleischner Low Risk

= 4 mm

A

No Followup Needed

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2
Q

Case 103 - Fleischner Low Risk

>4 mm - 6 mm

A

CT at 12 mo

If no change no further fu needed

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3
Q

Case 103 - Fleischner Low Risk

>6 - 8 mm

A

CT at 6-12 months

Then 18-24 months if no change

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4
Q

Case 103 - Fleischner High Risk

= 4 mm

A

CT at 12 mo

If no change no further f/u

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5
Q

Case 103 - Fleischner High Risk

>4 - 6 mm

A

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

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6
Q

Case 103 - Fleischner High Risk

>6 - 8 mm

A

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

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7
Q

Case 103 - Fleischner High Risk

>8 mm

A

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

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8
Q

Case 104

4 Causes of Tracheal Stenosis

A 
Intubation Injury
Malignancy
TB
Wegners Granulomatosis
Amyloidosis
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9
Q

Case 105

Causes of Thymic Hyperplasia

A 
Myasthenia Gravis
Steroids or chemo
Scleroderma
Hyperthyroidism - Grave's Dz
Hyperplasia
Rheumatoid Arthritis
Red Cell Aplasia
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10
Q

Case 105

How do you distinguish between Thymic hyperplasia and Neoplasia?

A

MRI using chemical shift artifact

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11
Q 
Case 106
SPN - Which is most likely malignant?
Solid Nodule
Ground-glass Nodule
Semi-solid Nodule of mixed attenuation (ground glass and solid)
A

Semi-solid Nodule of mixed attenuation

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12
Q

Case 106

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

A

BAC
Invasive Aspergillosis
Candidiasis
Cytomegalovirus

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13
Q

Case 106

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

A

Severely neutropenic patient

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14
Q

Case 106

BAC is a subtype of which cancer cell type?

A

Adenocarcinoma

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15
Q

Case 52

Five tumors that may affect central airways

A 
Lung CA
Hamartoma
Carcinoid
Mucoepidermoid Carcinoma
Endobronchial mets
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16
Q

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

A

T2

T3

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17
Q

Case 53

What organ systems are affected in Wegner’s Granulomatosis?

A

Lungs

Kidneys

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18
Q

Case 53

Define Wegener’s Granulomatosis

A

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

Limited form of the disease is confined to lungs

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19
Q

Case 53

Thoracic Manifestations of Wegener’s Granulomatosis

A 
Multiple Lung Nodules / Masses
Well Defined
Cavitation
Feeding Vessels
Peripheral Distribution
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20
Q

Case 54

Multiple poorly defined lung nodules in immunosuppressed patient?

A

Fungal Pneumonia

  • Invasive Aspergillus
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21
Q

Case 54

CT halo sign?

A

Ground glass surrounding a nodule indicating hemorrhage

Early sign in the course of infection with Aspergillus

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22
Q

Case 54

Most common fungal infection to affect immunosuppressed patients?

A

Pulmonary Aspergillosis

  • Potentially lethal
  • May undergo cavitation
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23
Q

Case 55

LAM v. EG

A

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

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24
Q

Case 55

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

A

LAM

Eosinophilic Granuloma - Langerhan’s Cell Histiocytosis

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25
Q

Case 55

Name two pleural complications of LAM

A

Chylothorax

Pneumothorax

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26
Q

Case 55

Describe the typical demographic features of LAM

A

Reproductive age female (35 yo avg)

Nonsmoker

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27
Q

Case 56

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

A

Community Acquired Bacterial Pneumonia

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28
Q

Case 55

Differences in cysts between LAM vs LCH

A

LAM

  • smooth cysts
  • regular and uniform

LCH
- irregular / bizarre cysts
AND
- nodules which can cavitate

    - Spares the Costophrenic Angles
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29
Q

Case 56

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

A

TB

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30
Q

Case 56

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

A

10%

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31
Q

Case 56

Are recurrent bacterial pneumonias an AIDS-defining illness?

A

Yes

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32
Q

Case 57

Low density nodes with peripheral enhancement?

A

TB

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33
Q

Case 57

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

A

Primary TB

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34
Q

Case 57

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

A

Pediatric

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35
Q

Case 57

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

A

Below

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36
Q

Case 58

HIV-positive patient with bilateral perihilar ground glass densities

A

Pneumocystis jiroveci pneumonia - PCP

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37
Q

Case 59

Name four benign causes of calcified LNs

A

TB
Histoplasmosis
Sarcoidosis
Silicosis

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38
Q

Case 59

Neoplasm with ossified lymph nodes

A

Osteosarcoma

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39
Q

Case 60

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

A

Fungal

Septic Infarcts

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40
Q

Case 60

What organism is most closely associated with septic infarcts?

A

Staph aureus

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41
Q

Case 60

Three common sources of septic infarcts

A

Tricuspid Endocarditis
Indwelling Catheters
Prosthetic Devices

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42
Q

Case 60

List four features of septic infarcts

A

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

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43
Q

Case 61

Four radiographic signs of bronchopleural fistula

A

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

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44
Q

Case 62

Right Apical Tumor - most common cell type?

A

Squamous Cell Carcinoma

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45
Q

Case 62

Name four absolute contraindications to surgical resection of superior sulcus tumors

A

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

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46
Q

Case 63

Irregular shaped cysts with some scattered nodules

A

Langerhan’s Cell Histiocytosis

  • 90% smokers
  • spares lung bases and CP angles
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47
Q

Case 64

Reticulonodular interstitial densities - three possible diagnosis

A

Drug toxicity
Lymphangetic carcinomatosis
Atypical Infection

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48
Q

Case 64

Malignancies commonly associated with lymphangitic carcinomatosis

A

Breast
Lung
Stomach
Colon

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49
Q

Case 64

Unilateral lymphangitic carcinomatosis

A

Lung CA

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50
Q

Case 65

Right apical mass with satellite nodules

A

Reactivation TB

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51
Q

Case 65

Satellite nodules - infection vs malignancy

A

Infection

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52
Q

Case 65

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

A

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

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53
Q

Case 67

Fatty diffuse mediastinal widening

A

Mediastinal Lipomatosis

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54
Q

Case 67

Three risk factors for developing mediastinal lipomatosis

A

Obesity
Cushing’s Syndrome
Steroids

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55
Q

Case 68

Azygous continuation of the SVC - associated extravascular abnormality

A

Polysplenia

56
Q

Case 68

Causes of Azygous Vein Enlargement

A

Vena Caval Obstruction
Tricuspid insufficiency
Right Sided Heart Failure

57
Q

Case 69

What value is considered positive for pulmonary nodule enhancement?

A

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

58
Q

Case 70

Diaphragmatic rupture - most common on L or R

59
Q

Case 70

Two most common causes of diaphragmatic rupture

A

Blunt Trauma

Penetrating Injury

60
Q

Case 70

Diaphragmatic hernia - what is the most common organ herniated?

61
Q

Case 70

Signs of Diaphragmatic Rupture

A 
NGT in the thorax
Elevated hemidiaphragm
Loss of normal diaphragm dome shape
Changing Diaph levels on serial CxR
Contralateral mediastinal shift
Left pleural effusion
62
Q

Case 71
Sternoclavicular dislocation
- Most common - ant vs post

63
Q

Case 71

Complications of posterior sternoclavicular joint dislocation

A

Injury to

  • brachiocephalic / subclavian veins
  • trachea
  • esophagus
64
Q

Case 72

Causes of unilateral absent perfusion on VQ Scan

A 
Ascending Aortic Aneurysm
Hilar Mass
Dissection
Pneumonectomy
PA Sarcoma
PA Hypoplasia / Agenesis
65
Q

Case 72

Causes of Ascending Aortic Aneurysm

A

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

66
Q

Case 73

Two complications of over inflated tracheostomy tube cuff

A

Tracheal Stricture
Tracheomalacia
Tracheal Rupture
Tracheoesophageal fistula

67
Q

Case 73

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

A

Tracheoesophageal

Tracheoarterial

68
Q

Case 74

Characteristics of Rounded Atelectasis

A 
Subpleural
Round / Oval
Sharply Marginated
Posterior
Lower Lobes
Abuts Pleural Thickening
69
Q

Case 75

Four causes of upper zone distribution of chronic infiltrative lung disease

A 
Cystic Fibrosis
Sarcoid
Silicosis
Berylliosis
Langerhan's CH
Coal Workers Pneumoconiosis 
Ankylosing Spondylitis
70
Q

Case 75

Upper zone distribution with reticular and nodular pattern

A

Sarcoid

LCH

71
Q

Case 75

Irregular bronchial dilation associated with pulmonary fiborisis

A

Traction bronchiectasis

72
Q

Case 75

Laboratory test elevated in patients with sarcoidosis

A

Elevated Angiotensin-converting enzyme levels (ACE)

73
Q

Case 76

Two entities associated with an ascending aortic aneurysm

A

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

74
Q

Case 76

What is the difference between a true and false aneurysm?

A

True - intact aortic wall

False - disrupted aortic wall

75
Q

Case 77

Centrally obstructing mass containing calcification

76
Q

Case 77

Are carcinoids benign or malignant?

77
Q

Case 77

Nuclear medicine studies for carcinoid?

A

Octreotide

78
Q

Case 77

What percentage of carcinoids demonstrate calcification on CT?

79
Q

Case 77

Four characteristics of Carcinoid

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

Case 78

Esophageal perforation due to repeated episodes of vomiting

A

Boerhaave’s Syndrome

81
Q

Case 78

Three causes of esophageal perforation

A

Iatrogenic
Impacted foreign body
Obstructing neoplasm
Trauma

82
Q

Case 79

HIV-positive patient with parahilar masses

A

Kaposi’s Sarcoma

83
Q

Case 79

Most commonly involved organ system by Kaposi’s Sarcoma?

84
Q

Case 79

Is Kaposi’s sarcoma (KS) gallium-avid?

85
Q

Case 80

Define bulla

A
  • Sharply demarcated airspace
  • Measures more than1 cm
  • Well defined wall measuring less than 1 mm
86
Q

Case 80

Define bleb

A 
Small
 - Less than 1 cm
Gas space within
 - Visceral pleura
 - Subpleural lung
87
Q

Case 80

Three potential complications of bullae

A

Pneumothorax
Infection
Hemorrhage

88
Q

Case 81

Name 5 endobronchial Metastases

A 
Thyroid
Breast
Kidney
Colon
Melanoma
89
Q

Case 83

Pneumonia with a diffuse reticulonodular pattern

A

Varicella Zoster Pneumonia

90
Q

Case 83

Overall incidence of pneumonia in patients with chickenpox?

91
Q

Case 83

Pregnant women - higher or lower incidence of VZ pneumonia?

92
Q

Case 83

Typical appearance of healed varicella pneumonia

A

Multiple diffuse discrete pulmonary calcifications

93
Q

Case 84

Four causes of unilateral enlarged apical cap

A 
Abscess
Lung CA
Lymphoma
Extrapleural Hematoma
Extrapleural Metastasis
Radiation Fibrosis
94
Q

Case 85

Type of emphysema most closely associated with cigarette smoking

A

Centrilobular

Upper lobes

95
Q

Case 86

How does drug toxicity present in the lungs?

A

Reticular interstitial opacities and ground glass densities

96
Q

Case 86

What percentage of patients receiving bleomycin develop pulmonary toxicity?

97
Q

Case 86

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

98
Q

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

99
Q

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

A

Cryptococcus

100
Q

Case 87

Which organ system is most commonly affected by cryptococcus?

A

Central Nervous System

101
Q

Case 87

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

A

Bone and skin

102
Q

Case 88

TNM Lung Cancer - Define N specifications

A 
N0 - No mets
N1 - Ipsilateal peripheral interlobar
      - Ipsilateral Hilar-interlobar
N2 - Ipsilateral Mediastinal
N3 - Supraclavicular Nodes
      - Contralateral Anything
103
Q

Case 89

Most common cause of SVC syndrome?

A

Malignancy - Lung CA

104
Q

Case 89

One common benign cause of SVC syndrome

A

Long term intravenous devices

Fibrosing mediastinitis

105
Q

Case 89

Three mechanisms by which the SVC may become obstructed

A

Extrinsic Compression
Direct Invasion
Intraluminal Thrombus

106
Q

Case 89

Typical Symptoms with SVC Obstruction

A

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

107
Q

Case 89

Diagnosis of SVC Obstruction requires what two things?

A

Decreased or Absent contrast in the SVC

Opacification of collateral vessels

108
Q

Case 90

Periosteal reaction in association with pulmonary disease

A

Hypertrophic Pulmonary Osteoarthropathy (HPOA)

109
Q

Case 90

Is HPOA symptomatic?

110
Q

Case 92

How is hemophilia genetically transmitted?

A

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

111
Q

Case 92

Name potential complications of intramuscular hemorrhage

A 
Joint Contracture
Ischemic Myopathy
Neuropathy
Pressure necrosis of adjacent bone
Pseudotumor formation
112
Q

Case 93

Two benign features of lytic bone lesions

A

Well circumscribed

Sclerotic Margins

113
Q

Case 93

Lytic rib lesion with benign features - name two likely causes

A 
Enchondroma
Fibrous Dysplasia
ABC
Non-ossifying Fibroma
*LCH
114
Q

Case 93

Chronic infiltrative lung disease and lucent bone lesions

115
Q

Case 93

Primary neoplasms frequently associated with lytic bone mets

A

Lung
Breast
Kidney
Thyroid

116
Q

Case 93

McCune-Albright Syndrome

A

Polyostotic fibrous dysplasia
Cafe au lait skin lesions
Precocious Puberty

117
Q

Case 94

Dressler’s Syndrome

A

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

118
Q

Case 95

Three classifications of bronchiectasis

A

Cylindrical
Varicose
Cystic

119
Q

Case 95

Name three congenital or developmental disorders associated with bronchiectasis

A 
Cystic Fibrosis
Yellow Nail Synd
Kartagner's
Mounier-Kuhn Synd
Young's Syndrome
Williams-Campbelll
120
Q

Case 96

Name causes of thoracic esophageal dysmotility

A

Achalasia Amyloidosis
Scleroderma Drugs
Chaga’s Dz

121
Q

Case 97

Atypical cavitary infection from SW United States

A

Coccidiomycosis

122
Q

Case 97
What is the typical pattern associated with disseminated coccidioidomycosis infection?

Cavities - initial or chronic form of this infection?

A

Multiple small nodules

Chronic

123
Q

Case 98

Define ground glass opacity

A

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

124
Q

Case 98

Name two technical features that are necessary components of HRCT imaging

A 
Thin collimation (1-2 mm)
High Spatial Frequency reconstruction algorithm
125
Q

Case 99
Retrosternal densities
Most likely cause?

A

Lymphadenopathy

126
Q

Case 99

Most common site of enlarged nodes in patients with breast CA

127
Q

Case 99

Medial breast lymphatics drain in to?

A

Internal mammary lymph nodes

128
Q

Case 100

Complications of TTNB

A

Pneumothorax Seeding the Bx Track
Chest Tube Air Embolism
Hemoptysis

129
Q

Case 101

Four entities associated with mucoid impaction and mucocele formation

A

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

130
Q

Case 101

Name 6 congenital conditions that affect the bronchi

A 
Congenital Bronchiectasis (Cystic Fibrosis, W.C. Synd)
Bronchial Isomerism Syndrome
Bronchial Atresia
Supernumerary Bronchus
Pig Bronchus
Cardiac Bronchus
131
Q

Case 101

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

A

Interalveolar pores of Kohn

Canals of Lambert

132
Q

Case 101

Give four possible etiologies of a tubular opacity on imaging studies

A

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

133
Q

Case 102

Centrilobular ground glass opacities DDx

A

Hypersensitivity Pneumonitis Bronchiolitis
RB-ILD PCP
PLCH

134
Q

Case 102

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

A

Lobular Bronchiole
Pulmonary Artery
Peribronchovascular Lymphatics

135
Q

Case 102

Seven pulmonary diseases associated with smoking

A

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

136
Q

Case 102

What type of immune reaction is associated with hypersensitivity pneumonitis?

137
Q

Case 103 - Fleischner Low Risk

> 8 mm

A

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

Chest (3 decks)

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