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Pulmonary > Lau PowerPoint - Chest Radiography Part 2 > Flashcards

Lau PowerPoint - Chest Radiography Part 2 Flashcards

1
Q

anterior mediastinal mass carries what major differentials?

A

4 T’s!!!! terribly lymphadenopathy, thymic tumors, teratoma, and thyroid mass.

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2
Q

aortic aneurysm and pericardial cyst are part of the differential for what mass location within the mediastinum?

A

anterior

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3
Q

what is the one indication that the mass is definitely NOT a hilar mass?

A

if you can see the mass hilum THROUGH the mass

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4
Q

thyroid masses can be hot or cold - what is the big difference?

A

hot masses are the cells that are making too much thyroid hormone and may simply be inflamed - cold masses are more indicative of cancer/malignancy

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5
Q

what is the most and least common differential for a mass in the anterior mediastinum?

A

lymphadenopathy and thyroid mass.

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6
Q

what is a consistently enlarged thymus indicate?

A

myasthenia gravis

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7
Q

what is the most common cause of middle mediastinal mass?

A

lymphadenopathy due to metastases or primary tumor

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8
Q

the following are differentials for which location within the mediastinum? hiatial hernia, aortic aneurysm, thyroid mass, duplication cyst, and bronchogenic cyst?

A

middle mediastinal mass

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9
Q

what is the one characteristic on an CXR that will definitely tell you the person has a hitial hernia?

A

gastric bubble above the diaphragm

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10
Q

What is the most common complaint from patients suffering from a hiatial hernia?

A

GERD (and gas)

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11
Q

middle mediastinal mass is most typically what until proven otherwise?

A

lung cancer (primary or metastasized)

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12
Q

which type of lung cancer is known to produce neuroendocrine hormones?

A

small cell (gotten by mostly smokers)

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13
Q

the differential for a ____ mediastinal mass includes neoplasm, lymphadenopathy, aortic aneurysm (as a single isolated mass).

A

posterior

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14
Q

if the mass is projecting above the clavicles where is it’s location?

A

posterior mediastinal

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15
Q

what is typically the cause of the left diaphragm being higher than right?

A

phrenic nerve injury (3,4,5)

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16
Q

differentials include tb, cancer and pneumonia - cardiomegaly is also present - what is not most likely of the three?

A

cancer

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17
Q

the patter of the “bat wing” on CXR is indicative of what?

A

pulmonary edema

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18
Q

These are short parallel lines at the lung periphery. Typically indicative of CHF

A

kerley B lines

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19
Q

what is the one major sign that almost always indicated pulmonary edema?

A

kerley B lines

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20
Q

current jelly sputum - what should be your no. 1 ddx?

A

aspiration pneumonia

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21
Q

what is the best CXR view to detect presence of LLL pneumonia?

A

lateral view

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22
Q

what are the three things we are always looking for (as PA’s) when viewing the CXR?

A

pleural effusion, infiltrates, and pneumothorax

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23
Q

concave menisci with blunting of both posterior costophrenic angles - what should be your no. 1 ddx?

A

pleural effusion

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24
Q

what is the radiographic sign that is indicative of pericardial effusion?

A

water bottle heart

25
Q

a set of findings on physical examination in people with large collections of fluid around their heart.

A

Ewart’s sign; + typically indicated pericardial effusion

26
Q

what will pericardial effusion do to the image of the heart on the cxr?

A

cause an enlarged heart shadow which appears as cardiomegaly

27
Q

the workup for pleural effusion includes a determination of what?

A

of whether the effusion is transudative or exudative - Light’s criteria

28
Q

Protein (pleural to serum ratio) >.5 transudate or exudate?

A

exudate - these also have greater absolute protein!! (Hint: when you got out - you want to go out with a bang in full effect (heavy) and clear of conscience)

29
Q

LDH (pleural to serum ratio) >.6 transudate or exudate?

A

exudate - these also have higher absolute LDH

30
Q

Clear yellow appearance - transudate or exudate?

A

transudate - exudate would be clear or turbid in appearance

31
Q

Specific gravity > 1.016 transudate or exudate?

A

exudate

32
Q

Glucose (serum to pleural ratio) <1 transudate or exudate?

A

transudate - exudate is >1

33
Q

suggests nephrosis, CHF, cirrhosis - transudate or exudate? MCC?

A

transudate; CHF

34
Q

infection (pneumonia, TB), malignancy,

empyema, peritoneal dialysis, pancreatitis, or chylothorax - transudate or exudate? MCC?

A

exudate; bacterial/pneumonia

35
Q

what condition with give you both transduative and exudative effusions?

A

pulmonary embolism

36
Q

PE in small vessel with give you what type of effusions?

A

transudate

37
Q

PE in large vessels will give you what type of effusions?

A

exudate - Hint: remember, you want to exit in a big way

38
Q

what are the two MCC of pleural effusion?

A

CHF and pneumonia

39
Q

what is the MCC of obstruction of the SVC?

A

cancer of the apices of the lung

40
Q

what is the typical presenting sign for cancer of the apices of the lung?

A

atraumatic shoulder pain

41
Q

a tumor of the pulmonary apex is called?

A

pancoast tumor aka sulcus tumor

42
Q

what is the best way to treat a pancoast tumor? 1. surgery 2. chemo/radiation 3. surgery then radiation 4. no treatment

A

radiation - surgery would only spread the tumor

43
Q

combination of drooping of the eyelid (ptosis) and constriction of the pupil (miosis), sometimes accompanied by decreased sweating (anhidrosis) of the face on the same side - what is this called?

A

Horner’s syndrome

44
Q

what type of lung cancer would also present with Horner’s Syndrome? On which side of the face would the anhidrosis present?

A

Pancoast tumor/sulcus tumor/cancer of the apex of the lung. RIGHT SIDE

45
Q

A sulcus line is indicative of what?

A

pneumothorax

46
Q

pts with a chronic pneumothorax should be given what for treatment?

A

doxycycline

47
Q

what are the four types of pneumo?

A

spontaneous, traumatic, iatrogenic, tension

48
Q

pneumo typically occurring as a result of underlying lung disease?

A

spontaneous (secondary) - primary would be without disease

49
Q

pneumo assoc with mechanical ventilation w/ barotrauma.

A

tension pneumo

50
Q

systolic crunch heard over the cardiac apex

A

hamman’s sign

51
Q

syndrome comprised of subcutaneous emphysema (air subcut tissue) and pneumo-mediastinum (air in center of chest cavity)

A

Hamman’s syndrome - must do needle decompression.

52
Q

what is the relation between hamman’s syndrome and hamman’s sign?

A

the syndrome can cause the appearance of the sign

53
Q

tension pneumo is an example of what kind of shock?

A

obstructive shock - IOW caused by mechanical impediment to ventricular filling

54
Q

streaky lucencies over the mediastinum is indicative of what two things?

A

pneumo-mediastinum and subcutaneous emphysema (and if together you have Hamman’s syndrome)

55
Q

which conditions include the following differentials: asthma, surgery (post op complication), traumatic tracheo-bronchial rupture, barotrauma, and smocking crack?

A

pneumomediastinum

56
Q

pnuemomediastinum should first be distinguished from what other two conditions?

A

pneumothorax; pneumopericardium

57
Q

what the one way you can differentiate pneumopericardium from pneumomediastinum? Hint: air pattern

A

air can be present underneath heart but should not be in neck if pneumopericardium

58
Q

what heart valve is typically replaced and why?

A

aortic - to prevent vegetation which leads to endocarditis and eventually the biggest danger is that this becomes a septic embolus

59
Q

term to describe fluid in the lungs

A

hydropneumothorax

Pulmonary (4 decks)

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