Respiratory

Question 1

non cardiac APO

Answer 1

HARD MONTH
Head injury
ARDS
Radiation, Renal failure
Drugs - C+ media, narcotics,  heroin
MI
O2 therapy
Near drowning 
Transfusion reaction 
HP

Question 2

Batwing

Answer 2

Pulmonary oedema
Bronchopn
PCP
Viral pn

Question 3

Reverse batwing

Answer 3

OP
Bronchoalv  carcinoma
Sarcoidosis
EG pn.
vasculitis
contusion
pulm haemorrhage

Question 4

Anterior mediastinal mass fx

Answer 4

Hilum  overlay 
Obliterates l & r heart border
Paravertabral/Para tracheal stripe thick
Blunt margins above clavicle
Retrosternal clear space preserved on lateral

Question 5

Anterior mediastinal mass ddx

Answer 5

5Ts
thyroid
teratoma
terrible lymphoma
thymoma
thoracic aorta

Question 6

Middle mediastinal mass fx

Answer 6

lt and rt paratracheal stripe >5mm
loss of Aortopylm window
loss of hilarious strictures visible
loss SVC
lateral doughnut sign

Question 7

middle mediastinal mass ddx

Answer 7

LN
bronchial ca
vascular aneurysm
bronchitis cyst
tracheal mass

Question 8

posterior mediastinal mass fx

Answer 8

widened Paravertabral lines
cervicothoracic sign
azygo-oesophageal line disrupted
hilum and cardiac borders visible

Question 9

Posterior mediastinal mass ddx

Answer 9

along VBS - Mets, myeloma, extramedullary haematopoiesis, ganglioneuroma
anterior upper - oesophageal, aorta, thyroid
anterior lower - hiatus hernia, bochdalek hernia

Question 10

if PE go to limb aa

Answer 10

must have PFO. need to do echo to assess heart and urgent embolectomy or thrombolysis
when have PE always suggest assess for DVT

Question 11

thallium vs gallium

Answer 11

thallium. Kaposi sarcoma and lymphoma both positive

gallium. lymphoma positive, Kaposi negative

Question 12

upper lobe fibrosis

Answer 12

CASSET P
CF
Ank spon
Sarcoidosis
Silicosis
EG
Tb
PCP

Question 13

halo

Answer 13

infective, neoplasm, haemorrhage, other

infective. atypical ( fungus, angio invasive, cryptococcus coccidicoyoycosis,),,mycobacteria, septic embolism, viral (HSV, cmv)
neoplasm. lymphoma, adenocarcinoma, Kaposi, scc
haem. trauma, Wegeners
other. EG, op,

Question 14

reverse halo

Answer 14

fungal pn
op
Tb
infarct
Wegeners
radiation necrosis 
alveolar sarcoid

Question 15

cavitation

Answer 15

CAVITY
CA.  SCC, mets
autoimmune - rheumatology nodule, PMF
Vascular. Wegeners 40s, good pastures 20s. check kidneys. septic or bland embolism
Infection. staph, Tb,  klebsiella, staph
Trauma. pneumatocele, haematoma
Youth. CCAM,  sequestration

Question 16

non resolving consolidation

Answer 16

wrong abx
immunocompromised
bronchial obstruction
recurrent aspiration
underlying pathology. abscess, bronchiectesis, sequestration, mass
organising pneumonia

Question 17

pulmonary calcification

Answer 17

single focus:
granuloma. previous mycoplasma infection
hamartoma. fat
neoplasm. carcinoid, GI (central or popcorn), osteosarcoma ( solid)
rxt
old infarct or injury

multiple foci:
healed miliary Tb, fungal or VCV
silicosis
post rx lymphoma
alveolar microlithiasis (sand lung)

interstitial:
chronic bronchitis
ARDS
asbestosis
busulphan long term use

Question 18

eggshell ca+

Answer 18

Tb
sarcoid
silicosis
pneumoconiosis
lymphoma. post rx
ddx: pulm aa, aortic, ant mediastinal mass (thymoma, teratoma)

Question 19

unilateral hyperlucent hemithorax

Answer 19

Swyer James.  post viral or mycoplasma as child
Pulm agenesis with hypertrophy other lung
Pneumonectomy
Ptx
Obstruction with air trapping
Embolism
Mucous plug
Mastectomy 
Poland sx

Question 20

bilateral hyperlucency

Answer 20

Normal lung volume:
oligaemia 2ndry to congenital heart abno. rt to lt shunt
bilateral PE
pulm htn

Increased lung vol:
emphysema
asthma
bronchiolitis. kids <1yo

Question 21

unilateral opacity hemithorax

Answer 21

mediastinum centre:
airspace opacity. infection, oedema, haem, tumor
pleural effusion
chest wall mass/lipoma
rotation

mediastinum towards opacity:
vol loss. obst with atelectesis
Pneumonectomy
pulm agenesis/hypoplasia
mesothelioma

mediastinum away from opacity:
mass effect.  
mesothelioma
pleural effusion, hemithorax,  chylothorax
red hepatisation

Question 22

bronchial obst

Answer 22

within lumen. inh Fb, mucous plug, ett, aspergilosis, bronchiolithiasis
within wall. carcinoid, bronchogenic ca, sarcoid, bronchial atresia, # bronchus
external. mediastinal mass. LN, primary or 2ndry malig, aortic aneurysm, LA enl, anomalous lt pulm aa arising rt pulm aa (rt main bronchus obst)

Question 23

bronchiectesis

Answer 23

UL. CF, rxt, Tb, ABPA, endoluminal mass
ML. lady wyndimere non Tb mycoplasma. Mac
LL. ciliary dyskinesias, kartagners, asthma, chronic aspiration, ctd, viral infection as child, CCAM, ABPA, Williams Campbell (no cartilage in walls)

Question 24

CF
bugs
abdo manifestations
chest manifestations

Answer 24

mycoplasma, pseudo Minas, staph aureus

abdo: me plug, rectal prolapse, cirrhosis, panc atrophy or ca+, GORD
chest: recurrent infections, ABPA, bronchiectesis UL bilateral, Pulm aa htn with bronchial aa dilatation

Question 25

airspace opacity

Answer 25

acute or chronic Acute: fluid. cardio and non cardio haem. Wegeners, good pastures, contusion, Pulm heamosiderosis, anti GBM infection. PCP, Tb, VCV, viral pn, bronchopn infarct ``` Chronic. sarcoid EG OP lymphangitis ca Malignancy. adenoca, lymphoma lipid pn sequestration ```

Question 26

pulmonary cysts

Answer 26

LCH. nodules>cavitate>bizarre cysts. smoker. LAM. even distribution. female childbearing age. check kidneys for AML and uterus for leiomyoma LIP. smooth and scattered. GGO and nodules. bronchovascular thickening. immunocompromised or CTDs Birt hogg dube. AD. pulm cysts basal and large +/- multiseptated, bilateral renal RCC/Oncocytoma and cutaneous angiofibromas acquired. PCP, cystic bronchiectesis, honeycombing, end stage sarcoid, pneumatocele, cryptococcus, staph a, hydatiform congenital. CCAM, congen lobar emphysema, pie, bpd

Question 27

nodules mx

Answer 27

benign ca (solid, popcorn, lamellar, central, target), fat = leave alone 4-8mm flies cheer >8mm bx, PET

Question 28

SPN

Answer 28

``` granuloma primary neoplasm met hamartoma carcinoid infection. pneumonia (round in kids, pneumococcal), hydatid, round atelectesis, OP autoimmune. RA, Wegeners, sarcoid vascular. AVM (multiple HTT), haematoma congenital. sequestration, bronchogenic cyst, intrapulm LN ```

Question 29

mets to lung

Answer 29

breast sarcoma RCC seminoma

Question 30

cannonball mets

Answer 30

rcc chorioca prostate

Question 31

flieschner

Answer 31

low risk: 4-6. 12m 6-8. 6 and 18m >8. 3, 9, 24m ``` high risk: <4. 12m 4-6. 6 and 18m 6-8. 3, 9, 24m >8. bx +/- pet ```

Question 32

pinpoint nodules

Answer 32

``` must be dense if can see. barytosis. MZ silicosis. UZ stannosis. Even UZ and LZ alveolar microlithiasis. sand lung with obliteration of heart and diaph shadow talcosis ```

Question 33

miliary nodules

Answer 33

ST density: febrile or afebrile Febrile: Tb, fungal, early HP Afebrile: CWP (MZ and spares bases and apicies), sarcoid (MZ and UZ), Miliary TB, Mets (LZ), HP High density: heamosiderosis (middle age male), silocisi, barytosis, stannosis, healed VZV

Question 34

conglomeration of nodules

Answer 34

``` sarcoid silicosis. PMF secondary mets bronchoalveolar ca in situ Tb fungal HP EG lymphoid granulomatosis ```

Question 35

reticular density cxr

Answer 35

``` acute or chronic. Acute: pulm odema. cardiacardiac or non infection. Viral, PCP, mycoplasma drug reaction pulm haemorrhage ``` Chronic: post infectious scars. Tb, PCP chronic interstitial oedema. MR/MS CTDs. Ank spon, RA, scleroderma (oesoph dilated) pulm haem inhalation. asbestosis (LZ), CW (MZ), HP (MZ), silicosis (UZ) sarcoid drugs. amiodarone (bright liver), chemo, rxt neoplasm. lymphangitis carcinomatosis, lymphatic spread, lymphoma idiopathic. UIP, TS, LAM, amyloid

Question 36

lymphangitis spread ca

Answer 36

breast stomach thyroid

Question 37

HRCT nodule distribution

Answer 37

Centrilobular, perilymphatic, random Centrilobular: TIB. infection No TIB. infection, HP, oedema, RB-ILD, adenoca, early LCH, vasculitis Perilymphatic: patchy. Sarcoid, silicosis, CWP, LIP, lymphoma, amyloid, perilymphatic spread ca Random: Haem mets, early LCH, Miliary TB, Miliary fungal, HP

Question 38

Honeycomb

Answer 38

UIP Fibrosis sarcoid Chronic HP

Question 39

reticulonodular

Answer 39

Lymphangitis carcinomatosis Silicosis Sarcoid

Question 40

Crazy paving

Answer 40

``` GGO with interlob septal thickening Pulm alv protinosis ARDS PCP Bacterial pn Pulm.oedema NSIP RXT Alveolar sarcoid ```

Question 41

Mosaic

Answer 41

sharply defined and geographical airtrapping- stays lucent on exp (should normally be more opac) any small airways disease, so ignore unless main finding constructive bronchiolitis asthma HP Vascular cause-oligaemia rather than airtrap (Pulm stenosis, congen heart rt to lt shunt, big PEs)

Question 42

UIP pattern

Answer 42

definate must have all 4: 1. subpleural basal predomin 2. reticulation/traction bronchiectesis 3. honeycomb 4. absence of inconsistent findings possible UIP: no honeycomb ``` Inconsistent: UZ or MZ Peri bronchovascular Extensive GGO Profuse nodules Discrete cysts Diffuse mosaic/airtrap Consolidation ```

Question 43

Causes of UIP

Answer 43

``` IPF CTD. RA (Scleroderma and polymyositis NSIP, sjogrens and RA LIP) Asbestosis HP CWP and silicosis Sarcoidosis Drugs. bleomycin, cyclophosphamide Bone marrow tx ```

Question 44

Causes OP

Answer 44

``` Infection Drugs Fumes HP COP. idiopathic ```

Question 45

NSIP

Answer 45

``` Basal and subpleural GGO Reticulation/fibrosis +/- cysts Homogenous. No normal lung between ``` younger than UIP (40-50s) inflammatory type. better prognosis fibrotic type. inflamm, RB-ILD, DIP, OP and LIP progress to

Question 46

Causes NSIP

Answer 46

``` Drugs CTDs Idiopathic RB-ILD/DIP OP LIP ```

Question 47

HIV Infections

Answer 47

CD4 >200. Tb, viral and bronchopn (GGO and TIB) CD4 <200. MAC, PCP, CD4 <100. CMV, Disseminated fungal (candida, cryptococcus, aspergilosis), lymphoma, Kaposi Chronic. Lymphoma, kaposis

Question 48

Aspergillus

Answer 48

N immunity. Aspergilloma. fungal ball in pre existing cavity. CF, sarcoid, TB, emphysema Decreased immunity. angioinvasive aspergillosis. infiltrates bronchial aa and can disseminate kidneys, cns, git. nodules with GG halo airways invasive. infiltrates BM. wall thickening, bronchiolitis, TIB Hyperimmunity. ABPA. Chronic asthma, CF. Finger in glove mucous plugging.

Question 49

Emphysema

Answer 49

Centrilobular. UL with central dot. Smokers. can cause pulm htn Pan lobular. LL. alpha 1 at. middle aged men. cirrhosis, panc ca and intracranial aneurysms Paraseptal. Smokers. Maran, IVDU, HIV

Question 50

Primary lung ca

Answer 50

SCLC. Central. Neuroendocrine, local invasion into SVC, paraneoplastic. NSCLC. Adenoca, Large cell, Sq Adenoca. Peripheral. lobular or multiple small nodules. pseudo cavitation (bubbly), can be lepeidic. Non smokers Large cell. peripheral and >4cm Sq. cell. Central, cavitating, panc past, rib invasion

Question 51

Primary lung cancer mets to

Answer 51

``` Brain Bone Adrenals LN Liver ```

Question 52

Unilateral pleural effusion

Answer 52

Tumour. Mesothelioma, mets, bronchogenic ca, lymphoma Infection. Klebsiella, Empyem, parapneumonic, etc of subdiaph inf Chylothorax. ruptured or injured thoracic duct, tumour infiltration Haemorrhage. trauma, iatrogenic

Question 53

Plural effusion

Answer 53

Transudate, exude, chylothorax or haemothorax Transudate. CCF, CRF, Meigs (ovarian tumor. Rt>lt), Liver failure Exudate. Protein >30. Infection, malig (lung, breast, ovary, lymphoma), infarct/PE, CVD (RA, SLE), Pancreatitis, subphrenic abscess, drugs (phenytoin) Haem. trauma, aneurysm, carcinoma, bleeding disorder

Question 54

elevated diaphragm

Answer 54

``` Phrenic nn palsy. tumor, trauma, iatrogenic Subpulmonic effusion. diaph peaks lateral (medial peak = LL collapse) Liver or spleen enl subphrenic mass Eventration Ascities splint in from pain hemiplegia scoliosis ```

Question 55

Empyema

Answer 55

``` obtuse angles with wall split rind C+ - pleural enhances late so do delayed scan (ie PV) air/fluid level biconvex cf crescentric *gram -ve, pneumococcus in kids, tb ``` Empyema necessitans. erodes into chest wall and OM ribs. +/- fistula

Question 56

pleural ca+

Answer 56

``` old empyema old haemothorax talc pleurodesis asbestos silicosis ```

Question 57

PTx

Answer 57

spontaneous. 20yo tall thin. ruptured subpleural bleb iatrogenic trauma lung disease. emphysema/bulla, CF, PCP, cystic lung disease, honeycomb, pn bronchopleural fistula. enl over time. don't resolve with chest drain alveolar rupture. asthma, ventilation, ards

Question 58

Pleural mass

Answer 58

Mets. adenoca, breast and bronchus mesothelioma pleural fibroma. smooth, 2-15cm diam, pedicle and changes location on moving, c+ homogeneous. located effusion lipoma invasion from chest wall mass.. ewings fibro thorax. smooth wall cx thickening. prior Tb, empyema or haemothorax. v. high density with ca+ (cf meso)

Question 59

Rib notching

Answer 59

``` Superior. Hyper PTH Osteogenesis imperfecta RA SLE Marfan NF ``` Inferior: Vascular collateral. SVC obst, AVM, Aortic coarct, TOF, absent pulm aa Neurogenic tumor. NF neurofibroma, schwannoma

Question 60

Cardiac moguls

Answer 60

1. aortopulm window. Aortic aneurysm, HTN, ectasia 2. Above Lt main bronchus. Pulm stenosis, Pulm aa HTN. Concavity = pulm atresia, rt>lt shunt, TGA 3. Below Lt main bronchus. Lt atrial/appendage enl, coronary aa aneurysm, sinus valsalva aneurysm, cardiac aneurysm

Question 61

Pulmonary HTN

Answer 61

``` Idiopathic. F child bearing age Anything causing hypoxia. Emphysema, chronic lung disease schistosomiasis mitral stenosis chronic PE Lt to Rt shunt. AD, VSD ```

Question 62

Cardiac mass

Answer 62

``` Thrombus Myxoma. Lt atrium > Rt Lipoma Fibroelastoma Rhabdomyosarcoma. Assoc TS. Kids <1yo Sarcoma Mets. Melanoma ```

Question 63

Pericardial mass

Answer 63

``` Primary. Mesothelioma, sarcoma, lipoma, teratoma Mets. Breast and lung Direct invasion from adj Pericardial cyst Pericardial effusion Pericarditis ```

Question 64

Pericardial ca+

Answer 64

``` Pericarditis. Tb Trauma Rheum fever Malignant Renal failure Asbestos plaques myocarditis. rheum fever, MI, aneurysm ```

Question 65

Thoracic outlet sx

Answer 65

``` 7th c rib non union 1st rib aberrant insertion ant scalene mm fibrous band supraclavicular tumour ```

Question 66

cardiac wall outpouching

Answer 66

``` Ventricular aneurysm. often ca+ Enl lt atrial appendage Pericardial cyst Hydatid coronary aa aneurysm myocardial or pericardial 1ry or 2ry malig ```

Question 67

Cardiomegaly

Answer 67

Cardiomyopathy. most xommon cause kids and young adults. Ischaemic, infective, Idiopathic, infiltration (sarcoid, amyloid), etoh, peripartum Pericardial effusion. globular, flask shape Multivalvular disease ASD. Congenital heart disease

Question 68

Rt atrial enl

Answer 68

Rt heart border outpouching on PA. Loss retrosternal clear space on Lat ``` Rt heart failure TR/TS AF AVSD/ ASD Anomalous pulm vv return Rt atrial obst. myxoma ```

Question 69

Rt Ventricle enl

Answer 69

Elevated cardiac apex PA Anterior prominence on Lat ``` TR/PR/PS ASD/VSD Anomalous pulm venous return Pulm HTN Acute PE ```

Question 70

Lt atrial enl

Answer 70

3rd mogul, double rt heart border, elevated lt main bronchus, splayed carina on PA Prominent upper posterior heart border, oesoph impression, posterior displacement lt main bronchus on Lat. ``` MR/MS VSD PDA LV failure MV obst. myxoma ```

Question 71

Lt ventricle enl

Answer 71

Cardiac apex down and out on PA Posterior inferior heart prominence on Lat ``` STEMI Dilated CM AR/AS MR HTN PDA ```

Question 72

Honeycomb vs cysts

Answer 72

Honeycomb thick walled | cysts thin walled