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My FRCR2A > Resp - ILD > Flashcards

Resp - ILD Flashcards

1
Q
  1. Calcified Mediastinal Lymph Nodes
  2. Egg Shell Calcification
A

Tuberculosis
Histoplasmosis
Amyloidosis (rare)
Metastases: papillary/medullary thyroid cancer, osteosarcoma, mucinous adenocarcinoma

egg-shell calcification**
Silicosis and coal workers pneumoconiosis
Sarcoidosis

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2
Q

Alpha 1 antitrypsin deficiency

A

Deficient liver glycoprotein

CT features
CT - panacinar emphysema at bases +/- bronchiectasis
Cirrhosis

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3
Q

Describe LAM
Lymphangioleiomyomatosis
Patient demographic?
CT findings
Differential

A

Non-smoking women childbearing age +/- history spontaneous pneumthorax

CT features
Normal lung with small cystic spaces
Chylous pleural effusion
Normal lung volumes

Differential
Histiocytosis - associated with smoking, small nodules and small cysts, pneumothorax.
Increased lung volumes

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4
Q

What lobe is affected in congential lobar overinflation?

A

Usually left upper lobe

Why? Undeveloped bronchial cartilage, and subsequent air trapping

Hyperlucency on CXR, and mediastinal shift.

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5
Q

What is Swyer-James Syndrome?

A

Normal development of infant lung impeded by bronchiolitis, with superadded infection.
Air trapping makes CXR lucent.

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6
Q

Unilateral Hyperlucency on CXR

A

Congential lobar overinflation (cartilage)
Swyer-James (infant bronchiolitis)
Large PE
Poland syndrme

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7
Q

Anterior junctional line

A

Formed by meeting of parietal and visceral pleura anteromedially

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8
Q

Posterior junctional line

A

Meeting of pleural surfaces of upper lobes behind oesophagus.

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9
Q

Azygo-oesophageal recess

A

Right lung and mediastinal reflection of azygous vein

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10
Q

Right paratracheal line
Right paraspinal stripe

A

*Right paratracheal line right wall trachea and right lung
**Right paraspinal stripe **- right lung and posterior medialstinal soft tissue

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11
Q

Reverse Halo Sign

A

Cryptogenic Organising Pneumonia (BOOP)

Others:
GPA
Sarcoidosis
Peumocystis carinii pneumonia

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12
Q

Halo sign

A

Invasive aspergillosis
(Central nodule with surrounding ground glass - haemorrhage)

Others
* Haemorrhagic mets
* Bronchoalveolar carcinoma
* Mycobacterials
* Hypersensitivity pneumonitis

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13
Q

What is Monrod sign

A

Air crescent surrounding aspergilloma

(Aspergilloma forms in immunocompetent patients with pre existing lung cavities)

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14
Q

Upper Zone Involvement

A

B - Beryllosis
R - Radiation
E - Eosinophilic granuloma (LCH) and EAA
A- Ank Spondylitis, amiodarone
S - Sarcoidosis
T - TB
S - Silicosis

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15
Q

Lower Zone Involvement

A

B - Bronchiectasis
A - Aspiration Pneumonia
D - Drugs and DIP
A - Asbestosis
S - Scleroderma (and RA)

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16
Q

Asbestosis features

A

Bilateral calcified pleural plaques
Spares CP angles
(mediastinum involvement - mesothelioma)

Unilateral pleural plaques - previous insult eg surgery, empyema.

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17
Q

Crazy paving
(interlobular septal thickening and GGO)

A
  1. Alveolar proteinosis

Others:
Goodpastures (haemorrhage)
Idiopathic pulmonary haemosiderosis -iron deposition
Sarcoidosis

Goodpasture syndrome presents glomerulonephritis/haemoptysis (anti-GBM)

18
Q

Sarcoid Demographic
CT Features

A
  1. Young, female, black, hypercalcaemia
  2. Garland triad, egg shell calcification, traction bronchiectasis, upper lobe predominance, perilymphatic nodules.
19
Q

LCH v LAM

A

q2 table

20
Q

What gives cystic change, nodules, upper lobe predominant, INCREASES lung volume, pneumothorax

A

LCH -strong association with smoking, Spares CP angles.

To different from LAM
-LAM no volume change
-chylous effusion

21
Q

Upper lobe GGO, reticulations, increased liver density. History of AF..

What is it?

A

Am(iod)arone induced lung and liver disease.

CT features
- increased liver density

10% develop lung disease
- GGO, reticulations, consolidation, pleural effusion.

22
Q

What spares CP angles?

A

LCH
Asbestosis

23
Q

Name the condition;
1. Heavy smoking
2. Centrilobular nodules
3. GGO

A

RBILD

Respiratory Bronchiolitis Interstitial Lung Disease - upper lobe dominant

Addition: DIP Desquamative interstitial pneumonia is though of as end spectrum of RB-ILD

24
Q

Recreational drugs
Particulate matter, hyperdense centilobular matter
Cavitating lung lesions
Apical bull/pneumothorax
Perihilar airspace opacification
LRTI
Nasal septal destruction
Lung abscess/pseudoaneurysm

A

Particulate matter, hyperdense centilobular matter - Talcosis
Cavitating lung lesions - Septic emboli, non-sterile IV
Apical bull/pneumothorax - inhalational drugs
Perihilar airspace opacification - cocaine, heroin, meth
LRTI - Aspiration
Nasal septal destruction - snorting cocaine
Lung abscess/pseudoaneurysm - injection site.

25
Q

Causes of cystic lung disease..

A

LCH (Langerhans Cell Histiocytosis) - smoker, centrilobular nodules, cavitation into cysts, upper lobe/mid zone, spares CP angle
Lymphangiomyomatosis (LAM) - child bearing age, TS, thin walled round cysts, uniform distribution, chylothorax.
Birthday Hogg Dube - associated with bilateral oncocytomas and chromophobe RCCs. Lower lobe predominant.
LIP
PCP.

26
Q

What is associated with Lymphocytic Interstitial Pneumonia (LIP)?

A

SJOGRENS (+sle + RA)
HIV (young)

Benign lymphoproliferative disorder lung infiltration.

27
Q

Ground glass appearance in hilar/mid zone distribution. Can have apical cystic form associated with penumothorax..

A

PCP (Pneumocystitis pneumonia)

Nb AIDS + ground glass change = PCP
AIDS + pneumothorax = PCP

28
Q

Define emphysema

A

Permanent enlargement of airspaces distal to the terminal bronchioles with alveolar wall destruction.

CXR findings: flattened hemi-diaphragm, AP diameter increases, increase retrosternal space.

Other:
Saber sheath trachea - coronal narrowing. Pathognomonic for COPD.
On CT, if Main PA >aorta, (PA/A ratio >1), indicates pulmonary HTN + worse outcome.

29
Q

Which emphysema is upper lobe predominant, associated with smoking, and common in asymptomatic elderly. Focal lucency with central dot sign (bronchovascuar bundle).

A

Centrilobular emphysema.

30
Q

Emphysema - lower lobe predeominant, associated with alpha 1 anti-trypsin

A

Pan - lobular

Usually presents in 60-70s but will present if 30s if smoker

31
Q

Emphysema with subpleural Lucencies?

A

Para-septal

Less than three bubbles thick.

32
Q

Describe Asbestosis

A

This is the lung fibrosis associated with exposure (not exposure itself).
Similar appearance to UIP - pleural thickening is the differentiating factor.
20 year latency between exposure + lung ca/mesothelioma.
Benign pleural effusion earliest benign related change. Pleural plaque 20-30 years. Calcifications 40yr.
Plaques spare spices and CP angles.
Round atelectasis is a mass like opacity with associated pleural thickening .
30-40yrs lag time to mesothelioma.

33
Q

What disease is associated with nodular opacities, +egg shell calcification of the hilar nodes.

A

Silicosis
Who ? Miners and quarry workers
Simple form described above.
Complicated form - Progressive Massive Fibrosis.
This scan also be seen in coal workers pneumonicosis - secondary to exposure to washed coal.

Silicosis raises risk of TB x3, so if cavitation think silicotuberculosis

34
Q

Macrocystic honeycombing
+/- bronchiectasis
Reticular abnormalities
Subpleural basal predominant distribution

A

Usual Interstitial Pneumonitis
When cause is idiopathic it’s Idiopathic pulmonary fibrosis

Macrocystic honeycombing, traction bronchiectesis, apicobasilar gradient.

CHRONIC HYPERSENSITIVITY v UIP - CHONIC HP involves air trapping (3 or more lobes), mid-upper lobe fibrosis.

35
Q

Ground glass
SUBPLEURAL SPARING
Posterior lower lobe predominance

A

NSIP (Non-specific interstitial pneumonia = is specific)

UIP v NSIP

UIP - apico to basilar gradient, heterogenous histology, honeycombing, traction bronchiectasis

NSIP - slight lower lobe predominance, homogenous , ground glass, (honeycombing if any is microcystic), SUBPLEURAL sparing

36
Q

African American female, 20-40, non-caseating granuloma, raised ACE, hypercalcaemia.

Lofgren syndrome -
1) Bilateral lymph node enlargement
2) Ankle arthritis
3) Erythema nodosum

A

Sarcoidosis

  • PERI-LYMPHATIC NODULES
  • UPPER LOBE PREDOMINANCE

Garland Triad, Lambda sign Gallium scan, CT galaxy sign

37
Q

Most common Lung Cancer

A

Non Small Cell Adenocarcioma

Peripheral tumour. Most common to present at solitary pulmonary nodule. Most common type in non smoker. Associated with pulmonary fibrosis.

38
Q

Most common central tumours

A

Non small cell - squamous — cavitation is classic. Paraneoplastic syndrome common with ectopic PTH hormone.

Small Cell — Associated with Lambert Eaton (proximal weakness - aCh related). Also related to SIADH. Bad prognosis.

Both central - both related to smoking.

39
Q

What is the largest lung cancer?

A

Non small cell - Large cell
This is peripheral. Least common. Usually large (>4cm). Poor prognosis.

40
Q

Name 4 types lung cancer?
LA on the coast.

A

Large, non small cell
Adenocarcinoma, non small cell

Squamous, non small cell.
Small

41
Q

What is Pancoast tumour

A

Apical tumour with associated syndrome of shoulder pain, C8-T2 radiculopathy, Horner’s syndrome.

My FRCR2A (7 decks)

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