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FRCR 2A > Thoracic/Cardio > Flashcards

Thoracic/Cardio Flashcards

1
Q

Differing features of LAM and LCH?

A
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2
Q

Pleural Fibroma Features

A
  • Benign tumours
  • Are NOT associated with prior aesbestos exposure
  • Tend to be asymptommatic unless large
  • 1/3 undergo malignant transformation
  • Associated with hypertropic pulmonary oesteoarthropathy
  • a paraneoplastic phenomenon
  • seen as a periosteal reaction (due to new bone formation)
  • usually seen in distal phalanges

BURNING PAIN WITH SWELLING AND STIFFNESS = HPOA

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3
Q

What is pathonomic of previous Aesbestos exposure?

A

BILATERAL calcified pleural plaques

-Costophrenic angles are SPARED

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4
Q

Causes of calicifed mediastinal lymph nodes?

A
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5
Q

Cancers associated with Lymphangitis Carcinomatosis?

A
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6
Q

What are 5Ts of anterior mediastinal masses?

A

Teratoma (seminoma)

Thymoma

Thyroid

Thoracic aorta

Terrible Lymphoma (Hodgkins usually anterior and Non-hodgkins posterior)

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7
Q

Differences in Hodgkins and Non Hodgkins Lymphoma?

Staging?

Spread?

A
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8
Q

What specific finding is seen in Constrictive Pericarditis?

A

Interventricular dependence. Also known as diastolic septal bounce.

Thickened pericardium also suggests contrictive pericarditis

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9
Q

What finding of Cardiac amyloid is seen on cardiac MRI?

A

Diffuse subendochondral late gadolinium enhancement

Raised myocardial native T1

Cardiac amyloid is leading cause of RESTRICTIVE Cardiomyopathy

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10
Q

What are some features of pulmonary hamartoma?

A
  • Fat containing lesion
  • Popcorn calcification
  • Tend to be peripheral

Carcinoid tends to be centrally located

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11
Q

What is Carneys Triad?

PGE

A
  1. Pulmonary Chondromas
  2. Gastric Leiomyosarcoma (GIST)
  3. Extra-adrenal paraganglioma
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12
Q

What is Carney Syndrome?

FAST

A
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13
Q

What is TNM staging for Lung Ca?

What are unresectable lung tumours staging?

A

Unresectable tumours are T4, N3 or M1

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14
Q

What are 3 different patterns of lung nodules?

A
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15
Q

What are contraindications to IVC filter placement?

A
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16
Q

Which primary cancers have the highest incidence of Lung mets?

CHEST

A
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17
Q

Most common origins of Lung Mets?

A
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18
Q

AAA Screening timeframe for size?

A
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19
Q

Cardiomyopathies MRI enhancement

Epicardial - SMAC

Subendocardial - CAP

Midwall - MDH

A

CAP - Crest/Amyloidosis/Post heart transplant

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20
Q

What is Nocardia?

Who does it occur in?

What are its features?

What is important NEGATIVE?

A

Rare infection that occurs mostly in BONE MARROW TRANSPLANT PATIENTS and with AIDs

  • Lobar consolidation
  • Nodules with cavitation
  • NO lymph node enlargement
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21
Q

What causes mediastinal lymph node calcification?

What causes mediastinal popcorn calcification?

A

TB

Histoplasmosis

Mets (from thyroid)

POPCORN (SST)

  • Silicosis
  • Sarcoidosis
  • TREATED Lymphoma
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22
Q

What are differentials for cavitating lesions?

What is mnemonic?

A

C Cancer

A Autoimmine (Wegners, Rheumatoid)

V Vascular (septic emboli)

I Infection (abscess, TB, cavitating pneumonia,

T Trauma (pneumatocele)

Y Youth (sequestration, CPAM, bronchogenic cyst)

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23
Q

What are the 2 features of pulmonary sequestration?

What are the 2 types?

How to differentiate types?

A
  1. Blood supply arises from aorta
  2. Lung segment has no communication with the bronchial tree

Intralobular: MORE common

Segment

  • Does NOT have its own pleura
  • Drains normally via pulmonary vein
  • Recurrent pneumonias

Extralobular: LESS common

-Has own pleura

Assc with other congenital abnormalities

-Venous drainage via systemic circ

Differentiate: INTRALOBULAR has aeration

EXTRALOBULAR has no aeration

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24
Q

What are chest features of amniotic fluid embolus?

A

Usually florid pulmonary oedema

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25
Q

CT with ground glass in AIDS patient

What is cause?

A

PCP

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26
Q

AIDS

Lung cysts, ground glass, pneumothorax

What is cause?

A

PCP

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27
Q

What is most common cause of acute onset focal airspace opacity in AIDS?

A

Strep pneumonia (or TB if low CD4)

If chronic - Lymphoma or Kaposi

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28
Q

Facts re TB

A
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29
Q

What are the 2 types of non tuberculous mycobacteria?

How to separate into 4 different presentations?

A
  1. Mycobacterium avium complex
  2. Mycobacterium kansaii
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30
Q

Is Aspergilloma seen in suppressed immune system or normal?

A

Seen in normal imune system. Where aspergillus grows in a known cavity

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31
Q

What is Lemmiere syndrome?

A

Jugular vein thrombosis with septic emboli

Seen after an oropharyngeal infection or recent ENT surg

Caused by fusobacterium necrophorim

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32
Q

What defines a pulmonary nodule?

A

Round or oval lesion measuring <3cm

33
Q

Different types of nodule calcification in lung?

A
34
Q

What nodule appearance is most suspicious for lung cancer?

A

A part solid lesion with ground glass component is most suspicious

Other suspicious features:

  • spiculated margins
  • air bronchograms through nodules

Reassuring signs:

-presence of fat

35
Q

What are criteria for PET in lung nodules?

A

Should be >1cm in size

36
Q

Doubling time and lung nodules

What is doubling time of lung cancers?

A

Doubling time is time it takes to double in size

Lung cancers doubling time is between 20 days and 400 days

Therefore any lesion with doubling time of <20 days or >400 days is almost certainly benign

37
Q

What is apperance of benign perifissural/ intrapulmonary nodules?

A

Triangular, oval or polygonal = benign

Rounded or spiculated = suspicious

Are probably intrapulmonary lymph nodes

38
Q

What lung cancers is ass with smokers?

What lung ca causes cavitation?

A
39
Q

What is used in assessing whether mediastinal/hilar/supraclavicular nodes are hot in lung cancer?

A

PET imaging used

CT is not accurate in making this distinction regardless of size

PET is therefore always done in Lung Ca prior to surgical intervention

40
Q

Nodal staging in lung Ca

Where is border between level 1 and level 2 lymph nodes in chest?

A

Distinction is lower border of the clavicles

Above this = level 1 (N3 disease due to supraclavicular nodes)

Below this = level 2 (N2 disease)

41
Q

Wedge resection vs lobectomy

What size makes difference?

A

Wedge = usually if peripheral and less than 2cm

Lobectomy = usually if larger than 3cm

42
Q

How to tell if bronchopleural fistula?

A

Post pneumonectomy, space will fill with fluid

If it starts to fill with air - this grasps diagnosis

43
Q

How will lung appear with chronic radiation changes?

A

Dense consolidation, traction bronchiectasis and volume loss

44
Q

What is the most common lung cancer in AIDS?

A

Kaposi

45
Q

Post pneumonectomy syndrome - when to expect?

When should pleural cavity be completly filled with fluid?

A

Post pneumonectomy - happens in first year.

Where hyperexpansion of remaining lung (other side) causes displacement of the heart with rotation in anticlockwise fashion.

-Presentation with dyspnoea and recurrent infections

Pleural cavity should be filled with fluid within 2 weeks of pneumonectomy or at least 2/3 of way

46
Q

Which side of the lung does boerrhave cause effusion?

A

LEFT

Usually rupture of left lateral wall of oesophagus

47
Q

Where are nodules of lymphangitis carcinomatosis found?

A

Usually subplural in location

Will see fissural thickening in this disease

48
Q

Lung nodule followup

A
49
Q

Lung Cancer Staging

A
50
Q

What is more suggestive of malignant vs benign pleural lesions?

A

Malignant pointers

  • Nodular pleural thickening
  • Involvment of mediastinal pleura
  • Circumerential involvement of pleura

Benign

  • presence of a stalk
  • pleural thicking of <1cm
51
Q

Which cancers cause lymphangitis carcinomatosis

A
52
Q

What are 4 main differentials in cystic lung disease?

A

1. LCH

2. LAM

3. Birt hogg dube (thin walled cysts, skin changes, RCC, oncocytomas(

4. Lymphocystic interstitial pneumonia (cystic disease in kid or adult with HIV, adult with Sjogrens)

53
Q

What defines aesbestosis?

A

Lung fibrosis associated with previous exposure

Looks like UIP + parietal pleura thickening

Rounded atelectasis is assocaited with previous aesbestos exposure.

54
Q

Malignant mesothelioma features?

What does it look like?

A

Circumferential pleural thickening extending to medial pleura

Pleural thickeness >1cm

Extension into the fissures = highly suggestive

55
Q

Honeycombing vs emphysema

A
56
Q

What is traction bronchiectasis?

A
57
Q

Mesothelioma

How does pleura appear?

A
58
Q

What are types of TAPVR

What is most common type?

A

Where blood returns to the right side of the heart and NOT the left atrium

Type 1 supracardiac is most common

Type 3 - infracardiac type

Veins drain below the diaphragm (hepatic veins or IVC)

Obstruction on the way through the diaphragm is common and causes pulmonary oedema (in newborn)

59
Q

At what point in cardiac cycle is best for imaging?

A

End diastole is best if HR <70

If high HR, end systole is best

60
Q

Differentials for Mosaic attenuation on CT?

Think Bright/Dark/Perfusion causes

A
61
Q

Appearances of acute vs chronic PE?

What is classical appearance of acute?

A
62
Q

What is interatrial coronary artery?

A

Where left coronary artery may originate from right coronary cusp and pass between aorta and pulmonary trunk

Can cause DEATH

Usually repaired

Considered a malignant course of the coronary artery

Right coronary artery can have a similar interatrial course if it arises from left cusp

63
Q

What is cut off for compressing vs US guided thrombin injection of post traumatic pseudoaneurysms in groin?

A

Manual compression if <2cm

If greater than this = inject thrombin under US guidance

Thrombin CAN be used even in patients on anticoagulation or heparin

64
Q

Name features of Osler Weber Rendu?

A
  1. Pulmonary AVMs
  2. Paradoxical emboli from AVMS (TIA and Strokes)
  3. High output cardiac failure
  4. Hypoxia due to shunting

Symptoms include:

  • Nosebleeds
  • Cutaneous telangiectasia
65
Q

What contributes to step artefact in cardiac CT?

A

Caused by misregistration of anatomical landmarks

Worsened by:

  1. Short detector row
  2. Large field of view
  3. Irregular heart rhythm
66
Q

What is usually worst affected by motion artefact?

A

The right coronary artery

67
Q

What are the rules pre PET?

Gym

Coffee

Insulin

A

Exercise to be avoided for 24 hours pre

Caffeine, alcohol and nicoteine avoided for at least 12 hours

Insulin - there should be 4 hours gap between scan and last dose

68
Q

External carotid branches

Some Anatomists Like Freaking Out Poor Medical Students

A
69
Q

What is Loeffler endocarditis?

A

Another description for Eosinophilic cardiomyopathy

  • Biventricular thrombus with endocardial fibrosis*
  • can cause restrictive cardiomyopathy and valve disease
  • elevated eosinophils
70
Q

LCH Summary

A
71
Q

Causes of egg shell calcifications in thoracic lymph nodes?

A
72
Q

EVAR Considerations

What neck angle is deemed unsuitable?

A

Less than 60 Degrees or >120 degrees

73
Q

Lung Mets

Most common in descending order

BKCP

A

Breast

Kidney

Colon

Pancreas

74
Q

What are the features of RBILD

Respiratory bronchiolitis interstitial disease?

A

3 Features

  1. Smoker
  2. Centrilobular nodules
  3. Ground glass opacification
75
Q

Complications of Uterine artery embolisation?

A
76
Q

What is Klippel Trenaunay Weber triad?

A

Port wine stain

Venous malformation or varicose veins

Soft tissue or bony hypertrophy of a single limb

77
Q

What features does double aortic arch give?

A

Leftward deviation of the trachea and impression on right tracheal wall

78
Q

HIV and CD4 level diseases

A
79
Q

What are the standard views on Cardiac CT?

What is best for looking at mitral valve?

A

4 chamber

3 chamber (LA, LV, aortic root)

2 chamber (LA, LV)

Short axis views

Mitral valve = 2 chamber mid diastole

FRCR 2A (25 decks)

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