Focal and Multifocal Lung Diseases

Question 1

If multiple pulmonary nodules are seen on imaging, the etiology is suspected to be this type of cancer

Answer 1

Hematogenous spread from elsewhere in the body (metastasis)

Question 2

This multifocal pulmonary infiltrate looks like pneumonia but has more hemoptysis and is common in immunosuppressed patients

Answer 2

Invasive aspergillosis

Question 3

Which cavitary pulmonary infiltrate shows with effusions and air-fluid levels in the cavities?

Answer 3

Pyogenic bacterial pneumonia

Question 4

Tests for cavitary GPA (Wegener granulomatosis)

Answer 4

cANCA/PR3 or pANCA/MPO

Will also have elevated ESR

Biopsy preferred (renal better than lung)

Question 5

Describe the cough in segmental/lobar tuberculosis

Answer 5

Non-productive

May have hemoptysis

Question 6

Which eosinophilic pneumonia will present without peripheral eosinophilia?

Answer 6

Acute eosinophilic pneumonia (too fast to spread)

Question 7

A ball seen on the peripheral edge of the lung with a comet tail would be seen in this condition

Answer 7

Rounded atelectasis

Question 8

Are foreign bodies causing segmental/lobar pulmonary blockage more often radiolucent or radiopaque?

Answer 8

90% are radiolucent (don’t show up)

Question 9

This fungus can cause lung masses up to 10cm in size

Answer 9

Cryptococcus

Question 10

Tuberculosis infiltrates typically show on chest x-ray with this appearance and in this area of the lungs

Answer 10

Cavitations

In upper lung zones

Question 11

Size of pulmonary nodules

Answer 11

<3mm (larger is a mass)

Question 12

True or false. Bacterial pneumonia commonly presents as segmental/lobar infiltrates

Answer 12

False. More commonly focal/multifocal

Question 13

Wedge shaped infiltrates on chest x-ray (Hampton Hump) suggest this condition

Answer 13

Pulmonary infarction

Question 14

True or false. A single nodule in the lung is rarely a metastatic malignancy

Answer 14

True

Question 15

Metastatic carcinomas in the lungs have this classic appearance on imaging

Answer 15

Cannon-ball metastases in lower lobes

Question 16

This type of eosinophilic pneumonia will present with rales

Answer 16

Acute eosinophilic pneumonia

Question 17

Most common cause of rapidly growing lung cancers which present with cavitations

Answer 17

Squamous cell carcinoma

(cancer outgrows its blood supply)

Question 18

Three most common cancers that cause pulmonary metastatic carcinomas

Answer 18

Renal

Prostate

Breast

Question 19

Describe bronchopulmonary sequestration and how it would look on imaging

Answer 19

Lung area that never developed properly

Well-defined on imaging with no change over time

Question 20

Treatment for BOOP

Answer 20

Chronic prednisone

Question 21

In which airways are carcinoid tumors typically found?

Answer 21

Central airways

Question 22

Radiation pneumonitis typically shows up this long after exposure

Answer 22

1-6 months after radiation

Question 23

Describe the process that commonly leads to lung lobe torsion

Answer 23

Lungs are moved aside during CABG surgery

Torsion obstructs blood flow

Post-op, patient gets perfusion-reperfusion injury

Question 24

Aspiration of medications with this ingredient in particular is a medical emergency

Answer 24

Medications containing iron

Question 25

Patients with bone marrow transplants (neutropenic) are more likely to have this type of pulmonary mass

Answer 25

Invasive pulmonary aspergillosis + mucormycosis

Question 26

Symptom for patients with pulmonary infarction

Answer 26

Hemoptysis (but continue anticoagulation)

Question 27

Most common cause of endemic fungal pneumonia (in the midwest)

Answer 27

Histoplasmosis

Question 28

Patients with this condition have atopy/asthma, neuropathic and skin lesions, high absolute eosinophils, and infiltrates and nodules without cavitations

Answer 28

Granulomatous with polyangiitis (Wegener's)

Question 29

Since malignancy can hide in lung infiltrates, imaging should be repeated after this much time to get resolution

Answer 29

6 weeks to 3 months

Question 30

This focal pulmonary infiltrate looks like pneumonia on chest x-ray, but the patient will have NO symptoms (no fever, chills, or elevated WBCs)

Answer 30

Alveolar cell carcinoma

Question 31

Treatment for ABPA (allergic bronchopulmonary aspergillus)

Answer 31

Prednisone (treat the asthma)

Question 32

Chronic eosinophilic pneumonia will show up like this on chest x-ray

Answer 32

"Reverse pulmonary edema" - more white on outside, clear in the center

Question 33

Mycoplasma pneumonia primarily shows up in these areas of the lungs

Answer 33

Lung bases or right middle lobe

Question 34

Aspiration of an oily substance can lead to lipoid pneumonia. Diagnosis of which can be confirmed with this test

Answer 34

Oil red O stain

Question 35

Silicosis in patients with rheumatoid arthritis is called this ...

Answer 35

Caplan syndrome

Question 36

Three causes of BOOP

Answer 36

Rheumatoid arthritis Graft vs heart disease Bleomycin

Question 37

Which type of pulmonary nodule mimics GPA?

Answer 37

Lymphomatoid granulomatosis

Question 38

Treatments for simple, chronic, and acute eosinophilic pneumonias

Answer 38

Simple = d/c drug cause or treat parasite Chronic = prednisone Acute = methylprednisolone

Question 39

A granulomas solitary pulmonary nodule would look like this on a PET scan

Answer 39

"Flip-flop fungus" Lymph nodes brighter than nodule

Question 40

Treatment for cavitary GPA (Wegener's granulomatosis)

Answer 40

Cyclophosphamide, steroids, rituximab

Question 41

Telltale symptom for patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

Answer 41

Footdrop

Question 42

Describe the Fleischner criteria

Answer 42

Guidelines for follow-up/management of pulmonary nodules in patients aged 35+

Question 43

Small satellite nodules seen in the lungs surrounding a larger nodule suggest this type of infection

Answer 43

Fungal infection

Question 44

Well circumscribed nodules without adenopathy are seen in this condition

Answer 44

Post-transplant lymphoproliferative disorders

Question 45

Which patients are most at risk of chronic eosinophilic pneumonia?

Answer 45

Females Age 20-40 With atopic history

Question 46

Describe the spread pattern of invasive aspergillosis and mucor

Answer 46

Angioinvasive, follows blood vessels

Question 47

Pulmonary masses in the hilar portion of the lower lung lobes are caused by this

Answer 47

Blastomycosis

Question 48

IV drug users are most at risk of these types of pulmonary nodules

Answer 48

Bacterial endocarditis spread from right sided heart valve

Question 49

Typical symptoms (4) for cavitary GPA (Wegener's granulomatosis)

Answer 49

Lower respiratory tract webbing Glomerulonephritis Vasculitis - ulcers/rashes on body Generally very sick (fever, weight loss, sinus issues)

Question 50

Simple eosinophilic pneumonia typically shows up in these areas of the lungs

Answer 50

Lower lung fields

Question 51

This segmental/lobar pulmonary infiltrate shows with a classic fingerlike plugging of airways pattern

Answer 51

ABPA Allergic Bronchopulmonary Aspergillus

Question 52

Describe how multifocal pulmonary infiltrates as a result of ankylosing spondylitis would present

Answer 52

Upper lung fibrous infiltrates Looks like TB (cavitations) Aspergillus colonization in cavities

Question 53

Bulky hilar and mediastinal adenopathy is associated with this multifocal pulmonary infiltrate

Answer 53

Hodgkin's lymphoma

Question 54

In what way might viral pneumonia appear differently to bacterial pneumonia on chest x-ray?

Answer 54

Viral follows airways, so looks more streaky on chest x-rays

Question 55

Pulmonary infiltrates seen on a chest x-ray that have a sharp, clean border suggests this condition

Answer 55

Radiation pneumonitis

Question 56

Most common cause of bacterial pneumonia

Answer 56

Strep pneumoniae (85%)

Question 57

Pneumonia caused by a worm would show this unique result on a CBC with differential

Answer 57

Eosinophils >60%

Question 58

Asthma with hypersensitivity to aspergillus causes atelectasis in these areas of the lungs and this type of sputum

Answer 58

Atelectasis in upper lobes Brown sputum

Question 59

Echinococcal lesions in the lungs and other organs are typically caused by this type of infection

Answer 59

Parasitic infection

Question 60

Which pneumonia shows with thick walled upper lobe cavitations without fluid levels?

Answer 60

Suppurative pneumonias

Question 61

Drugs (3) that can induce simple eosinophilic pneumonia

Answer 61

Nitrofurantoin Cocaine Amiodarone