HomeStretch CRACK vol 1. Endo/Thorax Flashcards
Syndromes associated with Pheo
- VHL
- MEN IIa/IIb
- NF1
- Sturge-Weber
- Tuberous sclerosis
Wolman dz
fatal metabolism error thing - b/l enlarged calcified adrenal glands
MEN 1
3Ps
- Pituatary
- Parathyroid
- Pancreas
MEN 2a
1M,2Ps
Medullary thyroid CA
Pheo
Parathyroid
MEN 2b
2Ms, 1P
- Medullary thyroid CA
- Marfanoid, mucosal neuromas
- Pheo
Delphian node
level 6 lymph nodes around the thyroid in front of neck
commonly enlarged with hashimotos
sick looking delphian node = laryngeal ca mets
Normal hilum on lateral radiograph, what is “the black hole”? What is on top of it and what is anterior to it?
Left upper lobe bronchus
Left PA
Right PA (is anterior)
Which hilum is more superior?
left hilar point should be 1 cm higher than the right
What obliterates the retrotracheal (raider) triangle?
Aberrant right subclavian artery
Bronchopulmonary segmental anatomy
In general, each lung has 10 segments: the upper lobes contain 3 segments, the middle lobe / lingula 2 and the lower lobes 5. Bilaterally, the upper lobes have apical, posterior and anterior segments and the lower lobes superior (apical) and 4 basal segments (anterior, medial, posterior and lateral). With this basic symmetric anatomy shared between the lungs, there are a few differences that can be described:
the middle lobe on the right has 2 segments: medial and lateral (easy to remember - middle lobe, medial and lateral).
the lingula on the left is part of the left upper lobe and is the equivalent of the middle lobe on the right, and hence it has 2 segments, but in this case, it is divided into superior and inferior segments.
there are 2 regions of the left lung in which 2 segments are joined as 1 as they have a common tertiary (segmental) bronchus:
left upper lobe apicoposterior segment
left lower lobe anteromedial segment
volume loss of one hemi-thorax with CT coronal showing only one PA
proximal interruption of the pulmonary artery
seen on the opposite side of the aortic arch
What are the kinds of atelectasis?
- Obstructive (absorptive)
- Compressive (relaxation/passive)
- Fibrotic (cicatrization)
- adhesive
cervicothoracic sign
something above the clavicles on CXR is in the posterior mediastinum
hilum overlay sign
if you see edges of vessels through a hilar mass - its either in the anterior or posterior mediastinum
Post bone marrow transplant graft versus host
Acute (20-100 days): favors extrapulmonary systems (skin, GI, liver)
Chronic (>100days): lymphocytic infiltration of airways and obliterative bronchiolitis
Post Bone Marrow Transplant pulmonary findings
Early neutropenic (0-30 days): pulmonary edema, hemorrage, drug induced lung injury; fungal pneumonia
Early (30-90 days): PCP, CMV
Late (>90 days): BO, COP
Ghon lesion
Ranke complex
Rassmussen aneurysm
- Ghon lesion = calcified TB pulmonary granuloma (sequela of primary TB)
- Ranke complex = Gohn + calcified hilar lymph node
- Rassmussen aneurysm = pulmonary artery pseudoaneursyms next to TB cavities
What are the three flavors of aspergillus?
Normal immune = aspergilloma
suppressed immune = invasive aspergillosis (halo sign and air crescent sign)
Hyper-immune = ABPA
Mnemoic for cavitary lung lesion
CAVITY
Cancer (scuaomous)
Auto-immune (wegeners, RA, Caplan)
Vascular
Infection (TB, Staph)
Trauma
Young (congenital)
Lung cancer subtypes
Squamous cell = smokers, central, cavitation, calcium (hyperPTH); does not express TTF-1
Large cell: least common subtype, peripheral
AdenoCA: peripheral, associated with fibrosis
small cell: smoker, central, svc obstruction, paraneoplastic syndromes (ACTH, SIADH, Lambert Eaton)
What is the test of choice to stage a pancoast tumor?
MRI - to check brachial plexi
Critical stage for lung cancer
3a versus 3b
Stage 3b implies N3 or T4 disease (M also is unresectable)
nucs crossover blitz!
Gallium/Thallium versus Kaposi Sarcoma and Lymphoma
Kaposi is Thallium hot and Gallium cold
Lymphoma is thallium hot and gallium hot
Cystic lung diseases
- LIP = LymphoCYSTIC Interstitial Pneunomia
- Benign lymphoproliferative disorder with lung infiltration
- Association with Sjogrens, SLE, RA, HIV in younger patient, Castlemans
-
Cysts with groundglass
- When I say LIP you say Sjogrens and HIV
- When I say LIP in a child you say HIV
- LCH = Langerhans Cell Histiocytosis
- Smoker, young (20s-30s)
- Spaces costophrenic angles
- Centrilobular Nodules + thicker, bizarre chapped cysts.
- LAM = Lymphangioleiomyomatosis
- Child-bearing aged women and TS
- Uniform, thin walled round cysts
- BHD = Birt Hogg Dube Syndrome
- Association with renal findings
- Thin walled “floppy cysts”
- Lower zone predominant
What does Asbestosis look like?
UIP with parietal pleural thickening
What is the first step in deciding if nodule pattern? Then what?
- Centrilobular spares the pleura (inhaled stuff - ie infection, RB-ILD, HP)
- Perilymphatic nodules run along subplearual and peribrochovascular (lymphatic stuff - sarcoid/silicosis and lymphangitic spread)
- random is random (hematogenous stuff - mets, fungal, military TB)
What are the ILDs?
- UIP = Usual interstitial Pneumonia
- The main one
- Honeycombing
- Apicobasal gradient
- Traction bronchietctasis
- NSIP = Nonspecific Interstitial Pneumonia
- Ground glass micronodules
- Subpleural sparing
- Scleroderma
- RB-ILD = Respiratory bronchiolitis - Interstitial Lung Disease
- Smoking related
- Apical centrilobular ground glass nodules
- DIP = Desquamative interstitial pneumonia
- Smoking related
- The worse end of spectrum of RB-ILD
- Peripheral, lower-lobe predominant ground glass with small cystic spaces
- Sarcoid
What is associated with NSIP?
What is associated with LIP?
What is associated with follicular bronchiolitis?
NSIP = Scleroderma
LIP(J) = Sjogrens (and HIV in kids)
Follicular Bronchiolitis = Sjogrens and RA
Lofgren syndrome
Acute sarcoid
b/l hilar LAD
arthritis
Erythema nodosum
(LofGren = sarGoid; loffler is the eosinophilia one)
CHF Stages
- Stage 1: redistribution (wedge pressure 13-18); cephalization, cardiomegaly, big vascular pedicle
- Stage 2: Interstitial edema (WP 18-25); kerly b lines
- Stage 3: Alveolar edema (wedge > 25); airspae fluffy opacities and pleural effusion
Pulmonary Alveolar Proteinosis Trivia
increased risk of what which infections?
Smoking association?
When seen in children associated with what?
treatment?
- increased risk of what which infections? NOCARDIA
- Smoking association? YES
- When seen in children associated with what? THYMIC ALYMPHOPLASIA
- treatment? BAL
Alveolar diseases (soup alphabet)
- PAP = Pulmonary alveolar proteinosis
- Crazy paving
- Lipoid Pneumonia
- Organizing Pneumonia (Cryptogenic [COP]) if cause unknown
- Persistent symptoms following pneumonia treatment
- COP = reverse halo
- Patchy airspace opacities or GGO in a peripheral or peri-bronchial pattern
- CEP = Chronic Eosinophillic Pneumonia
- Can look exactly like COP
- When I say COP, you say CEP too
- HP = Hypersensitivity Pneumonitis
- Subacute = patchy ground glass opacities
- Chronic = looks like UIP + air trapping
Bronchial carcinoid more likely to met in eye where
versus GI carcinoid
Bronchial carcinoid goes to inside eye in uveal tract while GI carcinoid goes to EOM
Tracheal disease - which spare posterior membranes? how to differentiate all of them
- Spare posterior membrane
- Relapsing polyCHONDritis and TBO (both have chondro in their name)
- TBO calcifies
- Relapsing polyCHONDritis and TBO (both have chondro in their name)
- Does not spare post membrane:
- Amyloid (calcifies)
- Wegeners (can calcify too. . .)
Williams campbell syndrome
congenital cystic bronchiectasis from deficiency of cartilage in the 4th-6th order bronchi
(“Williams with CF”)
Mounier-Kuhn syndrome
tracheobronchomegaly
Mendelson’s syndrome
Aspiration of gastric acid
Typical location of aspiration
If supine: posterior segment of upper lobes and superior segment of lower lobes
If upright: bilateral basal lower lobes
right is favored
Callogen Vascular Dz Pulm Manifestations
SLE = shrinking lung; has more pleural and pericardial effusions
RA = looks like UIP and COP
Scleroderma = NSIP
Sjogrens = LIP
What is associated with solitary fibrous tumor of the pleura?
Hypoglycemia (IGF secretion) = Doege-potter syndrome
Hypertrophic osteoarthropathy
(not associated with asbestosis)
Hughes-Stovin Syndrome
PA aneurysm similar to Behcet’s (may be the same thing)
