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Chest Review Cards > Chest Review Cards > Flashcards

Chest Review Cards Flashcards

1
Q

aortic nipple caused by what?

A

Left superior intercostal Vein

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2
Q

location of diaphragm level?

A

95% between end of 5th anterior rib and 6th anterior intercostal space

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3
Q

Pulmonary sequestration types and location?

A

Intralobar
- LL lesion (M/C posterior basal, 2/3 on left)
- accounts for the majority (75-85% of all sequestrations)
Extralobar
- 90% on left

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4
Q

Pulmonary sequestration definition?

A

Pulmonary sequestration (also called accessory lung) refers to aberrant formation of segmental lung tissue that has no connection with the bronchial tree or pulmonary arteries.

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5
Q

most common foregut duplication cyst?

A

Bronchogenic cyst

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6
Q

MC location for congenital lobar overinflation (emphysema)

A

left upper lobe: most common, 40-45%
right middle lobe: 30%
right upper lobe: 20%
(may involve more than a single lobe in 5%)
Therefore despite the left upper lobe being most commonly affected, the right hemithorax is the most common side to be affected
- M/C male (3:1)

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7
Q

How long does it take for air to be resorbed after obstruction?

A

18-24 hrs

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8
Q

Normal holes in alveolar septa are called what?

A

Pores of Kohn

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9
Q

Normal communications between alveoli and respiratory terminal and preterminal bronchioles is termed what?

A

Canals of Lambert

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10
Q

Adhesive atelectasis?

A

Alveolar collapse in presence of open airways  due to deficient/absent surfactant (e.g. respiratory distress syndrome of newborn, acute radiation, pneumonitis, viral pneumonia)

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11
Q

Cicatrization atelectasis?

A

Due to fibrosis -> increased collagen -> decreased air/Lung volume -> increased x-ray density

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12
Q

3 direct signs of atelectasis?

A

Displacement of interlobar fissures, increased density, crowding of bronchi

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13
Q

Luftsichel sign?

A

overinflated superior segment of LLL interposed between atelectatic upper lobe and mediastinum creating a sharp interface with medial edge of collapsed lobe

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14
Q

Thickness of cavity wall suggesting Malignancy?

A

1 mm = benign
5-15 mm = 50/50 benign/malignant
>15 mm = malignant (92%)

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15
Q

Water lily Sign/Sign of camalote?

A

membrane floating on top of fluid with in cyst -> ruptured echinococcal cyst

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16
Q

Exceptions for rule that Ca2+’s are benign?

A

(i) Peripheral primary carcinoma engulfing an existing calcified granuloma (Ca2+ is eccentric)
(ii) Solitary mets from osteosarc or chondrosarc
(iii) Primary pulmonary carcinoma occasionally presents with diffuse punctate deposits of Ca2+

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17
Q

Egg shell calcification of a lymph node may be due to what?

A

MC seen in silicosis and sarcoidosis, also coalworker’s pneumoconiosis, Hodgkin’s, PSS, histoplasmosis, blastomycosis, amyloidosis

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18
Q

Diffuse parenchymal calcification may be due to what?

A

alveolar microlithiasis, silicosis, mitral stenosis, healed disseminated infections (histoplasmosis, varicella pneumonitis), idiopathic, mets, pulmonary Ca2+ in longstanding hypercalcemia (chronic renal disease, secondary HPTH, diffuse myelomatosis)

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19
Q

common causes of pleaural calcification (other than asbestosis)

A

hemothorax, pyothorax, tuberculous effusion

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20
Q

nodules/spicules of cartilage and bone in the submucosa of the trachea and bronchi, may produce SSx of COPD?

A

Tracheobronchopathia osteochondroplastica

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21
Q

Pulmonary infarction – M/C to see changes where?

A

in lower lobes because of higher blood flow

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22
Q

Mets vs primary carcinom distribution?

A
  • Mets – M/C in lower lobes because of higher blood/lymph flow
  • Primary pulmonary carcinoma – M/C in upper lobes
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23
Q

Post primary TB location MCommonly?

A

apical and posterior segments of upper lobes, superior segment of lower lobes

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24
Q

aka for Platelike atelectasis?

A

Fleischneir’s lines

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25
Q

Kerley B lines indicate what?

A
  • Due to increased fluid/tissue in interlobular septa

- Also in pneumoconiosis, sarcoidosis, lymphangitic carcinomatosis, lymphoma

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26
Q

How thick can pleura be before you should start considering neoplasm as the most likely cause?

A

5mm

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27
Q

A small, hypertlucent lung should suggest what Dx?

A

Swyer-James/Macleod’s syndrome - as a result of post-infectious obliterative bronchiolitis. not always small, but often decreased in volume

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28
Q

Top 2 MC pneumonias at admission, and MC in hospitalized pts?

A
  • M/C/C of pneumonia in pts admitted to hospital = Strep. pneumoniae (2nd = M. pneumoniae)
  • M/C/C of pneumonia in hospitalized pts = Staph. aureus
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29
Q

Friedlander’s pneumonia caused by what?

A

Klebsiella, an encapsulated G- aerobe.

- Ingested in contaminated water, pulmonary disease follows colonization in GI

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30
Q

M/C/C of bronchopneumonia?

A

Staph aureus - G+

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31
Q

15-20% of pneumonias in otherwise healthy adults, G+ facultative anaerobe, has a capsule which makes it resistant to phagocytosis.

A

Streptococcus pneumoniae

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32
Q

peripheral skin ulcers, enlarged draining lymph nodes, and pneumonia?

A

Tularemic pneumonia

- Francisella tularensis, G-, common in rodents and small mammals, ticks/deer flies/mosquitoes act as vectors

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33
Q

G- nonecapsulated rod, frequent cause of hospital-acquired pneumonia (especially pts on mechanical ventilation)?

A

Pseudomonas aeruginosa pneumonia

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34
Q

what lung infection tends to form abscesses and cavities, pleural effusion, empyema?

A

Friedlander’s (Klebsiella) pneumonia

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35
Q

Currant jelly sputum?

A

klebsiella

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36
Q

most common bacterial cause of pneumonia?

A

Streptococcus pneumoniae is the most common bacterial cause of pneumonia in all age groups except newborn infants.

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37
Q

Pneumonic plague caused by what?

A

Yersinia pestis

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38
Q

Commonest infectious agent in Lungs of AIDS patients at autopsy

A

CMV

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39
Q

Infectious mononucleosis organism and MC finding?

A

• Epstein-Barr virus (EBV)
- M/C radiographic finding = splenomegaly

May also see: Enlarged hilar lymph nodes, diffuse reticular pattern

40
Q

Rickettsial pneumonia, MC in farmers?

A

Coxiella burnetii

41
Q

M/C/C of clinically evident nonbacterial pneumonia? (10-33% of all pneumonias)

A

Mycoplasma pneumoniae, which is the smallest free-living organism that can be cultured

42
Q

MC organisms in lung abscess?

A
  • M/C due to anaerobes (Staph, Strep, Klebsiella)
43
Q

Ghon focus?

A

initial site of parenchymal involvement in TB, can enlarge or undergo healing (formation of a peripheral fibrous capsule, dystrophic Ca2+)

44
Q

what lung and area is more commonly affected in TB?

A

Right, upper

45
Q

Ranke complex?

A

Ghon focus with a calcified ipsilateral hilar node

46
Q

Empyema necessitans?

A

empyema which broke thru pleura and collected in extrapleural space (TB)

47
Q

Effusion in TB?

A

10% kids, 40% adults, represents primary infection

48
Q

2 complications in primary TB?

A

Atelectasis and hematogenous dissemination

49
Q

Clinically apparent disease in TB develops in what % of tuberculin +ve people with normal chest films?

A

in 2-3%

50
Q

How often does cavitation happen in reactivation TB?

A

50%

51
Q

Miliary pulmonary TB, skin text neg how often?

A

25% -ve tuberculin test

52
Q

Miliary TB occurs how?

A

Hematogenous/lympatic dissemination. May be primary or reactivation infection.

53
Q

Distribution of Actinomycosis?

A

airspace pneumonia with out recognizable segmental distribution, usually perpheral, predilection for lower lobes

54
Q

commonest radiographic manifestation of histoplasmosis?

A

Hisoplasmoma: a well-defined, nodular shadow <3 cm, M/C lower lobe, may Ca2+ producing target lesion, Ca2+ of hilar lymph nodes, may slowly grow.

55
Q

Aspergillosis most common appearance?

A
  • Commonest form is fungus ball or mycetoma.
    solid, rounded dense mass with in spherical/ovoid cavity, M/C in lower lobes, fungus ball moves with changes in pt position, center may be filled in with mycelial mass.
56
Q

Hypersensitivity aspergillosis?

A

allergic bronchopulmonary aspergillosis (ABPA)
Finger in glove sign may be seen
is a type of eosinophillic lung disease

57
Q

Chronic eosinophilic pneumonia appearance?

A

homogeneous peripheral airspace consolidation, which responds to steroid treatment. This appearance results in a reverse bat’s wing appearance. About 50% of patients with CEP have asthma. CEP may be difficult to differentiate from Churg-Strauss syndrome (CSS)

58
Q

3 types of protozoan infection?

A

Amebiasis, Toxoplasmosis, Pneumocystis jirovecii (PCP, PJP)

59
Q

Tropical eosinophilia?

A

thought to be caused by Wucheria bancrofti and Brugia malayi
severe leukocytosis (60,000)
- X-ray – diffuse and symmetric reticulonodular pattern, M/C lower lung zones, and hilar nodes may enlarge, pleural effusion rare.

60
Q

4 stages of pulmonary sarcoid?

A
  1. Hilar and paratracheal adenopathy
  2. adenopathy with parenchymal involvement
  3. parenchymal involvement with out adenopathy
  4. fibrotic change progressing to pulmonary insufficiency with cor pulmonale
61
Q

In stage 1 sarcoid, what % have lymph node enlargement?

A

75-85% have lymph node enlargement, usually bilateral symmetric (5% unilateral, DDx Hodgkin’s  anterior mediastinal node enlargement, when hilar it’s usually unilateral or asymmetric).

62
Q

specific acute clinical presentation of systemic sarcoidosis? ( fever, arthralgia, enlarged hilar nodes, erythema nodosum (M/C presentation in Europe).)

A

Löfgren syndrome

63
Q

Skin test for sarcoid?

A

Kveim test

64
Q

Lung changes in RA?

A

Diffuse interstitial fibrosis and pneumonitis in 10-50%, M/C in males with subcutaneous Lung nodules

  • early – punctate/nodular opacities (DDx miliary TB, sarcoid, asbestosis)
  • Late – reticular, more prominent in basal portion (DDx PSS, idiopathic fibrosing alveolitis)
  • Later – honeycomb Lung
65
Q

MC manifestation of RA in the chest?

A

Pleural disease, May be enlarged for months/yrs, Uniteral/bilateral, M/C sole manifestation

66
Q

Necrobiotic nodules in RA?

A

Rare, well-circumscribed soft tissue tumor associated with advanced RA and multiple subcutaneous nodules elsewhere.
Peripheral, may be multiple.
+/- Cavitation  smooth inner lining.
May disappear during remission phases.

67
Q

Caplan’s syndrome?

A

Pneumoconioses (silica, coal dust) + RA -> single/multiple opacities in Lung field

68
Q

Findings in scleroderma/PSS?

A

coarse reticular/reticulonodular pattern in subpleural region of lower lobes.
Progressive loss of Lung volume due to progressive fibrosis.
Spontaneous pneumothorax develops due to presence of large lower lobe Lung cysts.
50% have pulmonary arterial HTN with enlarged central pulmonary Arterys & right ventricular dilation

69
Q

what does CREST stand for?

A

calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia

70
Q
  • M/C/C of respiratory distress in newborn

- M/C in preemies, term infants of diabetic moms

A

Hyaline Membrane Disease of Newborn

71
Q

Hyaline Membrane Disease appearance?

A

typically gives diffuse ground glass lungs with low volumes and a bell-shaped thorax
often tends to be bilateral and symmetrical
air bronchograms may be evident
hyperinflation (in a non ventilated patient) excludes the diagnosis
radiographs may show hyperinflation if the patient is intubated

72
Q

Transient respiratory distress (Wet-Lung disease) of newborn?

A
  • Aka retained lung fluid/distress
  • Normal sized lungs with diffuse haziness/reticular pattern, streaky parahilar opacities, hyperinflation, pleural effusion
  • M/C bilateral, may have right sided predominance
  • Clears with in 24-48 hrs
  • DDx pneumonia, pulmonary edema in newborn
73
Q

Wilson-Mikity Syndrome

A

refers to chronic lung disease in premature infants, characterized by early development of cystic interstitial emphysema (PIE).

  • Diffuse reticulonodular pattern
  • Focal areas of hyperaeration and atelectasis which can progress and appear cyst-like (alternating collapse and hyperaeration due to immaturity and uneven maturation of alveoli)
74
Q

2 types of Pulmonary Hemosiderosis?

A
  1. Idopathic pulmonary hemosiderosis
    - M/C kids <10 yoa
  2. Goodpasture’s syndrome
    - M/C young adults, males
75
Q

3 main (general) findings in Goodpasture’s?

A

Pulmonary hemorrhage, Fe deficiency, glomerulonephtitis

76
Q

Loeffler’s Syndrome?

A

transient pulmonary infiltration with eosinophilia

- M/C occurs in relation to extrinsic factors such as fungal infections, drug therapy, parasitic infection, other

77
Q

Radiographic findings in Goodpasture’s?

A

patchy airspace consolidation (acinar or more confluent in some areas), air bronchogram

  • Forms reticular pattern with in 2-3 days due to clearance of blood  chest x-ray is normal in 10-12 days
  • Develop progressive interstitial fibrosis with repeat episodes
78
Q

Pulmonary Infiltrates with Eospinophilia (PIE syndrome)?

A

Like Loeffler’s except more prolonged and malignant

79
Q

Rheumatic pneumonia (from rheumatic fever)

A
  • Not a true pneumonia  congestion and edema secondary to cardiac lesions
  • X-ray – hazy densities (M/C parahilar and midlung), +/- scattered pneumonitis
80
Q

necrotizing granulommatous inflammation of upper and lower respiratory tract, glomerulonephritis, necrotizing vasculitis of the Lung?

A

Wegener’s Granulomatosis

81
Q

Wegener’s Granulomatosis more common M or F?

A

M (2:1)

82
Q

Xray findings in Wegener’s?

A

rounded opacities (up to 10 cm diameter)

  • Multiple, bilateral, widely distributed
  • 1/3-1/2 cavitate  shaggy inner lining – cavities may disappear +/- Tx
  • Peripheral oligemia, lobar/total Lung atelectasis secondary to endotracheal/endobronchial obstruction, widespread airspace opacities
  • 50% pleural effusion
83
Q

Wegener’s AKA?

A

Granulomatosis with polyangitis (GPA)

84
Q

Hamman-Rich Syndrome?

A

Aka: Diffuse Interstitial Pulmonary Fibrosis, Acute interstitial pneumonitis (AIP)*
Acute, aggressive form of idiopathic pulmonary pneumonitis and fibrosis characterized by rapid progression of pulmonary insufficiency

85
Q

Pulmonary Langerhans cell histiocytosis seem most commonly in who?

A

can be seen as part of widespread involvement in patients with disseminated LCH or more frequently as a distinct entity in young adult smokers.

  • M/C whites, young adult males/middle aged females
  • > 90% have Hx of smoking
86
Q

bilateral diffusely dense lungs with little clinical symptoms?

A

Pulmonary alveolar microlithiasis
Often discovered incidentally on a chest radiograph. The radiographic features are frequently out of proportion to clinical symptoms

87
Q

insensitivity to pain, inability to produce tears, poor growth, and labile blood pressure
M/C Jewish
Lung findings including patchy bronchopneumonia and atelectasis, might be confused with CF

A

Familial Dysautonomia (Riley-Day Syndrome)

88
Q

CXR findings in Polycythemia?

A

– prominent vascular shadows, basal fibrosis -> increased basal markings secondary to congestion
- Discrete, rounded, mid-lung densities -> venous thrombi -> disappear in a couple of wks

89
Q

Multiple infections pf chest, urinary tract, etc, with no swollen lymph nodes?

A

The Agammaglobulinemias

  • Sex-linked recessive (mom to sons)
  • Secondary form acquired with multiple myeloma, leukemia, lymphoma
90
Q

Saber sheath trachea is pathognomonic for what?

A

chronic obstructive pulmonary disease (COPD)

Males, chronic smokers.

91
Q

Tracheal findings in relapsing polychondritis?

A

increased airway wall attenuation: common
smooth anterior and lateral airway wall thickening with sparing of the posterior membranous wall: if present is considered virtually pathognomonic
luminal narrowing: tracheo-bronchial and peripheral bronchial
accompanying dense tracheal cartilage calcification
dynamic imaging may demonstrate airway collapse best seen at end expiratory phase

92
Q

Tracheobronchopathia osteochondroplastica

A

Develop nodules/spicules of cartilage/bone in tracheal/bronchial submucosa.
Sessile and polypoid elevations, beaded appearance.

93
Q

Chronic pulmonary emphysema associated with right ventricular hypertrophy and large central pulmonary arteries. What is this describing?

A

cor pulmonale / pulmonary HTN

94
Q

Alpha-1-antitrypsin deficiency radiographic features?

A

pan-lobular emphysema
bronchiectasis - may be seen in up to 40% of cases
frank bullae formation
bronchial wall thickening

95
Q

associations with Vanishing Lung ?

A

Alpha-1-antitrypsin deficiency
Marfan syndrome
Ehlers-Danlos syndrome

Chest Review Cards (1 decks)

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