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Chest > CR Chest Opening Round > Flashcards

CR Chest Opening Round Flashcards

1
Q

Case 1

What are the only two specific and reliable signs of benignancy?

A

1) Absolute absence of growth for 2 yrs

2) Benign pattern of Calcification

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2
Q

Case 1

What are the size criteria for a T1a and T1b Lesion in the TNM staging system?

A

T1a –> 0-2 cm

T2a –> 2-3 cm

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3
Q

Case 1

What are 4 benign patterns of calcification in a SPN?

A
  • Central
  • Diffuse
  • Lamellar
  • Popcorn
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4
Q

Case 1
TNM T2a?
TNM T2b?

A

3-5 cm

5-7 cm

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5
Q

Case 1

TNM T3

A

> 7 cm

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6
Q

Case 2

Name 5 causes of ptx?

A

Trauma / Barotrauma
Iatrogenic
Spontaneous
COPD
Tumor - metastatic sarcoma
Infection - lung abscess, septic infarcts
Chronic Infiltrative Lung Dz - PLCH, Lymphangiomatosis

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7
Q

Case 3

AZG positioning of CVC

A

Reposition
Venous Rupture is most common complication
Left-sided insertion increases risk

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8
Q

Case 4

Are asbestos pleural plaques premalignant?

A

No

  • Diffuse bilateral, asymptomatic
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9
Q

Case 4

Asbestos professions

A 
Mining
Insulation
Textile
Construction
Ship Building
Brake lining, manufacturing, and repair
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10
Q

Case 5

Which level of the spine is most susceptible to spinal fractures?

A

Thoracolumbar junction (T12 - L2)

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11
Q

Case 6

Two major radiographic features of emphysema?

A

Overinflation

Reduced Vascularity

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12
Q

Case 6

Best radiographic indicator of lung overinflation?

A

Flattening of the diaphragm

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13
Q

Case 7

What infection is most commonly associated with a miliary pattern?

A

TB

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14
Q

Case 7

How is miliary TB disseminated to the lung?

A

Hematogenously

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15
Q

Case 7

Aside from TB, what other infection presents with a miliary pattern?

A

Fungal Infection

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16
Q

Case 7

Name 4 non-infectious entities that present with a miliary pattern?

A

Pneumoconioses (silicosis)
Langerhans Cell Histiocytosis (PLCH)
Sarcoid
Mets (thyroid and melanoma)

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17
Q

Case 7

Lung mets with miliary pattern?

A

Thyroid

Melanoma

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18
Q

Case 9

What are two primary signs of atelectasis?

A

Opacification

Displacement of Fissures

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19
Q

Case 9

Name five secondary signs of atelectasis

A 
Elevated Hemidiaphragm
Mediastinal Shift
Displacement of the hilum
Compensatory Hyperinflation
Crowded Vessels
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20
Q

Case 10
Primary vs Secondary PAH

Men vs Women

A

Primary - cause is unknown
Secondary - cause is known

Women (typically age

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21
Q

Case 10

Name the 3 PAH Mechanisms and give examples of each

A

1) Increased pulmonary blood flow
- -> Left to Right Shunt

2) Decreased Cross Sectional area of Pulmonary vasculature
- -> Chronic PE

3) Increased Resistance to Pulmonary Venous Drainage
- -> Mitral Valve Dz

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22
Q

Case 12

Bilateral symmetric lymph node enlargement?

A

Sarcoid

  • 50% Lung parenchymal dz (upper and mid lungs)
  • 50% Asymptomatic at presentation
  • Unknown etiology / Widespread Non-caseating granulomas
  • 20% Interstitial Fibrosis
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23
Q

Case 13

When does a pulmonary contusion appear / resolve?

A

Appears Early - within 6 hrs
Resolves within 7 days

Typically demonstrates subpleural sparing of the peripheral 1-2mm of the lungs

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24
Q

Case 14

What is the most common mechanism for pneumomediastinum?

A

Alveolar Rupture - 2ndry to Inc Alv Pressure
- Mechanical Ventilation / Blunt Trauma / Coughing / Vomiting / Valsalva

Other causes of Pneumomediastinum
- Tracheal Perforation / Esophageal Rupture / Air from Neck or retroperitoneum

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25
Q

Case 15

Four features of Malignant pleural thickening

A

> 1 cm in thickness
Nodular
Circumfrential
Involvement of Mediastinal Pleura

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26
Q

Case 15

Which is most common: Pleural metastasis or Malignant Mesothelioma

A

Mets

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27
Q

Case 15
Pleural Calcifications in Mesothelioma

Latency Period from exposure to malignancy

A

20%

Between 30 and 40 yrs

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28
Q

Case 16

How much fluid to see blunting of CPA?

A

200 cc on PA
75 cc on lateral
Lateral decubitus will identify 5cc

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29
Q

Case 16

Causes of Exudate

A

Infection
Infarction
Neoplasm
Inflammatory Disorders

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30
Q

Case 16

Causes of Transudates

A 
CHF
Low Protein
Myxedema
Cirrhosis
Nephrotic Syndrome
Constrictive Pericarditis
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31
Q

Case 18

Most helpful feature for differentiating a pleural from extrapleural mass?

A

Rib abnormalities such as destruction or remodeling

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32
Q

Case 18

Two most common causes of extra-pleural mass with rib destruction in an adult patient?

A

Mets

Melanoma

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33
Q

Case 18

Two causes of hypervascular chest wall masses?

A

Thyroid Carcinoma

Renal Cell Carcinoma

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34
Q

Case 20

Anterior junction line

A

Lower

Posterior junction line higher

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35
Q

Case 21

Major risk factors for developing esophageal carcinoma?

A

Smoking

Alcohol

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36
Q

Case 21

Two most common cell types of esophageal neoplasm?

A

Adeno CA
Squamous CA

A tracheoesophageal stripe >5mm is suspicious!

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37
Q

Case 21

Most common benign esophageal neoplasm?

A

Leiomyoma

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38
Q

Case 22
Three benign patterns of calcification

Examples of benign Ca+ pulmonary nodules

A

Central
Diffuse
Laminar
Popcorn

Granuloma, Hamartoma, AVM, Sequestration, infarct, mucous impaction

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39
Q

Case 22

Malignant patterns of calcification

A

Stippled

Eccentric

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40
Q

Case 23

Fat density in a SPN

A

Hamartoma

  • Benign
  • Can grow

Signs of Hamartoma:
Fat
Fat + Calcification
Popcorn calcification

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41
Q

Case 24
Four substances that may fill the alveolar spaces

Causes of chronic airspace disease

A

Pus - pneumonia
Protein - alveolar proteinosis
Blood - hemorrhage
Water - edema

BAC, Alveolar proteinosis, lipoid pneumonia, lymphoma, alveolar sarcoid

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42
Q

Case 24

Most common cause of lobar pneumonia in an immunocompetent host?

A

Streptococcus pneumoniae

Other organisms:
- Klebsiella / Legionella / Mycoplasma

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43
Q

Case 25

Radiation lung changes are called?

A

Radiation Pneumonitis

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44
Q

Case 25
How long after XRT can you see lung changes?

When does fibrosis occur?

A

6 to 8 weeks

6-12 months

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45
Q

Case 25

Dilated bronchi within areas of fibrosis after XRT?

A

Traction bronchiectasis

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46
Q

Case 26

Define ARDS

A

Clinical diagnosis or acute respiratory failure characterized by profound hypoxia with diffuse opacities

47
Q

Case 26

Causes of ARDS

A

Sepsis Pneumonia
Trauma Near Drowning
Aspiration Drug OD
Inhaled Toxins Transfusion

48
Q

Case 27
Bronchiectasis that is most severe in the upper lobes

2 Radiographic signs of bronchiectasis

A

Cystic Fibrosis: Autosomal Recessive

Signs

  • Tram-tracking
  • Ring Shadows
49
Q

Case 28

Apical Cavity

A

Post-primary TB

50
Q

Case 28

General categories of causes of lung cavities

A

Infection
Malignancy
Vasculitis
Granulomatoses

51
Q

Case 28

Cell type of lung CA that cavitates

A

Squamous Cell

52
Q

Case 28

Specific causes of cavitation in the lungs

A

TB
Squamous CA
Vasculitides and Granulomatosis
Infarction

53
Q

Case 29

Most common cause of intracavitary mass

A

Aspergilloma / Mycetoma

54
Q

Case 29

What pleural abnormality frequently accompanies a mycetoma?

A

Pleural Thickening

55
Q

Case 29

Treatment for asymptomatic aspergilloma

A

None

56
Q

Case 29

Therapeutic options for patients with hemoptysis and aspergilloma?

A

Embolization
Surgical Resection
Direct instillation of amphotericin B
Systemic anti-fungal therapy

57
Q

Case 30

Four causes of right cardiophrenic angle mass

A 
Lipoma / Pericardial fat pad / Thymolipoma
Pericardial cyst
Enlarged Epicardial Lymph Nodes
Mets
Diaphragmatic Hernia - Morgagni's
58
Q

Case 30

Pericardial Cyst - right or left?

A

Right Side

59
Q

Case 30

Do pericardial cysts communicate with the pericardium?

A

No

They are attached to the parietal pericardium

60
Q

Case 31

Name the order of left lower lobe basilar segmental bronchi from lateral to medial on a frontal radiograph

A

Anteromedial, lateral, and posterior

A - L - P

61
Q

Case 31

Order of the right basilar segmental bronchi from lateral to medial?

A

Anterior, lateral, posterior, medial

62
Q

Case 31

RLL Bronchi and numbers

A

Ant(8) Lat(9) Post(10) Medial(7)

63
Q

Case 31

LLL Bronchi and numbers

A

Posterior (10) Lateral (9) Anteromedial (7 and 8)

A - L - P

64
Q

Case 32
Round Pneumonia
- Organism?
- More common in pedi or adult?

A

S. pneumoniae

Pedi

65
Q

Case 33

Two mass features of mediastinal location on CxR?

A

Obtuse angle with adjacent lung

Smooth Sharp Margins

66
Q

Case 33

Most common cause of posterior mediastinal mass?

A

Neurogenic Tumor

67
Q

Case 33
Neurogenic Tumor
- Peripheral Types

A

Schwanoma

Neurofibroma

68
Q

Case 33
Neurogenic Tumor
- Sympathetic Chain

A

Ganglioneuroma

Neuroblastoma

69
Q

Case 33
Neurogenic Tumor
- Paraganglia

A

Pheochromocytoma

Chemodectoma

70
Q

Case 33
Neurogenic Tumor
- Symphathetic Chain Shape

A

Fusiform
Vertical
More commonly calcify
- Ganglioneuroma

71
Q

Case 34

Six causes of total lung atelectasis

A 
Tumor
Mucus Plug
ET Tube - Right Main Stem Intubation
Foreign Body
Trauma
TB Stenosis
72
Q

Case 33
Neurogenic Tumor
- Peripheral Nerves shape

A

Round - Schwanoma

73
Q

Case 34

Several Causes of hemothorax

A 
Trauma
Iatrogenic
Anticoagulation
Malignancy
Catamenial Hemothorax
74
Q

Case 35

Four CT features of empyema

A

Lenticular Shape
Obtuse Margins
Split Pleura Sign
Compression of adjacent lung parenchyma

75
Q

Case 35

Round shape - Lung abscess or Empyema

A

Lung Abscess

76
Q

Case 35

Most common cause of air fluid level within a pleural fluid collection?

A

Bronchopleural fistula

77
Q

Case 36

Two most common causes of rib notching

A

Neurofibromatosis

Coarctation

78
Q

Case 36

Osseous manifestations of neurofibromatosis

A

Widened Neural foramina
Rib Erosion / Notching / Rib Spreading
Scoliosis
Scalloping or posterior aspects of vertebral bodies (dural ectasia)

79
Q

Case 36

Most common cause of osseous destruction of a rib?

A

Metastatic Disease

80
Q

Case 37

Causes of thymic masses

A 
Thymoma        
Cyst
Hyperplasia  
Carcinoma
Thymolipoma
Carcinoid
81
Q

Case 38

Subcarinal mass DDx

A

Bronchogenic Cyst
Left Atrial Enlargement
Subcarinal Lymph Nodes / Mets

82
Q

Case 38

Common causes of intrathoracic lymphadenopathy

A

Malignancy:

  • Head and Neck, Breast, Melanoma, Genitourinary
  • Lymphoma / Leukemia

Infection:
- TB, fungal, viral, bacterial

Inflammatory:
- Sarcoid, Castleman’s, Angioimmunoblastic

83
Q

Case 39
Severe Silicosis

Types of Calcification in the lymph nodes

A

Progressive Massive Fibrosis: confluent opacification

Egg Shell

84
Q

Case 40

Cause of chronic Infiltrative Lung Dz with a basilar and subpleural distribution

A

Scleroderma

85
Q

Case 40
How do NSIP and UIP present?

Examples?

What is the difference between NSIP vs UIP

A

Both have subpleural distribution of irregular linear opacities, ground-glass attenuation, and traction bronchiolectasis

UIP: IPF, Asbestosis, Conn. tissue dz, drug toxicity
NSIP: Scleroderma

NSIP: unlike UIP honeycombing is absent

86
Q

Case 40

Soft tissue abnormality with scleroderma

A

Calcinosis

87
Q

Case 40

Honeycombing - NSIP vs UIP

A

UIP Only

88
Q

Case 41

Combination of calcified lung nodule and calcified lymph nodes

A

Ranke Complex

89
Q

Case 41

Lung nodule that occurs at the initial site of parenchymal involvement from primary TB

A

Ghon Focus

90
Q

Case 41

Two common radiographic findings associated with primary TB infection

A

Parenchymal consolidation

Mediastinal and Hilar Lymph Node Enlargement

91
Q 
Case 42
PVWP
 - Pulm Edema
 - Pleural Effusion
 - Alveolar Edema
A

17 mm Hg
20 mm Hg
25 mm Hg

92
Q

Case 42

Four radiographic signs of interstitial edema

A

Peribronchial Cuffing
Indistinct Pulmonary Vessels
Kerley Lines (interlobular septal thickening)
Thickening of the fissures

93
Q

Case 43

Most common cause of bronchiectasis

A

Prior infection

94
Q

Case 43

CT findings of bronchiectasis

A 
Bronchial diameter > adjacent artery
Bronchi visible peripherally
No tapering of bronchi peripherally
Bronchial wall thickening
Strings or clusters of cysts w or w/o air-fluid levels
95
Q

Case 44

Syndrome associated with AVM

A

Hereditary Hemorrhagic Telangiactasia / Osler Weber Rendu

  • Telangiectasias
  • AVMs
  • Aneurysms
  • Pulmonary / Gastrointestinal / Cuteneous / CNS
96
Q

Case 44

What percentage of AVMs are multiple?

A

30%

97
Q

Case 44

Name three symptoms or conditions associated with pulmonary AVMs

A

Cyanosis (from R to L shunt)
Dyspnea
Stroke
Brain Abscess

98
Q

Case 45

Causes of Ascending Aortic Aneurysm?

A

Cystic Medial Necrosis

Syphilis

99
Q

Case 45

Causes of Arch and Descending Aortic Aneurysm

A

Atherosclerotic
Mycotic
Post-traumatic

100
Q

Case 46

DDx for peripheral wedge shaped consolidation

A

Pulmonary Infarct
Neoplasm
Pneumonia
Hemorrhage

101
Q

Case 46

Wedge shaped peripheral opacity with feeding vessel

A

Pulmonary Infarct

- Central Lucencies

102
Q

Case 46

Incidence of incidentally detected acute pulmonary embolism on postcontrast CT?

A

1% - 5%

103
Q

Case 47

DDx multiple lung nodules or masses in pt w AIDS

A

Infection - fungal, mycobacterial, septic emboli

Neoplasm - lymphoma, Kaposi’s sarcoma

104
Q

Case 47

Most common type of lymphoma in pt with AIDS

A

Non-Hodgkins Lymphoma

105
Q

Case 47

Thoracic lymphoma typically nodal or extranodal in AIDS

A

Extranodal

106
Q

Case 48

Most common sites of traumatic aortic transection

A

Ligamentum Arteriosum
- Half make it to the hospital but die within 1 week
Aortic Root
Diaphragm

107
Q

Case 48

Direct Signs of Traumatic Aortic Injury

A 
Deformed Contour
Intimal Flap
Pseudoaneurysm
Intramural Thrombus
Extravasation
108
Q

Case 49
Most common cause of thoracic inlet mediastinal mass
- Adult
- Child

A

Thyroid Goiter: typically calcify

Lymphangioma

109
Q

Case 50

Chronic Airspace Dz DDx

A 
Lipoid Pneumonia
BAC
Lymphoma
Alveolar Proteinosis
Alveolar Sarcoid
110
Q

Case 50

Lipoid pneumonia most common cause

A

Aspirated Mineral Oil

- old ladies

111
Q

Case 51

Situs inversus with bronchiectasis

A

Kartegners Syndrome

112
Q

Case 51

Kartegner’s Syndrome triad

A 
Situs Inversus
Bronchiectasis - predilection to RML
Sinusitis
 - Infertility
 - Autosomal Recessive
113
Q

Case 33

What neurogenic tumor most commonly calcifies?

A

Ganglioneuroma

Chest (3 decks)

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