CR Chest Opening Round Flashcards by Armando Saenz

Case 1

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

1) Absolute absence of growth for 2 yrs

2) Benign pattern of Calcification

How well did you know this?

Not at all

Perfectly

Case 1

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

T1a –> 0-2 cm

T2a –> 2-3 cm

How well did you know this?

Not at all

Perfectly

Case 1

What are 4 benign patterns of calcification in a SPN?

Central
Diffuse
Lamellar
Popcorn

How well did you know this?

Not at all

Perfectly

Case 1
TNM T2a?
TNM T2b?

3-5 cm

5-7 cm

How well did you know this?

Not at all

Perfectly

Case 1

TNM T3

> 7 cm

How well did you know this?

Not at all

Perfectly

Case 2

Name 5 causes of ptx?

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

How well did you know this?

Not at all

Perfectly

Case 3

AZG positioning of CVC

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

How well did you know this?

Not at all

Perfectly

Case 4

Are asbestos pleural plaques premalignant?

Diffuse bilateral, asymptomatic

How well did you know this?

Not at all

Perfectly

Case 4

Asbestos professions

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

How well did you know this?

Not at all

Perfectly

Case 5

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

Thoracolumbar junction (T12 - L2)

How well did you know this?

Not at all

Perfectly

Case 6

Two major radiographic features of emphysema?

Overinflation

Reduced Vascularity

How well did you know this?

Not at all

Perfectly

Case 6

Best radiographic indicator of lung overinflation?

Flattening of the diaphragm

How well did you know this?

Not at all

Perfectly

Case 7

What infection is most commonly associated with a miliary pattern?

How well did you know this?

Not at all

Perfectly

Case 7

How is miliary TB disseminated to the lung?

Hematogenously

How well did you know this?

Not at all

Perfectly

Case 7

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

Fungal Infection

How well did you know this?

Not at all

Perfectly

Case 7

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

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

How well did you know this?

Not at all

Perfectly

Case 7

Lung mets with miliary pattern?

Thyroid

Melanoma

How well did you know this?

Not at all

Perfectly

Case 9

What are two primary signs of atelectasis?

Opacification

Displacement of Fissures

How well did you know this?

Not at all

Perfectly

Case 9

Name five secondary signs of atelectasis

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

How well did you know this?

Not at all

Perfectly

Case 10
Primary vs Secondary PAH

Men vs Women

Primary - cause is unknown
Secondary - cause is known

Women (typically age

How well did you know this?

Not at all

Perfectly

Case 10

Name the 3 PAH Mechanisms and give examples of each

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

How well did you know this?

Not at all

Perfectly

Case 12

Bilateral symmetric lymph node enlargement?

Sarcoid

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

How well did you know this?

Not at all

Perfectly

Case 13

When does a pulmonary contusion appear / resolve?

Appears Early - within 6 hrs
Resolves within 7 days

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

How well did you know this?

Not at all

Perfectly

Case 14

What is the most common mechanism for pneumomediastinum?

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

How well did you know this?

Not at all

Perfectly

Case 15 | Four features of Malignant pleural thickening

> 1 cm in thickness Nodular Circumfrential Involvement of Mediastinal Pleura

Case 15 | Which is most common: Pleural metastasis or Malignant Mesothelioma

Mets

Case 15 Pleural Calcifications in Mesothelioma Latency Period from exposure to malignancy

20% Between 30 and 40 yrs

Case 16 | How much fluid to see blunting of CPA?

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

Case 16 | Causes of Exudate

Infection Infarction Neoplasm Inflammatory Disorders

Case 16 | Causes of Transudates

``` CHF Low Protein Myxedema Cirrhosis Nephrotic Syndrome Constrictive Pericarditis ```

Case 18 | Most helpful feature for differentiating a pleural from extrapleural mass?

Rib abnormalities such as destruction or remodeling

Case 18 | Two most common causes of extra-pleural mass with rib destruction in an adult patient?

Mets | Melanoma

Case 18 | Two causes of hypervascular chest wall masses?

Thyroid Carcinoma | Renal Cell Carcinoma

Case 20 | Anterior junction line

Lower | Posterior junction line higher

Case 21 | Major risk factors for developing esophageal carcinoma?

Smoking | Alcohol

Case 21 | Two most common cell types of esophageal neoplasm?

Adeno CA Squamous CA A tracheoesophageal stripe >5mm is suspicious!

Case 21 | Most common benign esophageal neoplasm?

Leiomyoma

Case 22 Three benign patterns of calcification Examples of benign Ca+ pulmonary nodules

Central Diffuse Laminar Popcorn Granuloma, Hamartoma, AVM, Sequestration, infarct, mucous impaction

Case 22 | Malignant patterns of calcification

Stippled | Eccentric

Case 23 | Fat density in a SPN

Hamartoma - Benign - Can grow Signs of Hamartoma: Fat Fat + Calcification Popcorn calcification

Case 24 Four substances that may fill the alveolar spaces Causes of chronic airspace disease

Pus - pneumonia Protein - alveolar proteinosis Blood - hemorrhage Water - edema BAC, Alveolar proteinosis, lipoid pneumonia, lymphoma, alveolar sarcoid

Case 24 | Most common cause of lobar pneumonia in an immunocompetent host?

Streptococcus pneumoniae Other organisms: - Klebsiella / Legionella / Mycoplasma

Case 25 | Radiation lung changes are called?

Radiation Pneumonitis

Case 25 How long after XRT can you see lung changes? When does fibrosis occur?

6 to 8 weeks 6-12 months

Case 25 | Dilated bronchi within areas of fibrosis after XRT?

Traction bronchiectasis

Case 26 | Define ARDS

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

Case 26 | Causes of ARDS

Sepsis Pneumonia Trauma Near Drowning Aspiration Drug OD Inhaled Toxins Transfusion

Case 27 Bronchiectasis that is most severe in the upper lobes 2 Radiographic signs of bronchiectasis

Cystic Fibrosis: Autosomal Recessive Signs - Tram-tracking - Ring Shadows

Case 28 | Apical Cavity

Post-primary TB

Case 28 | General categories of causes of lung cavities

Infection Malignancy Vasculitis Granulomatoses

Case 28 | Cell type of lung CA that cavitates

Squamous Cell

Case 28 | Specific causes of cavitation in the lungs

TB Squamous CA Vasculitides and Granulomatosis Infarction

Case 29 | Most common cause of intracavitary mass

Aspergilloma / Mycetoma

Case 29 | What pleural abnormality frequently accompanies a mycetoma?

Pleural Thickening

Case 29 | Treatment for asymptomatic aspergilloma

None

Case 29 | Therapeutic options for patients with hemoptysis and aspergilloma?

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

Case 30 | Four causes of right cardiophrenic angle mass

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

Case 30 | Pericardial Cyst - right or left?

Right Side

Case 30 | Do pericardial cysts communicate with the pericardium?

No They are attached to the parietal pericardium

Case 31 | Name the order of left lower lobe basilar segmental bronchi from lateral to medial on a frontal radiograph

Anteromedial, lateral, and posterior A - L - P

Case 31 | Order of the right basilar segmental bronchi from lateral to medial?

Anterior, lateral, posterior, medial

Case 31 | RLL Bronchi and numbers

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

Case 31 | LLL Bronchi and numbers

Posterior (10) Lateral (9) Anteromedial (7 and 8) A - L - P

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

S. pneumoniae Pedi

Case 33 | Two mass features of mediastinal location on CxR?

Obtuse angle with adjacent lung | Smooth Sharp Margins

Case 33 | Most common cause of posterior mediastinal mass?

Neurogenic Tumor

Case 33 Neurogenic Tumor - Peripheral Types

Schwanoma | Neurofibroma

Case 33 Neurogenic Tumor - Sympathetic Chain

Ganglioneuroma | Neuroblastoma

Case 33 Neurogenic Tumor - Paraganglia

Pheochromocytoma | Chemodectoma

Case 33 Neurogenic Tumor - Symphathetic Chain Shape

Fusiform Vertical More commonly calcify - Ganglioneuroma

Case 34 | Six causes of total lung atelectasis

``` Tumor Mucus Plug ET Tube - Right Main Stem Intubation Foreign Body Trauma TB Stenosis ```

Case 33 Neurogenic Tumor - Peripheral Nerves shape

Round - Schwanoma

Case 34 | Several Causes of hemothorax

``` Trauma Iatrogenic Anticoagulation Malignancy Catamenial Hemothorax ```

Case 35 | Four CT features of empyema

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

Case 35 | Round shape - Lung abscess or Empyema

Lung Abscess

Case 35 | Most common cause of air fluid level within a pleural fluid collection?

Bronchopleural fistula

Case 36 | Two most common causes of rib notching

Neurofibromatosis | Coarctation

Case 36 | Osseous manifestations of neurofibromatosis

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

Case 36 | Most common cause of osseous destruction of a rib?

Metastatic Disease

Case 37 | Causes of thymic masses

``` Thymoma Cyst Hyperplasia Carcinoma Thymolipoma Carcinoid ```

Case 38 | Subcarinal mass DDx

Bronchogenic Cyst Left Atrial Enlargement Subcarinal Lymph Nodes / Mets

Case 38 | Common causes of intrathoracic lymphadenopathy

Malignancy: - Head and Neck, Breast, Melanoma, Genitourinary - Lymphoma / Leukemia Infection: - TB, fungal, viral, bacterial Inflammatory: - Sarcoid, Castleman's, Angioimmunoblastic

Case 39 Severe Silicosis Types of Calcification in the lymph nodes

Progressive Massive Fibrosis: confluent opacification Egg Shell

Case 40 | Cause of chronic Infiltrative Lung Dz with a basilar and subpleural distribution

Scleroderma

Case 40 How do NSIP and UIP present? Examples? What is the difference between NSIP vs UIP

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

Case 40 | Soft tissue abnormality with scleroderma

Calcinosis

Case 40 | Honeycombing - NSIP vs UIP

UIP Only

Case 41 | Combination of calcified lung nodule and calcified lymph nodes

Ranke Complex

Case 41 | Lung nodule that occurs at the initial site of parenchymal involvement from primary TB

Ghon Focus

Case 41 | Two common radiographic findings associated with primary TB infection

Parenchymal consolidation | Mediastinal and Hilar Lymph Node Enlargement

``` Case 42 PVWP - Pulm Edema - Pleural Effusion - Alveolar Edema ```

17 mm Hg 20 mm Hg 25 mm Hg

Case 42 | Four radiographic signs of interstitial edema

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

Case 43 | Most common cause of bronchiectasis

Prior infection

Case 43 | CT findings of bronchiectasis

``` 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 ```

Case 44 | Syndrome associated with AVM

Hereditary Hemorrhagic Telangiactasia / Osler Weber Rendu - Telangiectasias - AVMs - Aneurysms - Pulmonary / Gastrointestinal / Cuteneous / CNS

Case 44 | What percentage of AVMs are multiple?

30%

Case 44 | Name three symptoms or conditions associated with pulmonary AVMs

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

Case 45 | Causes of Ascending Aortic Aneurysm?

Cystic Medial Necrosis | Syphilis

Case 45 | Causes of Arch and Descending Aortic Aneurysm

Atherosclerotic Mycotic Post-traumatic

Case 46 | DDx for peripheral wedge shaped consolidation

Pulmonary Infarct Neoplasm Pneumonia Hemorrhage

Case 46 | Wedge shaped peripheral opacity with feeding vessel

Pulmonary Infarct | - Central Lucencies

Case 46 | Incidence of incidentally detected acute pulmonary embolism on postcontrast CT?

1% - 5%

Case 47 | DDx multiple lung nodules or masses in pt w AIDS

Infection - fungal, mycobacterial, septic emboli | Neoplasm - lymphoma, Kaposi's sarcoma

Case 47 | Most common type of lymphoma in pt with AIDS

Non-Hodgkins Lymphoma

Case 47 | Thoracic lymphoma typically nodal or extranodal in AIDS

Extranodal

Case 48 | Most common sites of traumatic aortic transection

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

Case 48 | Direct Signs of Traumatic Aortic Injury

``` Deformed Contour Intimal Flap Pseudoaneurysm Intramural Thrombus Extravasation ```

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

Thyroid Goiter: typically calcify Lymphangioma

Case 50 | Chronic Airspace Dz DDx

``` Lipoid Pneumonia BAC Lymphoma Alveolar Proteinosis Alveolar Sarcoid ```

Case 50 | Lipoid pneumonia most common cause

Aspirated Mineral Oil | - old ladies

Case 51 | Situs inversus with bronchiectasis

Kartegners Syndrome

Case 51 | Kartegner's Syndrome triad

``` Situs Inversus Bronchiectasis - predilection to RML Sinusitis - Infertility - Autosomal Recessive ```

Case 33 | What neurogenic tumor most commonly calcifies?

Ganglioneuroma