HomeStretch CRACK vol 1. Endo/Thorax

Question 1

Syndromes associated with Pheo

Answer 1

• VHL
• MEN IIa/IIb
• NF1
• Sturge-Weber
• Tuberous sclerosis

Question 2

Wolman dz

Answer 2

fatal metabolism error thing - b/l enlarged calcified adrenal glands

Question 3

MEN 1

Answer 3

3Ps

• Pituatary
• Parathyroid
• Pancreas

Question 4

MEN 2a

Answer 4

1M,2Ps

Medullary thyroid CA

Pheo

Parathyroid

Question 5

MEN 2b

Answer 5

2Ms, 1P

• Medullary thyroid CA
• Marfanoid, mucosal neuromas
• Pheo

Question 6

Delphian node

Answer 6

level 6 lymph nodes around the thyroid in front of neck

commonly enlarged with hashimotos

sick looking delphian node = laryngeal ca mets

Question 7

Normal hilum on lateral radiograph, what is “the black hole”? What is on top of it and what is anterior to it?

Answer 7

Left upper lobe bronchus

Left PA

Right PA (is anterior)

Question 8

Which hilum is more superior?

Answer 8

left hilar point should be 1 cm higher than the right

Question 9

What obliterates the retrotracheal (raider) triangle?

Answer 9

Aberrant right subclavian artery

Question 10

Bronchopulmonary segmental anatomy

Answer 10

In general, each lung has 10 segments: the upper lobes contain 3 segments, the middle lobe / lingula 2 and the lower lobes 5. Bilaterally, the upper lobes have apical, posterior and anterior segments and the lower lobes superior (apical) and 4 basal segments (anterior, medial, posterior and lateral). With this basic symmetric anatomy shared between the lungs, there are a few differences that can be described:

the middle lobe on the right has 2 segments: medial and lateral (easy to remember - middle lobe, medial and lateral).

the lingula on the left is part of the left upper lobe and is the equivalent of the middle lobe on the right, and hence it has 2 segments, but in this case, it is divided into superior and inferior segments.

there are 2 regions of the left lung in which 2 segments are joined as 1 as they have a common tertiary (segmental) bronchus:

left upper lobe apicoposterior segment

left lower lobe anteromedial segment

Question 11

volume loss of one hemi-thorax with CT coronal showing only one PA

Answer 11

proximal interruption of the pulmonary artery

seen on the opposite side of the aortic arch

Question 12

What are the kinds of atelectasis?

Answer 12

1. Obstructive (absorptive)
2. Compressive (relaxation/passive)
3. Fibrotic (cicatrization)
4. adhesive

Question 13

cervicothoracic sign

Answer 13

something above the clavicles on CXR is in the posterior mediastinum

Question 14

hilum overlay sign

Answer 14

if you see edges of vessels through a hilar mass - its either in the anterior or posterior mediastinum

Question 15

Post bone marrow transplant graft versus host

Answer 15

Acute (20-100 days): favors extrapulmonary systems (skin, GI, liver)

Chronic (>100days): lymphocytic infiltration of airways and obliterative bronchiolitis

Question 16

Post Bone Marrow Transplant pulmonary findings

Answer 16

Early neutropenic (0-30 days): pulmonary edema, hemorrage, drug induced lung injury; fungal pneumonia

Early (30-90 days): PCP, CMV

Late (>90 days): BO, COP

Question 17

Ghon lesion

Ranke complex

Rassmussen aneurysm

Answer 17

• Ghon lesion = calcified TB pulmonary granuloma (sequela of primary TB)
• Ranke complex = Gohn + calcified hilar lymph node
• Rassmussen aneurysm = pulmonary artery pseudoaneursyms next to TB cavities

Question 18

What are the three flavors of aspergillus?

Answer 18

Normal immune = aspergilloma

suppressed immune = invasive aspergillosis (halo sign and air crescent sign)

Hyper-immune = ABPA

Question 19

Mnemoic for cavitary lung lesion

Answer 19

CAVITY

Cancer (scuaomous)

Auto-immune (wegeners, RA, Caplan)

Vascular

Infection (TB, Staph)

Trauma

Young (congenital)

Question 20

Lung cancer subtypes

Answer 20

Squamous cell = smokers, central, cavitation, calcium (hyperPTH); does not express TTF-1

Large cell: least common subtype, peripheral

AdenoCA: peripheral, associated with fibrosis

small cell: smoker, central, svc obstruction, paraneoplastic syndromes (ACTH, SIADH, Lambert Eaton)

Question 21

What is the test of choice to stage a pancoast tumor?

Answer 21

MRI - to check brachial plexi

Question 22

Critical stage for lung cancer

Answer 22

3a versus 3b

Stage 3b implies N3 or T4 disease (M also is unresectable)

Question 23

nucs crossover blitz!

Gallium/Thallium versus Kaposi Sarcoma and Lymphoma

Answer 23

Kaposi is Thallium hot and Gallium cold

Lymphoma is thallium hot and gallium hot

Question 24

Cystic lung diseases

Answer 24

• LIP = LymphoCYSTIC Interstitial Pneunomia
  
  • Benign lymphoproliferative disorder with lung infiltration
  • Association with Sjogrens, SLE, RA, HIV in younger patient, Castlemans
  • Cysts with groundglass
    
    • When I say LIP you say Sjogrens and HIV
    • When I say LIP in a child you say HIV
• LCH = Langerhans Cell Histiocytosis
  
  • Smoker, young (20s-30s)
  • Spaces costophrenic angles
  • Centrilobular Nodules + thicker, bizarre chapped cysts.
• LAM = Lymphangioleiomyomatosis
  
  • Child-bearing aged women and TS
  • Uniform, thin walled round cysts
• BHD = Birt Hogg Dube Syndrome
  
  • Association with renal findings
  • Thin walled “floppy cysts”
  • Lower zone predominant

Question 25

What does Asbestosis look like?

Answer 25

UIP with parietal pleural thickening

Question 26

What is the first step in deciding if nodule pattern? Then what?

Answer 26

* Centrilobular spares the pleura (inhaled stuff - ie infection, RB-ILD, HP) * Perilymphatic nodules run along subplearual and peribrochovascular (lymphatic stuff - sarcoid/silicosis and lymphangitic spread) * random is random (hematogenous stuff - mets, fungal, military TB)

Question 27

What are the ILDs?

Answer 27

* UIP = Usual interstitial Pneumonia * The main one * Honeycombing * Apicobasal gradient * Traction bronchietctasis * N**S**IP = Nonspecific Interstitial Pneumonia * Ground glass micronodules * Subpleural sparing * **S**cleroderma * RB-ILD = Respiratory bronchiolitis - Interstitial Lung Disease * Smoking related * Apical centrilobular ground glass nodules * DIP = Desquamative interstitial pneumonia * Smoking related * The worse end of spectrum of RB-ILD * Peripheral, lower-lobe predominant ground glass with small cystic spaces * Sarcoid

Question 28

What is associated with NSIP? What is associated with LIP? What is associated with follicular bronchiolitis?

Answer 28

NSIP = Scleroderma LIP(**_J_**) = Sjogrens (and HIV in kids) Follicular Bronchiolitis = Sjogrens and RA

Question 29

Lofgren syndrome

Answer 29

Acute sarcoid b/l hilar LAD arthritis Erythema nodosum (LofGren = sarGoid; loffler is the eosinophilia one)

Question 30

CHF Stages

Answer 30

* Stage 1: redistribution (wedge pressure 13-18); cephalization, cardiomegaly, big vascular pedicle * Stage 2: Interstitial edema (WP 18-25); kerly b lines * Stage 3: Alveolar edema (wedge \> 25); airspae fluffy opacities and pleural effusion

Question 31

Pulmonary Alveolar Proteinosis Trivia increased risk of what which infections? Smoking association? When seen in children associated with what? treatment?

Answer 31

* increased risk of what which infections? NOCARDIA * Smoking association? YES * When seen in children associated with what? THYMIC ALYMPHOPLASIA * treatment? BAL

Question 32

Alveolar diseases (soup alphabet)

Answer 32

* PAP = Pulmonary alveolar proteinosis * Crazy paving * Lipoid Pneumonia * Organizing Pneumonia (Cryptogenic [COP]) if cause unknown * Persistent symptoms following pneumonia treatment * COP = reverse halo * Patchy airspace opacities or GGO in a peripheral or peri-bronchial pattern * CEP = Chronic Eosinophillic Pneumonia * Can look exactly like COP * When I say COP, you say CEP too * HP = Hypersensitivity Pneumonitis * Subacute = patchy ground glass opacities * Chronic = looks like UIP + air trapping

Question 33

Bronchial carcinoid more likely to met in eye where versus GI carcinoid

Answer 33

Bronchial carcinoid goes to inside eye in uveal tract while GI carcinoid goes to EOM

Question 34

Tracheal disease - which spare posterior membranes? how to differentiate all of them

Answer 34

* Spare posterior membrane * Relapsing polyCHONDritis and TBO (both have chondro in their name) * TBO calcifies * Does not spare post membrane: * Amyloid (calcifies) * Wegeners (can calcify too. . .)

Question 35

Williams campbell syndrome

Answer 35

congenital cystic bronchiectasis from deficiency of cartilage in the 4th-6th order bronchi ("Williams with CF")

Question 36

Mounier-Kuhn syndrome

Answer 36

tracheobronchomegaly

Question 37

Mendelson's syndrome

Answer 37

Aspiration of gastric acid

Question 38

Typical location of aspiration

Answer 38

If supine: posterior segment of upper lobes and superior segment of lower lobes If upright: bilateral basal lower lobes right is favored

Question 39

Callogen Vascular Dz Pulm Manifestations

Answer 39

SLE = shrinking lung; has more pleural and pericardial effusions RA = looks like UIP and COP Scleroderma = NSIP Sjogrens = LIP

Question 40

What is associated with solitary fibrous tumor of the pleura?

Answer 40

Hypoglycemia (IGF secretion) = Doege-potter syndrome Hypertrophic osteoarthropathy (not associated with asbestosis)

Question 41

Hughes-Stovin Syndrome

Answer 41

PA aneurysm similar to Behcet's (may be the same thing)