Exam 2 - Thoracic

Question 0

Pattern of Pneumonia:

• Starts in peripheral alveoli
• Bacterial
• Airspace pattern, Silhouette sign, Air bronchogram sign

Answer 0

Lobar pneumonia

Question 1

MC infectious disease in the world

Answer 1

Pneumonia

Question 2

MC cause of Lobar pneumonia

Answer 2

Streptococcus pneumonia

Question 3

Pattern of Pneumonia:

• Starts in mucosa of bronchi & bronchioles; spreads to alveoli
• Viral pneumonia

Answer 3

Interstitial/Lobular pneumonia

Question 4

MC Cause of Bronchopneumonia (segmental)

Answer 4

Staphylococcus aureus

Question 5

MC type of pneumonia in post-primary (reactivation) TB

Answer 5

Cavitary Pneumonia

Question 6

TB that is MC in children

• Little or no symptoms
• MC in upper lobes
• Ranke (primary) complex: hilar lymph node calcification + ghon tubercle

Answer 6

Primary TB

Question 7

TB that is MC in adults as reactivation or continuation of primary disease

• Cavitation is common
• Possible pleural effusion
• MC right side of posterior & apical segments of upper lobes

Answer 7

Post-Primary (Reinfective) TB

Question 8

Type of TB that is due to hematogenous dissemination

• uncommon
• small nodules scattered thru-out both lungs

Answer 8

Miliary TB

Question 9

Air in pleural space

- parietal pleura is intact while visceral pleura retracts toward hilum with the collapsing lung

Answer 9

Pneumothorax

Question 10

Air that has dissected into the pleurae, small, and not seen on a film. If it ruptures –> spontaneous pneumothorax

Answer 10

Blem

Question 11

With tension pneumothorax, mediastinal shifts _____ d/t fluid

Answer 11

Away

Question 12

What is the best view to view Pneumothorax

Answer 12

PA Chest with Expiration

Question 13

Key clinical sign for recognizing Subcutaneous Emphysema

Answer 13

Crackles upon palpation

Question 14

MC Anterior Mediastinal Masses

Answer 14

• Lymphoma (T-cells) — MC
• Thymoma — 2nd MC
• Teratoma
• Substernal Thyroid

Question 15

Thymic hyperplasia in adults is due to:

Answer 15

1. High does cortisone therapy
2. Chemotherapy
3. Myasthenia Gravis

Question 16

• aka Coin Lesion
• Nodule: 3cm
• Water Density

Answer 16

Solitary Pulmonary Nodule (SPN)

Question 17

What are some things that can mimic an SPN:

Answer 17

• Clothing, screen, film artifacts (water on inside)
• Skin or chest wall lesions (moles, nipples, etc)
• Hair artifacts
• Bone lesions
• Healing rib fractures
• Pleural or mediastinal lesions

Question 18

How does the size of a SPN determine if it’s benign or malignant?

Answer 18

Rarely Malignant: 5cm

Question 19

3 MC types of pulmonary scars:

Answer 19

1. TB
2. Histoplasmosis
3. Coccidiomycosis

Question 20

MC benign lung tumor

Answer 20

Hamartoma

Question 21

MC primary lung tumor

Answer 21

Bronchial Carcinoid Tumor aka Bronchial Adenoma

Question 22

Nodule or mass with irregular borders

• 50% are lobulate
• 16% cavitate
• Pleural tail / Comet tail (99% chance malignant)

Answer 22

Bronchogenic Carcinoma

Question 23

MC cell type of a Pancoast Tumor

• MC to cause airway obstruction
• Usually central

Answer 23

Squamous Bronchogenic Carcinoma

Question 24

MC cell type of small peripheral bronchi | - slow growth = large when discovered

Answer 24

Adenocarcinoma

Question 25

Metastasizes quickly to regional lymph nodes | - most aggressive & worst prognosis

Answer 25

Small Cell / Oat Cell

Question 26

Grows the quickest - periphery - large size - pleural effusion & pleural involvement are common

Answer 26

Large Cell Carcinoma

Question 27

Mass in the lung apex

Answer 27

Pancoast Tumor | superior sulcus tumor

Question 28

Best view to see Pancoast Tumor

Answer 28

Apical Lordotic View

Question 29

What are the MC cell types for Pancoast Tumor

Answer 29

MC = Squamous cell | 2nd MC = Adenocarcinoma

Question 30

MC spread of Metastatic Lung Disease | - single/multiple well defined nodules

Answer 30

Blood (MC) --- Hematogenous

Question 31

Spread of Metastatic Lung Disease | - Reticular nodular interstitial pattern, very small nodules

Answer 31

Lymphatic

Question 32

A chronic irreversible dilation of the airspaces distal to the terminal bronchiole with associated destruction of their walls

Answer 32

Emphysema

Question 33

Radiographic findings of Emphysema

Answer 33

- Sagittal dimension of chest increased - Low flat diaphragm - Pseudoblunting of costophrenic angles - Heart: small, vertical, elongated - Retrosternal clear space > 4.5cm - Horizontal anterior ribs & increased intercostal spaces - Hyperlucent lungs - Loss of vascular markings in periphery

Question 34

MC fungal disease in USA - Mississippi & Ohio valleys, Appalachian Mts - bird & bat excremate in dirt - pulmonary changes similar to TB

Answer 34

Histoplasmosis (h.capsulatum)

Question 35

Saprophytic fungus that abides in dirt, but is often airborne - Endemic SW USA (desert) - San Juanquin Valley fever

Answer 35

Coccidiomycosis (c.immitis)

Question 36

Collection of air within the visceral pleura | Dissection of air from the lung into the interstitium, then along septal lines and into the pleura

Answer 36

Bleb

Question 37

- Chronic bronchitis, smoking - Due to recurrent inflammation, scarring & fibrosing - Bronchovasicular structures/markings have irregular/accentuated contour

Answer 37

Dirty Chest

Question 38

A group of more than 200 disorders characterized by inflammation of the pulmonary interstitium & related structures - Only about 15% have identifiable cause, most of which are due to environmental exposure to certain agents

Answer 38

Interstitial Lung Disease

Question 39

- Increased risk of mesothelioma (mc pleural based tumor) - XRay: interstitial pattern, linear opacities start in lung base & move to apex, pleural effusion - MC cause of plaques & calcification - Starts over the domes of the diaphragm - MC cause of pulmonary fibrosis

Answer 39

Asbestosis | fibrogenic pneumoconiosis

Question 40

Fibrogenic Pneumoconiosis - Rock drilling, mining, foundries, etc - XRay: Silicon Nodules, Egg-Shell calcification of Lymph Nodes

Answer 40

Silicosis

Question 41

Fibrogenic Pneumoconiosis: | - Caplan's Syndrome: pneumoconiosis & RA

Answer 41

Coal Workers

Question 42

Which conditions are non-fibrogenic pneumoconiosis?

Answer 42

Siderosis Baritosis Stannosis

Question 43

Iron oxide, welders

Answer 43

Siderosis

Question 44

Due to inhaled organic dusts

Answer 44

Extrinsic Allergic Alveolitis

Question 45

Moldy sugar cane

Answer 45

Bagassosis

Question 46

Bird excreta (pigeon)

Answer 46

Bird Fanciers Lung

Question 47

Moldy hay

Answer 47

Farmers Lung

Question 48

Redwood dust

Answer 48

Sequoiosis

Question 49

Cotton Dust

Answer 49

Byssinosis

Question 50

MC Primary tumor of pleura

Answer 50

Pleural Mesothelioma

Question 51

3 reasons for enlarged heart:

Answer 51

1. Cardiomegaly 2. Pericardial Effusion 3. Extra-cardiac causes that mimic

Question 52

MC benign tumor of the heart

Answer 52

Myxoma | 75% in left atrium

Question 53

4 Key Radiographic signs: - Thickening of interlobular septa (Kerley B Lines) - Peribronchial Cuffing - Fluid in the fissures - Pleural Effusion

Answer 53

Pulmonary Interstitial Edema

Question 54

3 Key radiographic signs: - Fluffy, indistinct, patchy airspace densities - Bat wing/butterfly wing appearance *** - Pleural effusion

Answer 54

Pulmonary Alveolar Edema

Question 55

These key signs indicate what: 1. Kerley's Lines 2. Fluid in Fissure 3. Peribronchial Cuffing 4. Pleural Effusion 5. "Viking Horn Sign" (cephalization of blood flow)

Answer 55

Pulmonary Edema asso w/ CHF

Question 56

Thoracic aorta in aging patient

Answer 56

- Loss of elasticity: slight elongation & dilation - Ascending arch more convex at upper right heart border - Transverse arch bc prominent

Question 57

Thoracic Aortic Aneurysm is MC

Answer 57

descending

Question 58

Congenital syndrome due to cilia dyskinesia | - Situs inversus: all organs transposed

Answer 58

Kartagener Syndrome