Pulmonary Infection

Question 1

community acquired pneumonia

Answer 1

S. pneumonia, also atypical pneumonias (Mycoplasma, viral, chlamydia), legionella, klebsiella and gram negatives

Question 2

legionella pneumonia

Answer 2

elderly, severe infections

peripheral consolidations&raquo_space; lobar/multifocal pneumonia

Question 3

klebsiella and gram negative pneumonias

Answer 3

alcoholics/aspirators

voluminous inflammatory exudates; bulging fissure sign

Question 4

hospital acquired pneumonia

Answer 4

aspiration of colonized secretions

typically MRSA and resistant gram negatives like pseudomonas

Question 5

health care associated pneumonia

Answer 5

pneumonia >2 day hospitalization over past 90 days or nursin home

Question 6

ventilator associated pneumonia

Answer 6

polymicrobial infection

pseudomonas and acinetobacter

Question 7

pneumonia in immunocompromised patient

Answer 7

opportunistic infections: pneumocystis, Aspergillus, Nocardia, CMV

Question 8

lobar pneumonia

Answer 8

consolidation in single lobe; air bronchograms

usually bacterial, CAP

Question 9

lobular pneumonia/bronchopneumonia

Answer 9

patchy consolidation with poorly defined airspace opacities

s aureus

Question 10

interstitial pneumonia

Answer 10

inflammatory cells in interstitial tissue&raquo_space; diffuse/patchy ground glass opacification

mycoplasma, chlamydia, pneumocystis

Question 11

round pneumonia

Answer 11

S. pneumonia, seen in children

infection confined to incomplete formation of pores of kahn

Question 12

pneumonia complications

Answer 12

abscess, pulmonary gangrene, empyema, pneumatocele, bronchopleural fistula , emphyema necessitans

Question 13

emphyema stages

Answer 13

free flowing exudative effusion > fibrous strands >solid/jelly-like fluid

split pleura sign; enhancement of visceral and parietal pleural layers

Question 14

initial exposure to TB ?

Answer 14

contained disease (calcified granulomas/calcified hilar LN) vs primary TB (children/immunocompromised)

Question 15

primary TB imaging manifestations

Answer 15

ill defined consolidation, pleural effusion, LN, miliary disease

typically lower or RML

Question 16

Ghon focus

Answer 16

initial focus of infection, upper part of lower lobe, lower part of upper lob

Question 17

Ranke complex

Answer 17

Ghon focus + LN

Question 18

post primary/reactivation TB

Answer 18

adolescents/adults and caused by reactivation of dormant infection

chronic cough, low grade fever, hemoptysis, night sweats

upper lobe apical and posterior segments

Question 19

imaging hallmarks of reactivation TB

Answer 19

upper lobe predominant disease, cavitation, lack of adenopathy; tree-in-bud suggests endobronchial spread

Question 20

tuberculoma

Answer 20

well defined rounded opacity in upper lobes

Question 21

healed TB

Answer 21

apical scarring, upper lobe volume loss, hilar retraction

calcified granulomas may be present as wel; containment of initial infection by delayed hypersensitivity response

Question 22

miliary TB

Answer 22

random distribution of tiny nodules in hematogenously disseminated TB

primary or reactivation TB

Question 23

atypical mycobacterial infection

Answer 23

elderly woman with cough, low grade fever, weight loss

Lady Windermere syndrome; usually Mycobacterium avium intracellulare or M kansaii

bronchiectasis and tree-in bud nodules in the RML/lingula

Question 24

hot tub lung

Answer 24

hypersensitivity pneumonitis in response to atypical mycobacteria typically found in hoot tubs

centrilobular nodules

Question 25

endemic fungi

Answer 25

histoplasma, coccidiodes, blastomyces

Question 26

histoplasma

Answer 26

OH/MS river valleys, soil contaminated with bird/bat guano

calcified granuloma/histoplasmoma

may mimic reactivation TB

may cause fibrosing mediastinitis

Question 27

coccidiodes immitis

Answer 27

SW US

multifocal consolidation, multiple pulmonary nodules, miliary nodules

Question 28

blastomyces dermatitidis

Answer 28

central/SE US

flu-like illness that can progress to multifocal consolidation, ARDS, miliary disease