CXR

Question 1

Hyperinflation

Fibrosis/scarring

Answer 1

Cystic Fibrosis

*focus on clearance and reduction of lower airway secretions, reverse broncho-constriction (albuterol), treat bacterial in airways, pancreatic enzyme replacement, nutritional support, lung transplant only definitive treatment

Question 2

Abnormally dilated airways appearing as “tram tracks,” +/- mucous plugging (ring-shadows, air-filled cystic spaces)

Answer 2

Bronchiectasis

*treat infections, physiotherapy for loosening chest musous, embolization to stop bleeding, rehab, surgery, lung transplant

Question 3

Bilateral fibrosis, reticular opacities on CXR. Also, ground glass on high resolution CT

Answer 3

Idiopathic interstitial pneumonia (IPP)

*no real treatment. Some give prednisone.

Question 4

Bilateral hilar and right paratracheal lymphadenopathy, diffuse reticular infiltrates

Answer 4

Sarcoidosis

*oral prednisone, years of follow up for eyes, lungs, heart, etc (since dz is systemic)

Question 5

Linear streaking at lung bases, opacities of various shapes and sizes, honeycomb changes in advanced cases, pleural calcifications

Answer 5

Asbestosis

*No specific treatment.

Question 6

Calcification of the periphery of hilar lymph nodes–“eggshell calcification”

Answer 6

Silicosis

*get TB test and CXR,

Question 7

Interstitial and diffuse findings on radiograph, similar to atypical pneumonia. Consolidation possible.

Answer 7

Psittacosis

*Oral or IV tetracycline, oral erythromycin. Hx involves birds!

Question 8

Diffuse/small (2-5mm) opacities, prominent in upper lung

Answer 8

Coal Worker’s pneumoconiosis

*No treatment, supportive care, wear a respirator

Question 9

Small nodular densities SPARING the apices and bases of the lungs, interstitial infiltrates, non-caseous granulomas in the interstitium and air spaces,

Answer 9

Hypersensitivity pneumonitis

*treat proptly with corticosteroids, symptoms usually reversible if offending agent is removed

Question 10

Different findings based on stage of disease:
ACUTE: Diffuse pneumonia
PROGRESSIVE: shows miliary pattern
SUBACUTE: shows apical cavities, infiltrates, nodules
CHRONIC: shows disseminated diffuse pneumonia

Answer 10

Histoplasmosis

*Iatroconazole, IV amp B in severe, do not drink alcohol during tx

Question 11

When do you do an XR for bronchitis?

Answer 11

Not indicated, unless pt is dyspnic, hypoxic, elderly, or have significant comorbidities

Question 12

Lobar consolidation, occasional effusion

Answer 12

Pneumonococcal pneumonia (strep pneumo)

• VACCINATE
• Pen G, Amox, vanco

Question 13

cavitations and empyema if severe. NO AIR BRONCHOGRAM.

Answer 13

Staph Aureus

• flu shot
• PCN, cef, clinda (MSSA)
• vanco, linezolid, tmp (MRSA)

Question 14

Pleural involvement

Answer 14

H. flu

Amox, ceph, amox clauv

Question 15

Cavitation, empyema, lobar infiltrates

Answer 15

Klebsiella

*adress alcoholism, treat with ceph or cef

Question 16

Small, segmental infiltrates

Answer 16

Chlamydia pneumonia

*erythromycin or tetracycline

Question 17

UNILATERAL segmental infiltrates

Answer 17

Mycoplasma pneumonia

*Clarithromycin, azithromycin, doxy

Question 18

Thick-walled solitary cavity surrounded by consolidation, air-fluid level usually present.

Answer 18

Anaerobic pneumonia - empyema/lung abscess

*clindamycin IV then oral

Question 19

Multiple areas of cavitation within an area of consolidation

Answer 19

Necrotizing pneumonia

*abx until improvement seen on CXR for 1+ month, if abscess treat with abx until full resolution

Question 20

Single rounded opacity, unchanging with serial xrays, less than 3cm.

Answer 20

solitary pulmonary nodule

• smooth&well defined=more likely to be benigh.
• serial xrays to monitor, determine cause and treat appropriately

Question 21

Miliary pattern

Answer 21

Extrapulmonary tuberculosis

*report to local health department, treat with 4 drug therapy (isoniazid, rifampin, ethambutol, pyrazinamine).

Question 22

Right and left pulmonary artery enlargement, along with right ventricular/atrial enlargement

Answer 22

pulmonary hypertension

*treatment directed at underlying disease

Question 23

Clear visceral pleural line, +/- air fluid level, radiolucent costophrenic sulchus (“deep sulchus sign”), air and mediastinal shift

Answer 23

Pneumothorax

• Observe if very small
• Aspiration drainage + small bore chest tube for most
• suction+chest tube if severe

Question 24

Predilection for the lower lobes, usually affects both lungs, has multiple small lucencies within it.
Lung abscess greater than 2 cm may also occur.

Answer 24

pneumonia - pseudomonas

Question 25

Diffuse or patchy bilateral infiltrates that become confluent but SPARE costophrenic angles

Answer 25

Acute respiratory distress dyndrome

*tracheal intubation, continuous positive pressure mechanical airway ventilation. High mortality (30-40% esp if accompanied by sepsis, 90%)