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HomeStretch/Numbers > HomeStretch CRACK vol 1. Endo/Thorax > Flashcards

HomeStretch CRACK vol 1. Endo/Thorax Flashcards

1
Q

Syndromes associated with Pheo

A
  • VHL
  • MEN IIa/IIb
  • NF1
  • Sturge-Weber
  • Tuberous sclerosis
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2
Q

Wolman dz

A

fatal metabolism error thing - b/l enlarged calcified adrenal glands

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3
Q

MEN 1

A

3Ps

  • Pituatary
  • Parathyroid
  • Pancreas
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4
Q

MEN 2a

A

1M,2Ps

Medullary thyroid CA

Pheo

Parathyroid

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5
Q

MEN 2b

A

2Ms, 1P

  • Medullary thyroid CA
  • Marfanoid, mucosal neuromas
  • Pheo
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6
Q

Delphian node

A

level 6 lymph nodes around the thyroid in front of neck

commonly enlarged with hashimotos

sick looking delphian node = laryngeal ca mets

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7
Q

Normal hilum on lateral radiograph, what is “the black hole”? What is on top of it and what is anterior to it?

A

Left upper lobe bronchus

Left PA

Right PA (is anterior)

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8
Q

Which hilum is more superior?

A

left hilar point should be 1 cm higher than the right

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9
Q

What obliterates the retrotracheal (raider) triangle?

A

Aberrant right subclavian artery

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10
Q

Bronchopulmonary segmental anatomy

A

In general, each lung has 10 segments: the upper lobes contain 3 segments, the middle lobe / lingula 2 and the lower lobes 5. Bilaterally, the upper lobes have apical, posterior and anterior segments and the lower lobes superior (apical) and 4 basal segments (anterior, medial, posterior and lateral). With this basic symmetric anatomy shared between the lungs, there are a few differences that can be described:

the middle lobe on the right has 2 segments: medial and lateral (easy to remember - middle lobe, medial and lateral).

the lingula on the left is part of the left upper lobe and is the equivalent of the middle lobe on the right, and hence it has 2 segments, but in this case, it is divided into superior and inferior segments.

there are 2 regions of the left lung in which 2 segments are joined as 1 as they have a common tertiary (segmental) bronchus:

left upper lobe apicoposterior segment

left lower lobe anteromedial segment

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11
Q

volume loss of one hemi-thorax with CT coronal showing only one PA

A

proximal interruption of the pulmonary artery

seen on the opposite side of the aortic arch

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12
Q

What are the kinds of atelectasis?

A
  1. Obstructive (absorptive)
  2. Compressive (relaxation/passive)
  3. Fibrotic (cicatrization)
  4. adhesive
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13
Q

cervicothoracic sign

A

something above the clavicles on CXR is in the posterior mediastinum

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14
Q

hilum overlay sign

A

if you see edges of vessels through a hilar mass - its either in the anterior or posterior mediastinum

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15
Q

Post bone marrow transplant graft versus host

A

Acute (20-100 days): favors extrapulmonary systems (skin, GI, liver)

Chronic (>100days): lymphocytic infiltration of airways and obliterative bronchiolitis

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16
Q

Post Bone Marrow Transplant pulmonary findings

A

Early neutropenic (0-30 days): pulmonary edema, hemorrage, drug induced lung injury; fungal pneumonia

Early (30-90 days): PCP, CMV

Late (>90 days): BO, COP

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17
Q

Ghon lesion

Ranke complex

Rassmussen aneurysm

A
  • Ghon lesion = calcified TB pulmonary granuloma (sequela of primary TB)
  • Ranke complex = Gohn + calcified hilar lymph node
  • Rassmussen aneurysm = pulmonary artery pseudoaneursyms next to TB cavities
18
Q

What are the three flavors of aspergillus?

A

Normal immune = aspergilloma

suppressed immune = invasive aspergillosis (halo sign and air crescent sign)

Hyper-immune = ABPA

19
Q

Mnemoic for cavitary lung lesion

A

CAVITY

Cancer (scuaomous)

Auto-immune (wegeners, RA, Caplan)

Vascular

Infection (TB, Staph)

Trauma

Young (congenital)

20
Q

Lung cancer subtypes

A

Squamous cell = smokers, central, cavitation, calcium (hyperPTH); does not express TTF-1

Large cell: least common subtype, peripheral

AdenoCA: peripheral, associated with fibrosis

small cell: smoker, central, svc obstruction, paraneoplastic syndromes (ACTH, SIADH, Lambert Eaton)

21
Q

What is the test of choice to stage a pancoast tumor?

A

MRI - to check brachial plexi

22
Q

Critical stage for lung cancer

A

3a versus 3b

Stage 3b implies N3 or T4 disease (M also is unresectable)

23
Q

nucs crossover blitz!

Gallium/Thallium versus Kaposi Sarcoma and Lymphoma

A

Kaposi is Thallium hot and Gallium cold

Lymphoma is thallium hot and gallium hot

24
Q

Cystic lung diseases

A
  • LIP = LymphoCYSTIC Interstitial Pneunomia
    • Benign lymphoproliferative disorder with lung infiltration
    • Association with Sjogrens, SLE, RA, HIV in younger patient, Castlemans
    • Cysts with groundglass
      • When I say LIP you say Sjogrens and HIV
      • When I say LIP in a child you say HIV
  • LCH = Langerhans Cell Histiocytosis
    • Smoker, young (20s-30s)
    • Spaces costophrenic angles
    • Centrilobular Nodules + thicker, bizarre chapped cysts.
  • LAM = Lymphangioleiomyomatosis
    • Child-bearing aged women and TS
    • Uniform, thin walled round cysts
  • BHD = Birt Hogg Dube Syndrome
    • Association with renal findings
    • Thin walled “floppy cysts”
    • Lower zone predominant
25
Q

What does Asbestosis look like?

A

UIP with parietal pleural thickening

26
Q

What is the first step in deciding if nodule pattern? Then what?

A
  • Centrilobular spares the pleura (inhaled stuff - ie infection, RB-ILD, HP)
  • Perilymphatic nodules run along subplearual and peribrochovascular (lymphatic stuff - sarcoid/silicosis and lymphangitic spread)
  • random is random (hematogenous stuff - mets, fungal, military TB)
27
Q

What are the ILDs?

A
  • UIP = Usual interstitial Pneumonia
    • The main one
    • Honeycombing
    • Apicobasal gradient
    • Traction bronchietctasis
  • NSIP = Nonspecific Interstitial Pneumonia
    • Ground glass micronodules
    • Subpleural sparing
    • Scleroderma
  • RB-ILD = Respiratory bronchiolitis - Interstitial Lung Disease
    • Smoking related
    • Apical centrilobular ground glass nodules
  • DIP = Desquamative interstitial pneumonia
    • Smoking related
    • The worse end of spectrum of RB-ILD
    • Peripheral, lower-lobe predominant ground glass with small cystic spaces
  • Sarcoid
28
Q

What is associated with NSIP?

What is associated with LIP?

What is associated with follicular bronchiolitis?

A

NSIP = Scleroderma

LIP(J) = Sjogrens (and HIV in kids)

Follicular Bronchiolitis = Sjogrens and RA

29
Q

Lofgren syndrome

A

Acute sarcoid

b/l hilar LAD

arthritis

Erythema nodosum

(LofGren = sarGoid; loffler is the eosinophilia one)

30
Q

CHF Stages

A
  • Stage 1: redistribution (wedge pressure 13-18); cephalization, cardiomegaly, big vascular pedicle
  • Stage 2: Interstitial edema (WP 18-25); kerly b lines
  • Stage 3: Alveolar edema (wedge > 25); airspae fluffy opacities and pleural effusion
31
Q

Pulmonary Alveolar Proteinosis Trivia

increased risk of what which infections?

Smoking association?

When seen in children associated with what?

treatment?

A
  • increased risk of what which infections? NOCARDIA
  • Smoking association? YES
  • When seen in children associated with what? THYMIC ALYMPHOPLASIA
  • treatment? BAL
32
Q

Alveolar diseases (soup alphabet)

A
  • PAP = Pulmonary alveolar proteinosis
    • Crazy paving
  • Lipoid Pneumonia
  • Organizing Pneumonia (Cryptogenic [COP]) if cause unknown
    • Persistent symptoms following pneumonia treatment
    • COP = reverse halo
    • Patchy airspace opacities or GGO in a peripheral or peri-bronchial pattern
  • CEP = Chronic Eosinophillic Pneumonia
    • Can look exactly like COP
    • When I say COP, you say CEP too
  • HP = Hypersensitivity Pneumonitis
    • Subacute = patchy ground glass opacities
    • Chronic = looks like UIP + air trapping
33
Q

Bronchial carcinoid more likely to met in eye where

versus GI carcinoid

A

Bronchial carcinoid goes to inside eye in uveal tract while GI carcinoid goes to EOM

34
Q

Tracheal disease - which spare posterior membranes? how to differentiate all of them

A
  • Spare posterior membrane
    • Relapsing polyCHONDritis and TBO (both have chondro in their name)
      • TBO calcifies
  • Does not spare post membrane:
    • Amyloid (calcifies)
    • Wegeners (can calcify too. . .)
35
Q

Williams campbell syndrome

A

congenital cystic bronchiectasis from deficiency of cartilage in the 4th-6th order bronchi

(“Williams with CF”)

36
Q

Mounier-Kuhn syndrome

A

tracheobronchomegaly

37
Q

Mendelson’s syndrome

A

Aspiration of gastric acid

38
Q

Typical location of aspiration

A

If supine: posterior segment of upper lobes and superior segment of lower lobes

If upright: bilateral basal lower lobes

right is favored

39
Q

Callogen Vascular Dz Pulm Manifestations

A

SLE = shrinking lung; has more pleural and pericardial effusions

RA = looks like UIP and COP

Scleroderma = NSIP

Sjogrens = LIP

40
Q

What is associated with solitary fibrous tumor of the pleura?

A

Hypoglycemia (IGF secretion) = Doege-potter syndrome

Hypertrophic osteoarthropathy

(not associated with asbestosis)

41
Q

Hughes-Stovin Syndrome

A

PA aneurysm similar to Behcet’s (may be the same thing)

HomeStretch/Numbers (24 decks)

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