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Kim's > Respiratory > Flashcards

Respiratory Flashcards

1
Q

non cardiac APO

A 
HARD MONTH
Head injury
ARDS
Radiation, Renal failure
Drugs - C+ media, narcotics,  heroin
MI
O2 therapy
Near drowning 
Transfusion reaction 
HP
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2
Q

Batwing

A

Pulmonary oedema
Bronchopn
PCP
Viral pn

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3
Q

Reverse batwing

A 
OP
Bronchoalv  carcinoma
Sarcoidosis
EG pn.
vasculitis
contusion
pulm haemorrhage
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4
Q

Anterior mediastinal mass fx

A 
Hilum  overlay 
Obliterates l & r heart border
Paravertabral/Para tracheal stripe thick
Blunt margins above clavicle
Retrosternal clear space preserved on lateral
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5
Q

Anterior mediastinal mass ddx

A 
5Ts
thyroid
teratoma
terrible lymphoma
thymoma
thoracic aorta
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6
Q

Middle mediastinal mass fx

A 
lt and rt paratracheal stripe >5mm
loss of Aortopylm window
loss of hilarious strictures visible
loss SVC
lateral doughnut sign
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7
Q

middle mediastinal mass ddx

A 
LN
bronchial ca
vascular aneurysm
bronchitis cyst
tracheal mass
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8
Q

posterior mediastinal mass fx

A

widened Paravertabral lines
cervicothoracic sign
azygo-oesophageal line disrupted
hilum and cardiac borders visible

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9
Q

Posterior mediastinal mass ddx

A

along VBS - Mets, myeloma, extramedullary haematopoiesis, ganglioneuroma
anterior upper - oesophageal, aorta, thyroid
anterior lower - hiatus hernia, bochdalek hernia

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10
Q

if PE go to limb aa

A

must have PFO. need to do echo to assess heart and urgent embolectomy or thrombolysis
when have PE always suggest assess for DVT

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11
Q

thallium vs gallium

A

thallium. Kaposi sarcoma and lymphoma both positive

gallium. lymphoma positive, Kaposi negative

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12
Q

upper lobe fibrosis

A 
CASSET P
CF
Ank spon
Sarcoidosis
Silicosis
EG
Tb
PCP
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13
Q

halo

A

infective, neoplasm, haemorrhage, other

infective. atypical ( fungus, angio invasive, cryptococcus coccidicoyoycosis,),,mycobacteria, septic embolism, viral (HSV, cmv)
neoplasm. lymphoma, adenocarcinoma, Kaposi, scc
haem. trauma, Wegeners
other. EG, op,

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14
Q

reverse halo

A 
fungal pn
op
Tb
infarct
Wegeners
radiation necrosis 
alveolar sarcoid
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15
Q

cavitation

A 
CAVITY
CA.  SCC, mets
autoimmune - rheumatology nodule, PMF
Vascular. Wegeners 40s, good pastures 20s. check kidneys. septic or bland embolism
Infection. staph, Tb,  klebsiella, staph
Trauma. pneumatocele, haematoma
Youth. CCAM,  sequestration
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16
Q

non resolving consolidation

A 
wrong abx
immunocompromised
bronchial obstruction
recurrent aspiration
underlying pathology. abscess, bronchiectesis, sequestration, mass
organising pneumonia
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17
Q

pulmonary calcification

A

single focus:
granuloma. previous mycoplasma infection
hamartoma. fat
neoplasm. carcinoid, GI (central or popcorn), osteosarcoma ( solid)
rxt
old infarct or injury

multiple foci:
healed miliary Tb, fungal or VCV
silicosis
post rx lymphoma
alveolar microlithiasis (sand lung)
interstitial:
chronic bronchitis
ARDS
asbestosis
busulphan long term use
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18
Q

eggshell ca+

A 
Tb
sarcoid
silicosis
pneumoconiosis
lymphoma. post rx
ddx: pulm aa, aortic, ant mediastinal mass (thymoma, teratoma)
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19
Q

unilateral hyperlucent hemithorax

A 
Swyer James.  post viral or mycoplasma as child
Pulm agenesis with hypertrophy other lung
Pneumonectomy
Ptx
Obstruction with air trapping
Embolism
Mucous plug
Mastectomy 
Poland sx
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20
Q

bilateral hyperlucency

A

Normal lung volume:
oligaemia 2ndry to congenital heart abno. rt to lt shunt
bilateral PE
pulm htn

Increased lung vol:
emphysema
asthma
bronchiolitis. kids <1yo

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21
Q

unilateral opacity hemithorax

A 
mediastinum centre:
airspace opacity. infection, oedema, haem, tumor
pleural effusion
chest wall mass/lipoma
rotation
mediastinum towards opacity:
vol loss. obst with atelectesis
Pneumonectomy
pulm agenesis/hypoplasia
mesothelioma
mediastinum away from opacity:
mass effect.  
mesothelioma
pleural effusion, hemithorax,  chylothorax
red hepatisation
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22
Q

bronchial obst

A

within lumen. inh Fb, mucous plug, ett, aspergilosis, bronchiolithiasis
within wall. carcinoid, bronchogenic ca, sarcoid, bronchial atresia, # bronchus
external. mediastinal mass. LN, primary or 2ndry malig, aortic aneurysm, LA enl, anomalous lt pulm aa arising rt pulm aa (rt main bronchus obst)

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23
Q

bronchiectesis

A

UL. CF, rxt, Tb, ABPA, endoluminal mass
ML. lady wyndimere non Tb mycoplasma. Mac
LL. ciliary dyskinesias, kartagners, asthma, chronic aspiration, ctd, viral infection as child, CCAM, ABPA, Williams Campbell (no cartilage in walls)

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24
Q

CF
bugs
abdo manifestations
chest manifestations

A

mycoplasma, pseudo Minas, staph aureus

abdo: me plug, rectal prolapse, cirrhosis, panc atrophy or ca+, GORD
chest: recurrent infections, ABPA, bronchiectesis UL bilateral, Pulm aa htn with bronchial aa dilatation

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25
Q

airspace opacity

A

acute or chronic
Acute:
fluid. cardio and non cardio
haem. Wegeners, good pastures, contusion, Pulm heamosiderosis, anti GBM
infection. PCP, Tb, VCV, viral pn, bronchopn
infarct

Chronic.
sarcoid
EG
OP
lymphangitis ca
Malignancy. adenoca, lymphoma
lipid pn
sequestration
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26
Q

pulmonary cysts

A

LCH. nodules>cavitate>bizarre cysts. smoker.
LAM. even distribution. female childbearing age. check kidneys for AML and uterus for leiomyoma
LIP. smooth and scattered. GGO and nodules. bronchovascular thickening. immunocompromised or CTDs
Birt hogg dube. AD. pulm cysts basal and large +/- multiseptated, bilateral renal RCC/Oncocytoma and cutaneous angiofibromas

acquired. PCP, cystic bronchiectesis, honeycombing, end stage sarcoid, pneumatocele, cryptococcus, staph a, hydatiform
congenital. CCAM, congen lobar emphysema, pie, bpd

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27
Q

nodules mx

A

benign ca (solid, popcorn, lamellar, central, target), fat = leave alone
4-8mm flies cheer
>8mm bx, PET

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28
Q

SPN

A 
granuloma
primary neoplasm
met
hamartoma
carcinoid
infection. pneumonia (round in kids, pneumococcal), hydatid,  round atelectesis, OP
autoimmune. RA, Wegeners,  sarcoid
vascular.  AVM (multiple HTT), haematoma
congenital. sequestration, bronchogenic cyst, intrapulm LN
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29
Q

mets to lung

A

breast
sarcoma
RCC
seminoma

30
Q

cannonball mets

A

rcc
chorioca
prostate

31
Q

flieschner

A

low risk:
4-6. 12m
6-8. 6 and 18m
>8. 3, 9, 24m

high risk:
<4. 12m
4-6. 6 and 18m
6-8. 3, 9, 24m
>8. bx +/- pet
32
Q

pinpoint nodules

A 
must be dense if can see.
barytosis. MZ
silicosis. UZ
stannosis. Even UZ and LZ
alveolar microlithiasis. sand lung with obliteration of heart and diaph shadow
talcosis
33
Q

miliary nodules

A

ST density: febrile or afebrile
Febrile: Tb, fungal, early HP
Afebrile: CWP (MZ and spares bases and apicies), sarcoid (MZ and UZ), Miliary TB, Mets (LZ), HP

High density:
heamosiderosis (middle age male), silocisi, barytosis, stannosis, healed VZV

34
Q

conglomeration of nodules

A 
sarcoid
silicosis. PMF
secondary mets
bronchoalveolar ca in situ 
Tb
fungal
HP
EG
lymphoid granulomatosis
35
Q

reticular density cxr

A 
acute or chronic.
Acute:
pulm odema. cardiacardiac or non
infection. Viral, PCP, mycoplasma
drug reaction
pulm haemorrhage

Chronic:
post infectious scars. Tb, PCP
chronic interstitial oedema. MR/MS
CTDs. Ank spon, RA, scleroderma (oesoph dilated)
pulm haem
inhalation. asbestosis (LZ), CW (MZ), HP (MZ), silicosis (UZ)
sarcoid
drugs. amiodarone (bright liver), chemo, rxt
neoplasm. lymphangitis carcinomatosis, lymphatic spread, lymphoma
idiopathic. UIP, TS, LAM, amyloid

36
Q

lymphangitis spread ca

A

breast
stomach
thyroid

37
Q

HRCT nodule distribution

A

Centrilobular, perilymphatic, random
Centrilobular:
TIB. infection
No TIB. infection, HP, oedema, RB-ILD, adenoca, early LCH, vasculitis
Perilymphatic: patchy. Sarcoid, silicosis, CWP, LIP, lymphoma, amyloid, perilymphatic spread ca
Random: Haem mets, early LCH, Miliary TB, Miliary fungal, HP

38
Q

Honeycomb

A

UIP
Fibrosis sarcoid
Chronic HP

39
Q

reticulonodular

A

Lymphangitis carcinomatosis
Silicosis
Sarcoid

40
Q

Crazy paving

A 
GGO with interlob septal thickening
Pulm alv protinosis
ARDS
PCP
Bacterial pn
Pulm.oedema
NSIP
RXT
Alveolar sarcoid
41
Q

Mosaic

A

sharply defined and geographical
airtrapping- stays lucent on exp (should normally be more opac)
any small airways disease, so ignore unless main finding

constructive bronchiolitis
asthma
HP
Vascular cause-oligaemia rather than airtrap (Pulm stenosis, congen heart rt to lt shunt, big PEs)

42
Q

UIP pattern

A

definate must have all 4:

  1. subpleural basal predomin
  2. reticulation/traction bronchiectesis
  3. honeycomb
  4. absence of inconsistent findings

possible UIP:
no honeycomb

Inconsistent:
UZ or MZ
Peri bronchovascular
Extensive GGO
Profuse nodules
Discrete cysts
Diffuse mosaic/airtrap
Consolidation
43
Q

Causes of UIP

A 
IPF
CTD. RA (Scleroderma and polymyositis NSIP, sjogrens and RA LIP)
Asbestosis 
HP
CWP and silicosis
Sarcoidosis 
Drugs. bleomycin, cyclophosphamide
Bone marrow tx
44
Q

Causes OP

A 
Infection
Drugs
Fumes
HP
COP. idiopathic
45
Q

NSIP

A 
Basal and subpleural
GGO
Reticulation/fibrosis
\+/- cysts 
Homogenous. No normal lung between

younger than UIP (40-50s)

inflammatory type. better prognosis
fibrotic type. inflamm, RB-ILD, DIP, OP and LIP progress to

46
Q

Causes NSIP

A 
Drugs
CTDs 
Idiopathic
RB-ILD/DIP
OP
LIP
47
Q

HIV Infections

A

CD4 >200. Tb, viral and bronchopn (GGO and TIB)
CD4 <200. MAC, PCP,
CD4 <100. CMV, Disseminated fungal (candida, cryptococcus, aspergilosis), lymphoma, Kaposi

Chronic. Lymphoma, kaposis

48
Q

Aspergillus

A

N immunity. Aspergilloma. fungal ball in pre existing cavity. CF, sarcoid, TB, emphysema

Decreased immunity.
angioinvasive aspergillosis. infiltrates bronchial aa and can disseminate kidneys, cns, git. nodules with GG halo
airways invasive. infiltrates BM. wall thickening, bronchiolitis, TIB

Hyperimmunity.
ABPA. Chronic asthma, CF. Finger in glove mucous plugging.

49
Q

Emphysema

A

Centrilobular. UL with central dot. Smokers. can cause pulm htn
Pan lobular. LL. alpha 1 at. middle aged men. cirrhosis, panc ca and intracranial aneurysms
Paraseptal. Smokers. Maran, IVDU, HIV

50
Q

Primary lung ca

A

SCLC. Central. Neuroendocrine, local invasion into SVC, paraneoplastic.
NSCLC. Adenoca, Large cell, Sq
Adenoca. Peripheral. lobular or multiple small nodules. pseudo cavitation (bubbly), can be lepeidic. Non smokers
Large cell. peripheral and >4cm
Sq. cell. Central, cavitating, panc past, rib invasion

51
Q

Primary lung cancer mets to

A 
Brain
Bone
Adrenals
LN
Liver
52
Q

Unilateral pleural effusion

A

Tumour. Mesothelioma, mets, bronchogenic ca, lymphoma
Infection. Klebsiella, Empyem, parapneumonic, etc of subdiaph inf
Chylothorax. ruptured or injured thoracic duct, tumour infiltration
Haemorrhage. trauma, iatrogenic

53
Q

Plural effusion

A

Transudate, exude, chylothorax or haemothorax

Transudate. CCF, CRF, Meigs (ovarian tumor. Rt>lt), Liver failure
Exudate. Protein >30. Infection, malig (lung, breast, ovary, lymphoma), infarct/PE, CVD (RA, SLE), Pancreatitis, subphrenic abscess, drugs (phenytoin)
Haem. trauma, aneurysm, carcinoma, bleeding disorder

54
Q

elevated diaphragm

A 
Phrenic nn palsy. tumor, trauma, iatrogenic
Subpulmonic effusion. diaph peaks lateral (medial peak = LL collapse)
Liver or spleen enl
subphrenic mass
Eventration
Ascities 
splint in from pain
hemiplegia
scoliosis
55
Q

Empyema

A 
obtuse angles with wall
split rind
C+ - pleural enhances late so do delayed scan (ie PV)
air/fluid level
biconvex cf crescentric
*gram -ve, pneumococcus in kids, tb

Empyema necessitans. erodes into chest wall and OM ribs. +/- fistula

56
Q

pleural ca+

A 
old empyema
old haemothorax
talc pleurodesis
asbestos
silicosis
57
Q

PTx

A

spontaneous. 20yo tall thin. ruptured subpleural bleb
iatrogenic
trauma
lung disease. emphysema/bulla, CF, PCP, cystic lung disease, honeycomb, pn
bronchopleural fistula. enl over time. don’t resolve with chest drain
alveolar rupture. asthma, ventilation, ards

58
Q

Pleural mass

A

Mets. adenoca, breast and bronchus
mesothelioma
pleural fibroma. smooth, 2-15cm diam, pedicle and changes location on moving, c+ homogeneous.
located effusion
lipoma
invasion from chest wall mass.. ewings
fibro thorax. smooth wall cx thickening. prior Tb, empyema or haemothorax. v. high density with ca+ (cf meso)

59
Q

Rib notching

A 
Superior.
Hyper PTH
Osteogenesis imperfecta 
RA
SLE
Marfan
NF

Inferior:
Vascular collateral. SVC obst, AVM, Aortic coarct, TOF, absent pulm aa
Neurogenic tumor. NF neurofibroma, schwannoma

60
Q

Cardiac moguls

A
  1. aortopulm window. Aortic aneurysm, HTN, ectasia
  2. Above Lt main bronchus. Pulm stenosis, Pulm aa HTN. Concavity = pulm atresia, rt>lt shunt, TGA
  3. Below Lt main bronchus. Lt atrial/appendage enl, coronary aa aneurysm, sinus valsalva aneurysm, cardiac aneurysm
61
Q

Pulmonary HTN

A 
Idiopathic. F child bearing age
Anything causing hypoxia. Emphysema,  chronic lung disease
schistosomiasis
mitral stenosis
chronic PE
Lt to Rt shunt. AD,  VSD
62
Q

Cardiac mass

A 
Thrombus
Myxoma. Lt atrium > Rt
Lipoma
Fibroelastoma
Rhabdomyosarcoma. Assoc TS. Kids <1yo
Sarcoma
Mets. Melanoma
63
Q

Pericardial mass

A 
Primary. Mesothelioma, sarcoma, lipoma, teratoma
Mets. Breast and lung
Direct invasion from adj
Pericardial cyst
Pericardial effusion
Pericarditis
64
Q

Pericardial ca+

A 
Pericarditis. Tb
Trauma
Rheum fever
Malignant
Renal failure
Asbestos plaques
myocarditis. rheum fever, MI, aneurysm
65
Q

Thoracic outlet sx

A 
7th c rib
non union 1st rib
aberrant insertion  ant scalene mm
fibrous band
supraclavicular tumour
66
Q

cardiac wall outpouching

A 
Ventricular aneurysm. often ca+
Enl lt atrial appendage
Pericardial cyst 
Hydatid
coronary aa aneurysm
myocardial or pericardial 1ry or 2ry malig
67
Q

Cardiomegaly

A

Cardiomyopathy. most xommon cause kids and young adults. Ischaemic, infective, Idiopathic, infiltration (sarcoid, amyloid), etoh, peripartum
Pericardial effusion. globular, flask shape
Multivalvular disease
ASD.
Congenital heart disease

68
Q

Rt atrial enl

A

Rt heart border outpouching on PA.
Loss retrosternal clear space on Lat

Rt heart failure
TR/TS 
AF
AVSD/ ASD
Anomalous pulm vv return
Rt atrial obst. myxoma
69
Q

Rt Ventricle enl

A

Elevated cardiac apex PA
Anterior prominence on Lat

TR/PR/PS
ASD/VSD
Anomalous pulm venous return
Pulm HTN
Acute PE
70
Q

Lt atrial enl

A

3rd mogul, double rt heart border, elevated lt main bronchus, splayed carina on PA
Prominent upper posterior heart border, oesoph impression, posterior displacement lt main bronchus on Lat.

MR/MS
VSD
PDA
LV failure
MV obst. myxoma
71
Q

Lt ventricle enl

A

Cardiac apex down and out on PA
Posterior inferior heart prominence on Lat

STEMI
Dilated CM
AR/AS
MR
HTN
PDA
72
Q

Honeycomb vs cysts

A

Honeycomb thick walled

cysts thin walled

Kim's (6 decks)

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