Resp Exam Prep Flashcards
Cryptogenic organising pneumonia (COP) - aka BOOP (Bronchiolitis obliterates organising pneumonia).
Who? Patients post infection, post transplant, or with drug toxicity
CT findings:
REVERSE HALO SIGN
Patchy GGO
Other causes of reverse halo:
Wegeners granulomatosis
Sarcoidosis
PCP
What is the halo sign?
- Central nodule surrounded by GGO
Most synonymous with
INVASIVE ASPERGILLOSIS
Others:
Septic emboli
Fungal infections
TB
Haemorrhages mets
Minimally invasive adenocarcinoma of lung (Bronchioalveolar ca).
Allergic bronchopulmonary aspergillosis (ABPA)
-is part of the spectrum of diseases caused by fungus aspergillus.
Occurs in hypersensitive patients ie CF or asthmatics
‘Finger in glove’ sign
Associated with tree in bud appearance
Central bronchiectesis ‘ring shadows’
Clinical presentation may include malaise, headache, intermittent chest pain, eosinophilia.
Classic thoracic sarcoidosis
Perilymphatic nodules and interlobular septal thickening
Associated mediastinal and hilar lymph nodes
Egg shell calcification
(Pleural disease is not typical)
Chest markers and related pleural reflection
LAM
Caplin syndrome
Name for combination of pneumoconiosis and rheumatoid arthritis
IPF v NSIP
IPF can only be diagnosed in absence of a precipitating condition eg. Asbestosis, RA, drug toxicity.
Other things: NSIP patients approx 10 yrs younger.
Conditions where costophrenic angle spared
Asbestosis
LCH
Calcified mediastinal lymph nodes
ARDS - Acute respiratory distress syndrome
Patients develop rapidly progressive dyspnoea, tachypnoea and hypoxia.
Alveoli fill with fluid/pus and right to left shunt develops
Oxygenation can not improve the hypoxia
CXR: Patchy confluent opacification
CT : extensive GGO and posterior dependent consolidation
Wedge Capillary pressure
- measures left atrial pressure (surrogate) which will rise with LVF/ aortic valve/ mitral valve issue
- if wedge pressure raised then consider cardia cause
- non-cardiac cause will not elevate it
Emphysema
Bronchiolitis obliterans syndrome
(NOTE NOT BOOP)
Part of CLAD (chronic lung allograft dysfunction)
- when the graft undergoes fibrosis
CT findings - mosaic attenuation with air trapping, bronchial wall thickening and bronchiectasis.
Random9
More egg shell calcification
Upper and lower zone involvement
CF is upper lobe.
Amiodarone is upper lobe.
Amiodarone lung disease
Congenital lobar overinflation
Caused by underdevelopment of bronchial cartilage in affected lobes.
Bronchus can not remain patent during expiration and leads to air trapping. Usually left upper lobe.
Hyperlucent lobe on CXR.
Other causes hyperlucent lung
- swyer-James — bronchiolitis
Poland syndrome
Crazy paving - interlobular septal thickening on background of patchy GGO.
Most common association - Alevolar proteinosis
— over production of surfactant +/- reduced clearance mechanisms (assoc. smoking).
Others:
- Goodpasture
- Idiopathic pulmonary haemosiderosis
- Sarcoidosis
LCH v LAM
Asthma Complications
Cavitating Lung Lesions
‘CAVITY’
C - Cancer (Squamous cell - bronchogenic or met, or adenocarcinoma)
A - Autoimmune granuloma (GPA/RA)
V - Vascular (septic emboli)
I - Infection (abscess, TB, cavitating pneumonia)
T - trauma (pneumatocele)
Y - youth (congential - CPAM, sequestration, bronchogenic cyst )
AIDS
Normal CD4 lymphocytes 800-1000
As patient becomes increasingly immunocompromised different disease occur.
CD4 counts
<350 TB
<200 PCP, Kapsoi
< 150 Fungal infections
<50 Lymphoma, MAI, CMV
AIDS - TB
<350 post primary TB (ie cavitation, which can then progress to fibrosis, volume loss, traction bronchiectesis).
<200 - primary or military, consolidation, LN enlargement (low with rim enhancement), pleural effusion
Simon focus - healed site of primary infection in lung apex
Ghon focus - calcified lung lesion <5mm
Ranke complex - Ghon focus + calcified lymph node
Rasmussen aneurysm - PA aneurysm within TB cavity.
PCP - dry cough, malaise
GGO peri hilar and basilar
Black bronchus sign
Lung cysts and therefore pneumothorax
Lobar collapse
Lipoid pneumonia
Fire eater
Old person - oil based laxative or cod liver oil
Mendelson syndrome
Gastric acid aspiration
- chemical pneumonitis - nasty
- range of issues from mild bronchiolitis to haemorrhaging pulmonary oedema.
Acute kidney injury criteria
Lady Windermere
Cystic fibrosis
-autosomal recessive
1) exocrine gland dysfunction - mucus lung secretions are far more viscous than normal
2) ciliary dyskinesia, therefore mucus is poorly cleared.
