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Chest Review Cards Flashcards

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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
Kerley B lines indicate what?
- Due to increased fluid/tissue in interlobular septa | - Also in pneumoconiosis, sarcoidosis, lymphangitic carcinomatosis, lymphoma
26
How thick can pleura be before you should start considering neoplasm as the most likely cause?
5mm
27
A small, hypertlucent lung should suggest what Dx?
Swyer-James/Macleod’s syndrome - as a result of post-infectious obliterative bronchiolitis. not always small, but often decreased in volume
28
Top 2 MC pneumonias at admission, and MC in hospitalized pts?
- 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
29
Friedlander’s pneumonia caused by what?
Klebsiella, an encapsulated G- aerobe. | - Ingested in contaminated water, pulmonary disease follows colonization in GI
30
M/C/C of bronchopneumonia?
Staph aureus - G+
31
15-20% of pneumonias in otherwise healthy adults, G+ facultative anaerobe, has a capsule which makes it resistant to phagocytosis.
Streptococcus pneumoniae
32
peripheral skin ulcers, enlarged draining lymph nodes, and pneumonia?
Tularemic pneumonia | - Francisella tularensis, G-, common in rodents and small mammals, ticks/deer flies/mosquitoes act as vectors
33
G- nonecapsulated rod, frequent cause of hospital-acquired pneumonia (especially pts on mechanical ventilation)?
Pseudomonas aeruginosa pneumonia
34
what lung infection tends to form abscesses and cavities, pleural effusion, empyema?
Friedlander’s (Klebsiella) pneumonia
35
Currant jelly sputum?
klebsiella
36
most common bacterial cause of pneumonia?
Streptococcus pneumoniae is the most common bacterial cause of pneumonia in all age groups except newborn infants.
37
Pneumonic plague caused by what?
Yersinia pestis
38
Commonest infectious agent in Lungs of AIDS patients at autopsy
CMV
39
Infectious mononucleosis organism and MC finding?
• Epstein-Barr virus (EBV) - M/C radiographic finding = splenomegaly May also see: Enlarged hilar lymph nodes, diffuse reticular pattern
40
Rickettsial pneumonia, MC in farmers?
Coxiella burnetii
41
M/C/C of clinically evident nonbacterial pneumonia? (10-33% of all pneumonias)
Mycoplasma pneumoniae, which is the smallest free-living organism that can be cultured
42
MC organisms in lung abscess?
- M/C due to anaerobes (Staph, Strep, Klebsiella)
43
Ghon focus?
initial site of parenchymal involvement in TB, can enlarge or undergo healing (formation of a peripheral fibrous capsule, dystrophic Ca2+)
44
what lung and area is more commonly affected in TB?
Right, upper
45
Ranke complex?
Ghon focus with a calcified ipsilateral hilar node
46
Empyema necessitans?
empyema which broke thru pleura and collected in extrapleural space (TB)
47
Effusion in TB?
10% kids, 40% adults, represents primary infection
48
2 complications in primary TB?
Atelectasis and hematogenous dissemination
49
Clinically apparent disease in TB develops in what % of tuberculin +ve people with normal chest films?
in 2-3%
50
How often does cavitation happen in reactivation TB?
50%
51
Miliary pulmonary TB, skin text neg how often?
25% -ve tuberculin test
52
Miliary TB occurs how?
Hematogenous/lympatic dissemination. May be primary or reactivation infection.
53
Distribution of Actinomycosis?
airspace pneumonia with out recognizable segmental distribution, usually perpheral, predilection for lower lobes
54
commonest radiographic manifestation of histoplasmosis?
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
Aspergillosis most common appearance?
- 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
Hypersensitivity aspergillosis?
allergic bronchopulmonary aspergillosis (ABPA) Finger in glove sign may be seen is a type of eosinophillic lung disease
57
Chronic eosinophilic pneumonia appearance?
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
3 types of protozoan infection?
Amebiasis, Toxoplasmosis, Pneumocystis jirovecii (PCP, PJP)
59
Tropical eosinophilia?
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
4 stages of pulmonary sarcoid?
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
In stage 1 sarcoid, what % have lymph node enlargement?
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
specific acute clinical presentation of systemic sarcoidosis? ( fever, arthralgia, enlarged hilar nodes, erythema nodosum (M/C presentation in Europe).)
Löfgren syndrome
63
Skin test for sarcoid?
Kveim test
64
Lung changes in RA?
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
MC manifestation of RA in the chest?
Pleural disease, May be enlarged for months/yrs, Uniteral/bilateral, M/C sole manifestation
66
Necrobiotic nodules in RA?
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
Caplan’s syndrome?
Pneumoconioses (silica, coal dust) + RA -> single/multiple opacities in Lung field
68
Findings in scleroderma/PSS?
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
what does CREST stand for?
calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia
70
- M/C/C of respiratory distress in newborn | - M/C in preemies, term infants of diabetic moms
Hyaline Membrane Disease of Newborn
71
Hyaline Membrane Disease appearance?
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
Transient respiratory distress (Wet-Lung disease) of newborn?
- 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
Wilson-Mikity Syndrome
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
2 types of Pulmonary Hemosiderosis?
1. Idopathic pulmonary hemosiderosis - M/C kids <10 yoa 2. Goodpasture’s syndrome - M/C young adults, males
75
3 main (general) findings in Goodpasture's?
Pulmonary hemorrhage, Fe deficiency, glomerulonephtitis
76
Loeffler’s Syndrome?
transient pulmonary infiltration with eosinophilia | - M/C occurs in relation to extrinsic factors such as fungal infections, drug therapy, parasitic infection, other
77
Radiographic findings in Goodpasture's?
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
Pulmonary Infiltrates with Eospinophilia (PIE syndrome)?
Like Loeffler’s except more prolonged and malignant
79
Rheumatic pneumonia (from rheumatic fever)
- Not a true pneumonia  congestion and edema secondary to cardiac lesions - X-ray – hazy densities (M/C parahilar and midlung), +/- scattered pneumonitis
80
necrotizing granulommatous inflammation of upper and lower respiratory tract, glomerulonephritis, necrotizing vasculitis of the Lung?
Wegener’s Granulomatosis
81
Wegener’s Granulomatosis more common M or F?
M (2:1)
82
Xray findings in Wegener's?
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
Wegener's AKA?
Granulomatosis with polyangitis (GPA)
84
Hamman-Rich Syndrome?
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
Pulmonary Langerhans cell histiocytosis seem most commonly in who?
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
bilateral diffusely dense lungs with little clinical symptoms?
Pulmonary alveolar microlithiasis Often discovered incidentally on a chest radiograph. The radiographic features are frequently out of proportion to clinical symptoms
87
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
Familial Dysautonomia (Riley-Day Syndrome)
88
CXR findings in Polycythemia?
– 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
Multiple infections pf chest, urinary tract, etc, with no swollen lymph nodes?
The Agammaglobulinemias - Sex-linked recessive (mom to sons) - Secondary form acquired with multiple myeloma, leukemia, lymphoma
90
Saber sheath trachea is pathognomonic for what?
chronic obstructive pulmonary disease (COPD) | Males, chronic smokers.
91
Tracheal findings in relapsing polychondritis?
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
Tracheobronchopathia osteochondroplastica
Develop nodules/spicules of cartilage/bone in tracheal/bronchial submucosa. Sessile and polypoid elevations, beaded appearance.
93
Chronic pulmonary emphysema associated with right ventricular hypertrophy and large central pulmonary arteries. What is this describing?
cor pulmonale / pulmonary HTN
94
Alpha-1-antitrypsin deficiency radiographic features?
pan-lobular emphysema bronchiectasis - may be seen in up to 40% of cases frank bullae formation bronchial wall thickening
95
associations with Vanishing Lung ?
Alpha-1-antitrypsin deficiency Marfan syndrome Ehlers-Danlos syndrome

Chest Review Cards (1 decks)

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