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Boards > Thoracic > Flashcards

Thoracic Flashcards

1
Q

Inspiratory reserve volume

A

Volume that you can inspire after normal respiration (tidal volume)

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2
Q

Expiratory reserve volume

A

Amount you can expire after a normal expiration (tidal volume)

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3
Q

Inspiratory Capacity

A

Inspiratory reserve volume + tidal volume

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4
Q

Functional residual capacity

A

Expiratory reserve volume + residual volume

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5
Q

Vital capacity

A

Everything but the residual volume

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6
Q

Obstructive versus restrictive lung disease

A

Obstructive - Decreased FEV / FVC (airway collapse - emphysema)

Restrictive - Normal FEV / FVC (destruction - fibrosis)

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7
Q

Right versus left hemidiaphragm on lateral view

A
  1. Stomach bubble - left
  2. Right is higher, usually more anterior
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8
Q

Ribs on lateral view

A

Right ribs are bigger and more posterior

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9
Q

Left upper lobe bronchus, RPA, LPA on lateral view

A

Left upper lobe bronchus - central dark dot

RPA is anterior and below it

LPA is posterior and above

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10
Q

Supernumerary pulmonary veins

A

Usually 2 on each side. Most common variant is a RML supernumerary vein. The left superior vein most commonly causes Afib.

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11
Q

Forms of atelectasis

A

Obstructive (absorptive) - from obstruction

Compressive (relaxation/passive) - from mass effect directly on lungs (pleural effusion)

Fibrotic (cicatrization) - scarring/fibrosis (TB, radiation)

Adhesive - loss of surface tension (loss of surfactant, ARDS)

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12
Q

Hilum overlay sign

A

If mass near the hilum and Hilar vessels obscured, then there is a mass adjacent to the hilum. If not obscured mass likely in the anterior mediastinum.

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13
Q

Cervicothoracic sign

A

Mass extends above clavicles - mass is in neck, NOT mediastinum

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14
Q

Incomplete border sign

A

If border is indistinct, then mass likely from pleura

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15
Q

Strep pneumonia

A

Lobar consolidation. Most common in AIDS

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16
Q

Klebsiella pneumonia

A

Bulging fissure. Currant jelly sputum. Alcoholics.

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17
Q

Pseudomonas

A

CF, Kartagener’s, ICU patient on ventilator

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18
Q

Mycoplasma pneumonia

A

Most common CAP in 5-20 year old. Associated with SJS. Unilateral lucent lung

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19
Q

Graft versus host disease

A

Bronchiolitis obliterans - air trapping (mosaic attenuation). Usually presents after 100 days post bone transplant.

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20
Q

Post bone transplant complications

A

Early neutropenic (0-30 days) - pulmonary edema, DILI, hemorrhage, fungal pneumonia (invasive aspergillosis)

Early (30 - 90 days) - PCP, CMV

Late (> 90 days) - BO, COP

21
Q

PCP

A

AIDS patients. Perihilar GGOs sparing periphery. Thin cysts can occur.

22
Q

AIDS infections by CD4 count

A

> 200 Strep, TB

< 200 PCP, atypical mycobacterial

< 100 CMV, disseminated fungal, mycobacterial

23
Q

Primary TB

A

Ghon complex (Nodule + Ipsi lymphadenopathy).

If calcified Ranke complex

24
Q

Latent TB

A

No symptoms, no findings on CXR

25
Q

Post primary TB (reactivating)

A

Cavitary lesion in apical or posterior upper lobe and superior lower lobe.

Rasmussen aneurysm

26
Q

Hot tub lung

A

Hypersensitivity pneumonitis from MAC.

Centrilobular GGOs.

27
Q

ABPA

A

Hyper immune reaction to aspergillosis. Seen with asthma, CF. Finger in glove mucoid bronchiectasis.

Elevated IgE levels

28
Q

COVID pneumonia

A

Peripheral GGOs. Can have reverse halo sign.

29
Q

Lemierre syndrome

A

Jugular vein thrombosis with septic emboli (ENT surgery, oropharyngeal infection)

Caused by Fusobactyerium necrophorum

30
Q

FDG activity of solid and GG nodules

A

Solid nodules (> 1cm) - SUVmax > 2.5, cancer

GG nodules - cold cancer. Hot - likely infectious/inflammatory

31
Q

Lung cancer trivia

A

1.5 x more likely in right lung. 70% in upper lobes. Air bronchogram through nodule is very suspicious.

32
Q

Lung cancer screening

A

50-80 with >20 pack year hx.

25% reduction in mortality.

CTDIvol < 3 mGy, 75 mGy-cm

Thickness < 2.5 mm

Growth > 1.5 mm

33
Q

Lung Rads 2

A

Solid nodules < 6mm

GG nodules < 3.0 cm

Perifissural nodules < 1.0 cm

1 yr f/u

34
Q

Lung Rads 3

A

Solid nodule 6-8 mm

Subsequent exam new nodule > 4mm

GG nodule > 3.0 cm

6 month f/u

35
Q

Lung Rads 4a, b, X

A

Solid nodules > 8 mm

New solid nodule 6-8 mm

3 month f/u vs PET vs biopsy

36
Q

Fleischner criteria

A

Used for pt NOT in lung screening program.

Age > 35

NO known or suspected cancer, and NOT immunocompromised

Same size cutoffs as Lung RADS (<6mm, 6-8mm, >8mm)

37
Q

Fleischner recommendations

A

< 6 mm - no f/u if low risk. 1 yr f/u if high risk

6-8 mm - 6-12 month f/u low risk, 3-6 month if high risk

> 8 mm 3-6 month f/u, PET, bx for low and high risk

2 yr stability, stop follow-up. GG nodules (> 6 mm) need 5 years f/u.

38
Q

Small cell lung cancer

A

Central lymphadenopathy. Strongly associated with smoking. Most commonly causes SVC obstruction and paraneoplastic syndromes: (Lamber Eaton, SIADH, ACTH).

39
Q

Adenocarcinoma

A

Associated with non-smokers and pulmonary fibrosis. GG nodule, slow growing.

40
Q

Squamous cell lung cancer

A

Central, association with smoking. Cavitation. Paraneoplastic syndrome PTH. Does not express TTF-1.

41
Q

Large cell lung cancer

A

Least common subtype. Usually large, peripheral. Poor prognosis.

42
Q

CT angiogram sign

A

Enhancing vessels running through consolidated lungs.

Invasive mucinous adenocarcinoma.

43
Q

Pancoast tumor

A

Shoulder pain, radiculopathy, Horner syndrome.

MRI to stage. Not amenable to surgery.

44
Q

Tumor staging (Lung cancer)

A

T1 < 3 cm

T2 - 3-5 cm or invades pleura, main bronchus, or causes obstruction

T3 - 5-7 cm or invades chest wall, pericardium, phrenic nerve (paralysis), has one or more satellite lesion in same lung.

T4 - invades diaphragm, great vessels, carina, or satellite lesion in the contra lung. also if it invades intrapericardial portion of the pulmonary vein

45
Q

Nodal staging (Lung cancer)

A

PET/CT used for staging.

N1 - ipsilateral lung or hilum

N2 - Ipsilateral mediastinal or subcarinal nodes

N3 - contralateral mediastinal or hilar. Also scalene or supraclavicular nodes.

If above the clavicle or manubrium -> N3 and not resectable*

46
Q

Contraindications to lobectomy/resection

A

Invasion through fissure, vasculature, main bronchus, Stage 3B (N3 or T4 disease), malignant effusion.

47
Q

Kaposi sarcoma

A

Most common lung cancer in AIDS patients. CD < 200. Flame shaped opacities. Bloody pleural effusion.

Th positive, Ga negative. Lymphoma is Th and Ga positive.

48
Q

Cancers that like to metastasize to lungs

A

Kidney, breast, colon, thyroid, head and neck.

Feeding vessel sign.

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