Rndm Flashcards
1.Trauma with left sided pleural effusion with high triglyceride level
2. Same but right sided pe
Answer
1.duct disruption above T5/6
2.duct disruption below T5/6
Lymphangitis carcinomatosis mnemonic
Certain- colon
Cancers- cervix
Spread- stomach
By-breast
Plugging-pancreas
The- thyroid
Lymphatics- lung/ larynx
Requirements for fdg scan:(timings)
1. Renal function
2. Insulin treatment
3. Fasting
4. Caffeine, alcohol, nicotine
5. Exercise
-FDG is renally excreted. Patients with a poor renal function are at risk of enduring a higher dose than those with a normal renal function. However, assuming the dose is correctly adjusted down there is no reason such patients cannot undergo PET/CT scanning.
-Insulin treatment :There should be at least a 4-hour gap between the last insulin dose and the FDG tracer dose time.
-fasting- 6 hours.
Caffeine, alcohol and nicotine must be avoided for at least 12 hours prior to the scan.
Exercise should be avoided for 24, if not 48 hours prior to the scan.
A 46-year-old American man who has come to the UK on a holiday trip arrives at the
AED with worsening shortness of breath. Chest X-ray shows bilateral asymmetrical calcified mediastinal and hilar nodes, and chronic pulmonary histoplasmosis is provisionally diagnosed. The worsening symptoms are attributed to fibrosing mediastinitis. All the following conditions can occur as complications of fibrosing mediastinitis, except
A. SVC syndrome
B. Pulmonary arterial hypertension
C. Pulmonary venous stenosis
D. Tracheal stenosis
E. Aortic stenosis
And:
E - aortic stenosis
Everything’s stenosed or obstructed except aorta
Congenital lobar emphysema
Which lobes are affected in their order of frequency
Left upper lobe> right middle lobe > right upper lobe
Pt with oral and genital ulcers
History of thrombophlebitis
Well defined intensely enhancing mass on arterial phase
Behçet’s disease
The mass is a pulmonary artery aneurysm
Most common site of aneurysm is aorta
Pt who returned home after holiday - fever and malaise
Bilateral non segmental bronchopneumonia
Ct shows multiple small nodules with enlarged mediastinal and hilar nodes which show popcorn calcification
Histoplasmosis
Frequently in North America
Chronic may resemble post primary tb with cavitation
In some cases may cause fibrosis mediastinitis and can lead to construction of mediastinal strictures
Tracheobronchial dilatation
Teachea >30 mm right and left bronchus> 20 mm
Upper zone emphysema
Lower zone bronchiectasis
Mounier Kuhn syndrome
Other ds ass with secondary tracheobronchial dilation - Kenny caffev ehler Danlos, Marfans , cutie lads
multiple rounded ring shadows are seen in the upper zone (usually unilateral), with associated chest wall deformity and resected ribs. Often, other signs of tuberculosis such as calcified granulomas or lymph nodes are seen.
Or
A well defined mass in the apex with areas of pleural calcification in mid and lower lobes
Plombage
A 58-year-old man who worked in the mines for several years presented with progressive shortness of breath on exertion. Extensive interstitial thickening and small nodules bilaterally with large masses of consolidation in the upper lobes were noted on the most recent chest radiograph. Comparison with previous films suggested central migration of the consolidation like upper lobar masses. What is the diagnosis?
A. Pneumoconiosis with progressive massive fibrosis
B. End-stage sarcoidosis
C. End stage Langerhans Cell Histiocytosis (LCH)
D. Cryptogenic fibrosing alveolitis
E. Old TB
A. Pneumoconiosis with progressive massive fibrosis
On chest radiographs, large opacities (progressive massive fibrosis) may be seen in complicated coal worker pneumoconiosis, as in complicated silicosis.
The large opacities result from nodule coalescence and are observed commonly in the middle
lung zone or peripheral one-third of the lung on axial chest images and in the upper lung zone on longitudinal images. The large opacities gradually migrate towards the hilum, leaving emphysematous lung tissue between the fibrotic tissue and the pleural surface.
You are performing a tunnelled dual lumen dialysis line via a right jugular approach on a 50-year-old with chronic renal failure. As you are peeling the sheath, you hear a hushing sound and the patient suddenly becomes agitated, with an acute decrease in his partial oxygen saturation pressure. Which of the following is the most appropriate immediate management?
A. Perform needle decompression in the right mid-clavicular line, 2nd interspace
B. Obtain a chest X-ray
C. Inject 10 mL of contrast down the sheath and look for extravasation
D. Put the patient head down and give fast intravenous crystalloid
E. Administer high-flow oxygen and put the patient in the left lateral position.
Administer high-flow oxygen and put the patient in the left lateral position.
This scenario describes an iatrogenic air embolism. This is an uncommon complication that has an incidence of aroimd 0.13%. Treatment includes high-flow oxygen and placing the patient
in the left decubitus position. This would allow the air to rise in the right atrium where it can be aspirated using a transjugular approach.
Needle decompression in the right mid-clavicular line is the treatment for a tension pneumothorax.
A chest X-ray might show air in the right heart but will not help in the immediate management.
Injecting 10 mL of contrast down the sheath is performed when you are suspecting extravasation and placing the patient head down and giving fast intravenous crystalloid is the treatment for hypotension.
Smooth lamellar periosteal reaction in the metadiaphysis with new bone formation
Hypertrophic osteoarthropathy
Look for underlying thoracic causes
Extra thoracic causes- inflammatory bowel disease and liver cirrhosis
Primary tumors that cause pulmonary embolism
Gastric carcinoma
Ovarian carcinoma
Extra hepatic bile duct carcinoma
Earliest and most common manifestations in
1.sarcoid
2. RA
1.pleural effusion
2. Pleural thickening
A 62-year-old widow presented to the Neurology Clinic with fatigue and weakness, particularly after minimal exertion. Cranial nerve examination revealed rapid fatigability of the facial muscles and her chest radiograph showed mediastinal widening. The patient then underwent contrast enhanced CT of the chest. Which of the following findings best fits the given clinical scenario?
a Diffuse mediastinal adenopathy and a widespread interstitial thickening b Retrosternal goitre demonstrating areas of necrosis and haemorrhage with avid contrast enhancement
C Isolated homogeneous soft tissue mass within the anterior mediastinum outlined by fat d Diffuse, invasive mass containing areas of haemorrhage and calcification encasing the major vessels
e Large, eccentric aortic arch aneurysm
Answer C: Isolated homogeneous soft tissue mass within the anterior mediastinum outlined by fat
The neurological findings are classic of the myasthenia gravis - an autoimmune disorder characterised by antibodies against postjunctional acetylcholine receptors. The condition is often associated with thymoma.
A 60-year-old man has chronic obstructive pulmonary disease (COPD). He has a long smoking
1
C(
01 pl
history and is being considered for lung volume reduction surgery (LVRS). What pattern of disease would give the best chance of a successful outcome following LRVS?
a Mild, predominantly upper and mid zone paraseptal emphysema b Severe lower zone bullous emphysema and mild upper zone paraseptal emphysema
C Severe upper zone bullous emphysema with relatively spared lower zones d Severe upper zone bullous emphysema with moderate lower zone centrilobular emphysema e Severe centrilobular emphysema affecting all zones
Lung volume reduction surgery (LVRS) is a palliative procedure for patients with advanced disease.
It has a number of clinical exclusion criteria because of relatively high operative risk. There are still some controversies around this form of surgery, but it is likely to continue to have a place in the treatment of emphysema. It comprises wedge resection of the areas of greatest disease, mainly the upper lobes, thus improving the performance of the remaining lung. Best candidates for surgery have upper lobe predominant emphysema, a good amount of normal or mildly emphysematous lung and significant regional heterogeneity on perfusion scintigraphy.
Empyema
What’s the ph and its contents
Ph<7.3
Glucose is low
LDH is raised
Neutrophils +
Baby with high respiratory rate
Absent spleen
Vsd
What other finding on the echo is most likely
Tricuspid atresia
Occurs with right ventricular hypoplasia and asplenia
A 28-year-old man undergoes an HRCT after complaints of chronic cough and phlegm production. He is known to be a user of recreational drugs.
Which of the following findings is NOT likely to be found? Select ONE answer only.
Apical bullae
Air space opacification in the lower lobes bilaterally
Cavitating lung nodules
Centrilobular hypodense micronodules
Perihilar air space opacification
Ans centrilobular..
It should be hyper dense in talcosis not hypo
There are a number of ways in which recreational drug use can affect the patient and be seen radiologically.
• Talcosis - embolisation of particulate matter injected intravenously gives rise to centrilobular micronodules which may be high density.
• Septic emboli - secondary to non-sterile intravenous injection and endocardial vegetations. Cavitating lung nodules associated with clinical manifestations of infection.
• Apical bullae/pneumothorax - associated with inhalational drugs, cannabis, cocaine, ecstasy, amphetamines
• Pulmonary oedema - Perihilar airspace pacification with or without pleural effusions. Associated with cocaine, heroin, methamphetamine use.
• Consolidation - straightforward lower respiratory tract infection secondary to atypical lifestyle, concurrent immunosuppression, or aspiration during periods of reduced consciousness.
• Nasal septum destruction - associated with snorting cocaine, due to vasoconstriction and necrosis.
• Skin abscesses and pseudoaneurysm - formation at injection sites
Contra indications for ivc placement
• Septic thromboemboli
• Bacteraemia is a relative contraindication
• Size incompatibility (IVC <15mm or >30mm. If the IVC measures 30-40mm a birds nest type filter can be used)
• Complete occlusion of the IVC
• Deranged clotting is a relative contraindication
• Given the patient cohort of interest the clotting is highly likely to be deranged owing to attempted therapeutic anticoagulation. The following are therefore broad guidelines applicable to most interventional procedures only, individual practice may vary hugely in this regard
• INR >1.5
• PLT <50
A cardiologist requests a cardiac CT for a 55-year-old lady who presents with atypical chest pain. She has severe brittle asthma and therefore beta-blockers are contraindicated. Her resting heart rate is 90 beats per minute, which decreases to 85 beats per minute with a breath hold.
N
Which phase of the cardiac cycle would be optimal for image acquisition in this patient?
Early diastole
End-diastole
End systole
Mid-diastole
Mid-systole
And- end systole
In patients with heart rates below around 70 beats per minute, end-diastole is the optimal time for imaging. In these patients, diastole is the longest period the heart is still for, and therefore ideal for imaging
Diastole is also the part of the cardiac cycle which decreases in duration when the heart rate increases. This reduces the duration of the imaging window during cardiac CT. The period of time the heart remains still for in systole stays constant when the heart rate increases. Therefore in patients with increased heart rates, imaging at end-systole is the optimal target.
Capillary wedge pressure >15
Cardiogenic cause
Left heart failure
Otherwise non cardiogenic like ards
Pulmonary veno- occlusive disease- PAH plus normal capillary wedge pressure;
Lung cancer differentiation
Fdg pet
Not dotatate pet which is used for neuroendocrine tumor
62 year old patient undergoes a CT guided lung biopsy of a suspicious right upper lobe mass. The procedure is completed as planned with a small post-biopsy pneumothorax. After approximately 2 minutes, the patient complains of a headache and collapses with a general tonic clonic seizure.
What should you do next?
A) Do nothing and await the resuscitation team
Position the patient in the left lateral decubitus position with high flow oxygen
C) Position the patient head down with high flow oxygen
D) Give buccal midazolam
E) Chest drain insertion for likely tension pneumothorax
Air embolism management
And- b
Risk factors for biopsy related pneumothorax
• COPD
• Small lesion size.
Long needle path
Repeated pleural puncture
