Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
69 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
IVDU patient presents with fever, cough, and CXR with multiple bilateral pulmonary opacities. Most likely:
A) Bacterial endocarditis B) Metastasis C) Staph PNA D) Strep PNA E) Lemierre's Disesease |
A) Bacterial endocarditis
|
IV drug abusers get endocarditis of the tricuspid valve (right-sided endocarditis), which causes multiple septic pulmonary emboli. Mortality rate is only 3%-9%, lower than left-sided [aortic valve] endocarditis.
|
|
|
40. A 24 year old confused, disoriented male has Cheyne-Stokes respiration and bilateral upper lobe opacities. Most likely cause:
A. Septic emboli B. Aspiration C. Neurogenic pulmonary edema D. Pneumonia E. Alveolar proteinosis |
Answer: C) Neurogenic pulmonary edema
|
Cheyne Stokes respiration is cyclic alternations between apnea and hyperpnea, in which PCO2 fluctuates and is unstable. It occurs when the respiratory centers of the brain become insensitive to changes in CO2. Thus this is a neurogenic event.
|
|
|
41. Acquired bronchiectasis is seen in all of the following except:
A. Idiopathic pulmonary hemosiderosis B. Immotile cilia C. CF D. Immune disorders |
Answer: A) Idiopathic pulmonary hemosiderosis
|
Idiopathic pulmonary hemosiderosis is an old term, nowadays referred to as idiopathic pulmonary hemorrhage (IPH). Radiographically it is indistinguishable from Goodpasture’s. There are recurrent bouts of pulmonary hemorrhage resulting in airspace disease. As it resolves one can see numerous centrilobular tiny nodules on HRCT. With recurrent bouts of hemorrhage, hemosiderin is deposited in the interstitium and can result in progressive fibrosis. I realize that any pulmonary fibrosis can result in traction bronchiectasis, but bronchiectasis is not described with IPH and even if one may theoretically see them, they will not form the predominant pattern.
|
|
|
42. Of the following, what is the most common cause of pneumomediastinum:
A) Alveolus rupture B) Extension of pneumothorax C) Bleb rupture D) Extension of pneumoperitoneum |
alveolar rupture
|
|
|
|
43. A focal consolidation in the lung demonstrates Hounsfield units greater than 125 on chest CT. What is the most likely cause?
a. Amiodarone toxicity b. Pseudolymphoma c. Bronchogenic CA d. Sarcoid |
Amiodarone toxicity
|
Because amiodarone contains about 37% iodine by weight, it has a high attenuation value on CT. Question also recalled in the GI section with the liver presenting with a 125 HU attenuation. Note, must have liver deposition before lung findings because of clearance through liver.
|
|
|
45. Least likely nontreated condition to have mediastinal calcification:
a. lymphoma b. thymoma c. teratoma d. thyroid goiter |
lymphoma
|
|
|
|
47. Most common radiologic finding for a bronchoalveolar cell carcinoma is?
A) Solitary pulmonary nodule B) Peripheral focal infiltrate |
A) Solitary pulmonary nodule
|
|
|
|
48. Thymic carcinoid is most likely to present with:
A. SIADH B. Cushings syndrome C. Hyperinsulinemia D. Carcinoid syndrome E. Tricuspid and pulmonary valve disease |
B) Cushings syndrome due to ectopic ACTH
|
|
|
|
49. Regarding CT guided percutaneous biopsy of a solitary pulmonary nodule, which of the following is false?
A. Seeding of the tract is common B. Patients with COPD have a greater risk of pneumothorax C. 90% sensitivity for malignancy D. It is more difficult to establish a benign diagnosis than malignant |
A) Seeding of the tract is common (reported, but uncommon)
|
|
|
|
51. Which of the following has increased Functional Residual Capacity:
A. EG B. COPD C. Asbestosis D. IPF |
copd
|
Functional Residual Capacity (FRC) is the volume of air remaining in the lungs after a normal expiration (TV) and includes Expiratory Reserve Volume (ERV) and Residual Volume (RV). Increased FRC is due to obstructive disease. COPD leads to increased total lung capacity and residual volume thus increasing FRC. FEV1, FEV1/FVC, and diffusing capacity are all reduced in COPD. Asbestosis and IPF are restrictive diseases.
|
|
|
53. Which is not associated with calcified mediastinal or hilar lymph nodes (and a miliary pattern of disease (on some recalls))?
A. Histoplasmosis B. TB C. EG D. Silicosis E. Sarcoid |
EG
|
Pulmonar histiocytosis x or EG: (also called Langerhans cell histiocytosis or eosinophilic granuloma of the lung), an uncommon idiopathic disease characterized in its early stages by granulomatous nodules containing Langerhans histiocytes and eosinophils, which are primarily peribronchial.
|
|
|
54. What is seen with RUL collapse
A. Juxtaphrenic peak B. Medial deviation of the bronchus intermedius C. Expansion of the posterior aspect of the RML D. Herniation of the posterior aspect of the LUL E. Rotation of the left mainstem bronchus |
A) Juxtaphrenic Peak
|
|
|
|
55. What is a cause of isolated RUL edema?
A. Mitral Stenosis B. Mitral Regurgitation C. Tricuspid stenosis. D. Aortic stenosis. E. Aortic regurgitation. |
B) Mitral regurgitation
|
Asymmetric RUL edema (9%) due to preferential flow of the regurgitant jet being preferentially directed toward the right superior (RUL) pulmonary vein with subsequent increases in hydrostatic pressure in that portion of the lung. This is pathognomonic.
|
|
|
56. Which of the following is true regarding chronic eosinophilic pneumonia
A. Quick response to treatment B. Multiple relapses if tx stopped C. Peripheral eosinophilia is uncommon D. Male>Female |
Multiple relapses if treatment stopped
|
Eosinophilia and hypoxemia both almost universal. Bilateral peripheral lung opacities, "photographic negative of pulmonary edema". Steroids rapidly suppress both clinical and radiographic abnormalities.
|
|
|
57. Which of these is not upper lobe predominate in distribution?
A. Centrilobular emphysema B. Eosinophilic granuloma C. Alpha one antitrypsin deficiency D. Sarcoid E. Silicosis |
D) Alpha-1 antitrypsin deficiency
|
• Alpha 1 anti-trypsin : Diffuse or lower lobe predominance
• EG = Bilateral middle and upper lobes, with relative sparing of the costophrenic angles. • Silicosis = Upper lobes (especially posterior) and parahilar regions. • Sarcoidosis = Patchy upper lobe distribution, sometimes diffuse • Centrilobular emphysema = Symmetric involvement of upper lobes |
|
|
60. Best sign for pneumothorax on a supine radiograph is:
A. Deep sulcus sign B. Continuous diaphragm sign C. Nacleiros V sign D. Westermark sign |
A) Deep Sulcus sign
|
Deep sulcus sign occurs b/c the anterior costophrenic angle becomes sharply delineated and thus the lateral costophrenic sulcus appears abnormally deep and hyperlucent. Approximately 30% of pneumothoraces present on supine radiographs remain undetected. In a supine pt, the most nondependent portion of the pleural space is anterior or anteromedial. Continuous diaphragm sign is seen in pneumomediastinum.
Nacleiros V sign represents gas outlining the lateral descending aorta and extending b/w the parietal pleura and medial hemidiaphragm, sign of pneumomediastinum. Westemark sign is focal pulmonary oligemia in pulmonary embolism. |
|
|
62. For mediastinoscopy by a midcervical approach, which group of lymph nodes is difficult to access:
A. High right paratracheal B. High left paratracheal C. Low right paratracheal D. Low left paratracheal E. AP window |
Ans: AP window
(if AP window is not a choice, then lft paratracheal is answer) |
It should be noted that mediastinoscopy does not access all mediastinal lymph nodes. The nodes around the aortopulmonary window and aortic arch are difficult to reach, and the prevascular, retrotracheal, paraesophageal, and inferior pulmonary ligament areas are inaccessible. In general, the nodal stations that can be assessed are in a plane anterior to the trachea.
|
|
|
63. HRCT finding consistent with interstitial lung disease is:
A. Alveolar edema B. Bat wing or perihilar distribution C. Confluent consolidation D. Honeycombing E. Air Bronchograms |
D) Honeycombing
|
Honeycoming is diagnostic of fibrosis and an interstitial process.
|
|
|
68. 40 year old female with fasting glucose of 20, lower extremity weakness, insidious onset of fatigue, and CXR showing large peripheral mass. What is the most likely etiology:
a. undifferentiated large cell lung CA b. pleural blastoma c. fibrous tumor of the pleura |
Answer: C) Fibrous tumor of the pleura
|
Localized fibrous tumor of the pleura (LFTP) is a benign mesothelioma (no association with asbestos exposure). It is largely resectable, even when the size is large, and has a favorable prognosis. Episodic hypoglycemia is seen in 4%; hypertrophic pulmonary osteoarthropathy [pain / swelling of limbs, especially tibia / fibula] in 20-35%. Other Sx include dyspnea and cough.
-Dähnert 5th p. 504, 104 |
|
|
69. On a CT, which other origin is seen at the level of the origin of the right middle lobe medial segment bronchus?
A. right lower lobe - anterior basal segment B. right lower lobe - lateral basal segment C. right lower lobe - posterior basal segment D. right lower lobe - medial basal segment E. right lower lobe - superior segment |
Answer: (E) Right lower lobe - superior segment
|
Superior segment of the right lower lobe bronchus originates at the level of the RML bronchus
|
|
|
70. The histological findings of usual interstitial pneumonia are indistinguishable from which of the following interstitial lung diseases:
a. Alph-1-antitripsin deficiency b. sarcoidosis c. scleroderma d. centrilobular emphysema e. alveolar proteinosis |
Answer: (C) Scleroderma
|
I have seen other tests where the answer is lupus- look for a collagen vascular disease
Sarcoid: parenchymal dz predominantly mid-zone with reticular nodular pattern (46%), progressive fibrosis with upper lope retration (20%) LAM: randomly scattered pulmonary cysts. Centrilobular emphysema: upper lobe distribution of emphysematous change. Alveolar proteinosis: alveoli filled with proteinaceous material with normal interstitium. Alpha-1 antitripsin deficiency: panacinar emphysema. Scleroderma: pulmonary dz occurs in 10-66% of cases with bibasilar pulmonary fibrosis. Histologically this resembles the pattern of usual interstitial pneumonia. This is the best answer. |
|
|
71. The cancer most likely to metastasize through unilateral lymphangitic spread is:
a. Breast b. Lung c. Stomach d. Colon e. Thyroid |
lung
|
Bronchogenic carcinoma is the most common cause of unilateral lymphangitic carcinomatosis.
|
|
|
72. Which of the following most commonly results in an exudative pleural effusion?
a. congestive heart failure b. noncardiogenic edema c. cirrhosis d. nephritis e. malignancy |
Malignancy
|
|
|
|
74. Which of the following pathologic changes is most closely associated with smoking:
a. panlobular emphysema b. centrilobular emphysema c. lower lobe distribution d. early bullae formation e. early bronchiectasis |
Centrilobular distrib.
|
There are four major types of emphysema defined anatomically. These are: 1. Centrilobular or centriacinar; 2. panlobular or panacinar; 3. paraseptal (distal acinar) emphysema; and 4. paracicatricial (irregular).
Centrilobular emphysema affects the predominately the respiratory bronchioles in the central portion of the secondary pulmonary lobule. It usually identified in the upper-lung zones, and it is associated with cigarette smoking (causes up to 50%). Panlobular involves all the components of the acinus an therefore involves the entire lobule. It is classically associated with alpha-1 protease inhibitor (alpha-1-antitrypsin) deficiency (cause in 10-15%), although it may be seen without protease deficiency in smokers and eldely. Paraseptal involves the distal part of the secondary lobule (alveolar dusts and sacs). It can be an isolated phenomenon in young adults, and is associated with spontaneous pneumothorax. |
|
|
77. In which of the following would CT densitometry be most useful?
a. alveolar proteinosis b. BOOP c. Lipoid pneumonia d. Tuberculosis e. Bronchiolitis obliterans |
Lipiod pna
|
Lipoid pneumonia may show a mass of low-attenuation approaching that of subcutaneous fat (-150 to 50 HU). When seen, this is very specific.
|
|
|
78. Which of the following thoracic masses demonstrates the most vigorous contrast enhancement?
a. thymoma b. teratoma c. paraganglioma d. lymphoma e. cardiac myxoma |
Answer: (C) Paraganglioma
|
Paragangliomas are tumors of the paraganglionic cells and in the chest are chemodectomas or functioning paragangliomas. Chemodectomas are aortic body tumors and are seen as masses of the aortopulmonary window. Functioning paragangliomas occur rarely in the chest and mostly in the posterior mediastinum. These masses are usually extremely vascular and enhance brightly at enhanced CT. At MRI they may show high signal intensity on T2 wieghted images.
|
|
|
82. Which of the following does not demonstrate a crazy-paving pattern on CT:
A. Alveolar proteinosis B. ARDS C. Centrilobular granulomatosis D. Sarcoid E. Lipoid pneumonia |
Ans: C) Centrilobular granulomatosis
|
Crazy paving causes: pulmonary alveolar proteinosis, ARDS, PCP, Lipoid pneumonia.
|
|
|
83. A 60 year old female has recently been diagnosed with adenocarcinoma of the lung. She presents to her physician with acute onset of dyspnea. Which of the following would be the most likely reason for her shortness of breath:
A. Malignant pleural effusion B. Metastatic disease to the right diaphragm C. Invasion into a bronchus resulting in atelectasis D. Involvement of the vagus nerve |
Answer: C) Invasion into a bronchus resulting in atelectasis
|
BAC (most common subtype of adenoca) can appear as air space consolidation and is the second most common radiographic pattern (30% first is solitary nodule). This is due to tumor growth along the alveolar wall combined with secretion of mucin. Copious production of mucin leads to expansion of the lobe and the bulging fissure sign. Occasional cavitation may be seen in the consolidated lung.
|
|
|
87. For a patient with left vocal cord paralysis, which portions of the thoracic anatomy need to be included in a CT scan:
A. Aortico-pulmonary window B. Left common carotid artery C. Diaphragm D. Thoracic inlet |
AP window
|
The recurrent laryngeal nerve is a distal vagal branch which provides motor function to the inferior constrictor muscle and endolaryngeal muscles (vocal cord function). The Vagus nerve (X) exits the cranium at the jugular foramen and plunges along the posterolateral aspect of the carotid artery to the AP window on the left and the clavicle on the right.
|
|
|
89. Rounded atelectasis is most likely due to: (note: pleural plaques was not an answer choice)
A. Pleural effusion B. Lobar consolidation C. Pneumothorax D. Bronchogenic carcinoma |
Ans: A Pleural effusion (although if asbestos was an option, that would be correct answer)
|
|
|
|
90. All are true regarding type 2 pneumocytes except:
a. can regenerate b. have intracellular bridges c. synthesize DNA d. produce surfactant |
B. have intracellular bridges
|
Type 2 pneumocytes are capable of mitosis (therefore they can regenerate and must be able to synthesize DNA) and are thought to produce surfactant.
|
|
|
91. Which of the following cell types can serve as pluripotent cells in repairing the alveoli?
a. type I pneumocyte b. type II pneumocyte c. stem cells d. macrophage e. capillary endothelial cells |
Type 2 pneumocytes
|
Type II pneumocytes produce surfactant, have phagocytic ability and regenerate.
The Type I pneumocyte is a very large, thin cell stretched over a very large area. This cell cannot replicate and is susceptible to a large number of toxic insults. Type I pneumocytes are responsible for gas exchange occurring in the alveoli. |
|
|
93. Malignant mesothelioma is grossly and histologically most similar to:
a. adenocarcinoma b. invasive thymoma c. melanoma d. lymphoma e. uremia |
AdenoCA
|
|
|
|
94. HRCT shows multiple fluffy, ill-defined 2-3 mm V or Y shaped opacities which are subpleural (2-3 mm from pleura) and adjacent to the bronchiole; the most likely etiology is:
a. PCP b. acinar c. edema d. lymphangitic carcinamatosis e. interstitial edema f. Bronchiolitis |
Answer: Bronchiolitis
|
Bronchiolitis: HRCT shows bronchiectasis and bronchiolectasis, mosaic perfusion, air trapping, tree in bud, centrilobular ground-glass opacities. Both the subpleural Y and V-shaped structures, as well as the tree in bud appearance, reflect mucus impacted in the small bronchi.
Lymphangitic spread: HRCT shows nodular thickening of bronchovasc bundles, polygonal arcades, beaded septal thickening, subpleural thick, pleural fluid Ref: Thoracic requisites and Dahnert |
|
|
95. HRCT shows polygonal appearing structures with central dots, subpleural in location; the most likely etiology is:
a. PCP b. acinar c. edema d. lymphangitic carcinomatosis e. interstitial edema f. Bronchiolitis |
d. lymphangitic carcinomatosis
|
Lymphangitic spread can also present with nodules 2-3 mm from the pleura, although it is more likely to extend to the pleura and along septal lines, as it obstructs the lymph flow. Lymphangitic spread would show thickening of the septa as well as of the central dot in the secondary pulmonary lobules. Airspace disease would manifest as consolidation. On CT, lymphangitic carcinomatosis presents as circumferentially thickened linear irregular/nodular “beaded” densities forming a reticular network and as well-defined polygonal lines (=interlobular septa).
|
|
|
97. Pleurodesis agents include all of the following except:
a. minocycline b. doxycycline c. talc d. tetracycline e. ethyl alcohol f. bleomycin |
E. ethyl alcohol
|
|
|
|
98. Common chest findings of rheumatoid arthritis include all of the following EXCEPT:
a. cavitating lung nodules b. pleural effusion c. lymphadenopathy d. pleuritis e. basilar fibrosis/interstitial disease |
LAD
|
Pulmonary manifestations in RA are more common in men. Manifestations are: exudative pleural effusions, alveolitis, basilar interstitial fibrosis and are usually preceded by joint involvement. Lung fibrosis is typically bilateral, peripheral and lower lobe predominant. Patients have pulmonary nodules termed necrobiotic nodules which are peripheral and usually less than 1 cm in diameter but can exceed 5 cm and may cavitate. Arteritis, pulmonary hypertension and bronchiolitis obliterans may also occur. Caplan syndrome is fibrotic nodules occurring in coal miners with rheumatoid lung.
|
|
|
100. Regarding a patient with AIDS and tuberculosis, which of the following is false?
• AIDS patients respond to anti-TB drugs just as well as immunocompetent patients. • Resistant strains in institutionalized patients are common • Miliary pattern is common • May present with adenopathy alone • There is a lack of inflammatory cells in pathologic specimens |
C. Miliary pattern is common
|
TB in AIDS patients is usually reactivation TB, and it occurs with less severe immunocompromise than other opportunistic infections. With mild degrees of immunocompromise, TB usually manifests with a typical reactivation pattern – cavitary disease involving the apicoposterior segments of the upper lobes and superior segments of the lower lobes without adenopathy. As the immunocompromise worsens, the pattern comes to resemble primary TB with prominent adenopathy, and possible dissemination of the disease through the lungs, pleura, and other parts of the body.
|
|
|
101. Pulmonary vascular resistance is highest at:
• main pulmonary artery • Segmental arteries • Subsegmental arteries • Muscular arterioles • Capillaries |
Capillaries
|
The site of greatest pulmonary vascular resistance is the site of greatest pressure drop, i.e., the pulmonary capillaries.
|
|
|
102. Which nerve passes beneath the aortic arch at the aorticopulmonic window?
• left vagus nerve • right vagus nerve • left recurrent laryngeal nerve • right recurrent laryngeal nerve • left phrenic nerve |
lft recurrent laryngeal
|
|
|
|
103. The azygos vein enters the SVC at which location?
a. Anterior aspect inferior to the right main bronchus b. Posterior aspect inferior to the right main bronchus c. Anterior aspect superior to the right main bronchus d. Posterior aspect superior to the right main bronchus |
d. Posterior aspect superior to the right main bronchus
|
|
|
|
104. The most common symptom in idiopathic pulmonary fibrosis is:
A. Dyspnea B. Hemoptysis C. Chest pain D. Weight loss E. Fatigue |
Answer: A - Dyspnea
|
• Dyspnea upon exertion is the most common symptom. Most patients have a nonproductive cough in the early part of the disease, and approximately 50% have constitutional symptoms (eg, flulike illness, fatigability, weight loss, arthralgias).
• Approximately 5% have no presenting symptoms when IPF is diagnosed. |
|
|
105. Which entity appears most like lymphangioleiomyomatosis on high resolution computed tomography?
A. Langerhans cell histiocytosis B. Silicosis C. Panolobular emphysema D. Centrilobular emphysema E. Sarcoidosis |
LCH
|
LYMPHANGIOLEIOMYOMATOSIS (LAM): Proliferation of smooth muscle cells along lymphatics in lung, thorax and abdomen. Unknown etiology. Rare. Clinical: young women presenting with spontaneous pneumothorax, chylothorax, hemoptysis, slowly progressive dyspnea. 10-year survival 75%. Similar lesions may be seen in tuberous sclerosis (LAM has been dubbed a form of tuberous sclerosis).
|
|
|
107. How can you best differentiate sarcoid from lymphangitic spread of tumor?
• Peribronchovascular nodules • Subpleural nodules • Architectual distortion • Ground glass opacities |
Answer: C - architectural distortion
|
Architectural distortion indicates fibrosis and is not seen in lymphangitic spread of tumor.
|
|
|
108. Most common presentation of fulminant legionella at peak severity of symptoms?
• Unilateral lobar consolidation • Lobar consolidaton with cavitation • Bilateral diffuse interstitial infiltrates • Bilateral consolidation |
ANSWER: D - Bilateral consolidation
|
|
|
|
109. Regarding mosaic attenuation lung disease seen on high resolution CT—which study is best to help narrow the differential?
• Expiratory CT • Standard contrast-enhanced CT • FDG PET • V/Q scan • Decubitus CXR |
Exp CT
|
Three different processes may cause a mosaic pattern of lung attenuation: (1) patchy airspace dz; (2) diffuse small airway dz (ie, bronchiolitis), which causes patchy areas of air trapping and hyperlucency; or (3) patchy perfusion 2° to vascular dz. The goal is to distinguish small vessel from small airways disease. Expiratory CT can confirm air-trapping as the cause for mosaic attenuation.
|
|
|
Which part of the secondary pulmonary lobule is most often seen on high resolution CT?
• interlobular septa • centrilobular bronchiole • centrilobular lymphatics • centrilobular pulmonary artery • interlobular pulmonary vein |
Answer: D - centrilobular pulmonary artery
|
The hallmark of HRCT is the visualization of the smallest pulmonary unit (seen on gross) which is the secondary pulmonary lobule (about 18-20 acini, each composed of multiple alveoli). The interlobular septae are composed of venules and lymphatics and create a hexagon around the secondary pulmonary lobule. Differential diagnoses are based on whether thickening of the septae is smooth or nodular. Septae can be seen in edema, lymphangitic spread, fibrosis, pneumonias, sarcoid, and even in normals.
|
|
|
As it traverses the diaphragm, the vagus nerve accompanies the
• IVC • Thoracic duct • Azygous • Esophagus • Aorta |
esophagus
|
|
|
|
On a PA chest X-ray, the mediastinal borders are formed by all EXCEPT
• Right atrium • Left atrial appendage • Main PA • Left ventricular outflow tract • Right ventricular outflow tract |
LVOT
|
|
|
|
What CT finding is characteristic of B-cell Lymphoma in an HIV positive patient:
A. Lobar consolidation B. Multiple 1-5 cm scattered masses C. Ill-defined small centrilobular nodules D. Mediastinal adenopathy |
Answer: B - Multiple 1-5 cm scattered nodules/masses
|
AIDS related lymphoma is the major cause of a solitary well defined pulmonary nodule which often coexists with pleural effusion and axillary lymphadenopathy. The CT pattern of multiple well defined pulmonary nodules also strongly correlates with AIDS related lymphoma. If the nodules are ill defined think of Kaposi Sarcoma, Cryptococcus, PCP, TB. Therefore the appearance of ill defined nodules clustered in a perihilar distribution was strongly suggestive of KS.
|
|
|
Which of the following is false regarding subcarinal lymph nodes?
a. Can easily be differentiated from bronchogenic cyst on CT b. Involvement does not preclude surgical resection of primary lung cancer c. Easily accessible by mediastinoscopy d. Can posteriorly displace the left mainstem bronchus |
Answer: A - Can easily be differentiated from bronchogenic cyst on CT
|
|
|
|
A patient is found to have low arterial oxygen saturation which does not improve with the administration of 100% O2. Venous oxygenation is normal. The most likely explanation for these findings is?
• Ventilation-Perfusion mismatch. • Diffusion abnormality • Left-to-right shunt • Right-to-Left shunt |
R-L shunt
|
|
|
|
118. Which of the following entities is not associated with cigarette smoking:
• centrilobular emphysema • extrinsic allergic alveolitis • laryngeal cancer • respiratory bronchiolitis • eosinophilic granulomatosis |
Answer: Extrinsic allergic alveolitis.
|
|
|
|
119. Which vessel lies anterior to the right upper lobe bronchus?
• Truncus anterior • Right superior pulmonary vein • Right interlobar pulmonary artery |
Answer A (truncus anterior)
|
|
|
|
120. Which anatomic structure is anterior to the left upper lobe bronchus?
• Left main pulmonary artery • Superior left pulmonary vein • Main pulmonary artery • Aorta |
Answer: B - Superior left pulmonary vein
|
|
|
|
121. What is not associated with Langerhans Histiocytosis
• Diabetes insipidus • Renal failure • Thymoma • Vertebra plana |
Renal failure
|
Also known as EG, Hand Schuller Christian, Letterer Siwe (disseminated disease with high mortality). Benign form has solitary or multiple bone lesions often in the skull or long bones leading to pain or mass effect. Soft tissue involvement can occur. Floating teeth appearance is characteristic. Hepatosplenomegaly occurs. DI results from pituitary involvement, dysarthria and nystagmus from cerebellar involvement. Thymic involvement can occur. Can see a sequestrum or geographic bone lesion. Involvement of the vertebral body can lead to vertebra plana.
|
|
|
122. Which of the following lung disorders results in increased lung volumes:
A. Idiopathic pulmonary fibrosis B. Asbestosis C. Eosinophilic granuloma D. Bleomycin toxicity E. Lymphangitic carcinomatosis |
EG (Langerhans)
|
A. Fibrosis causes decreased lung volumes
B. Asbestosis – restrictive pattern of lung impairment, fibrosis C. Langerhans – shows combination of restrictive and obstructive patterns, multiple small cysts and diffuse fine reticulonodular pattern, systemic disease associated with cyst and bleb formation, spontaneous pneumothorax, and ill defined nodular infiltrates progressing to fibrosis and honeycomb lung, increased lung volumes in 1/3 of pts (most fibrotic dz have decreased lung volumes!) D. Bleomycin toxicity: The lung disease is usually chronic and leads to bibasilar reticular opacities that may progress to air space consolidation. Peripheral linear and nodular opacities, predominantly in the lung bases, are the earliest findings in bleomycin toxicity |
|
|
123. What is the cause of fibrosing mediastinitis?
|
Causes: mediastinal histoplasmosis, idiopathic. May result in obstruction of pulmonary artery, veins, bronchi. Calcified lymph nodes
|
|
|
|
125. Beta pleated sheets are indicative of
|
Amyloidosis
|
|
|
|
126. Regarding pectus excavatum, which of the following is false?
• can mimic RML consolidation • should be corrected in infancy/neonate • often associated with scoliosis • involves the manubrium and sternum • severity best assessed with U/S |
severity best assessed with U/S
|
|
|
|
127. What is most commonly assoicated with a complete tracheal cartilage ring?
• Esophageal Atresia • Pulmonary Sling • Right Arch with an Aberant Left Subclavian Artery |
Pulmonary sling
|
|
|
|
129. During exercise there is increased blood flow to the pulmonary artery. Why isn’t there pulmonary hypertension?
• Capillaries Dilate • Arterioles Dilate |
Capillaries dilate
|
|
|
|
Most important (predictive) prognostic factor s/p lung volume reduction surgery on CT:
a. Severity of emphysema b. Distribution of emphysema c. Size of the pulmonary artery d. Position of the diaphragm e. Type of emphysema f. CT density of lung |
Distribution of emphysema
|
|
|
|
What is true regarding subcarinal lymphadenopathy?
a. pushes left mainstem posteriorly b. makes surgery contraindicated c. transbronchial biopsy is best way to sample them d. easily accessible by mediastinoscopy e. cannot be easily differentiated from bronchogenic cyst on CT |
Answer: Transbronchial biopsy is best way to sample them
Subcarinal LAD makes Stage IIIA, not IIIB. Pushes L mainstem bronchus anteriorly. Not easily accessible by mediastinoscopy, which is better for upper and anterior LNs. E is just wrong. |
|
|
|
Most important risk factor to progress to lung infarction in setting of PE:
a. Left ventricular failure b. Clot burden c. Central clot d. Emphysema e. Pulmonary fibrosis |
LV Failure
|
|
|
|
Which is LEAST likely to have pleural effusion:
a. Lymphoma b. Lupus c. LCH d. Cancer e. UIP |
UIP
UIP findings: Subpleural (not D) and basal (not C) reticular pattern with honeycombing and minimal ground-glass opacification (not E) on HRCT. |
|
|
|
6 months after bone marrow transplant with dyspnea and obstructive PFTs. Best test to make diagnosis:
a. CTA b. FEV1 c. FEV1 pre and post bronchodilators d. Inspiratory and expiratory thin section CT |
Ins and Exp CT
|
|
|
|
What is seen on lateral CXR?
a. Anterior wall of bronchus intermedius b. RLL superior segment bronchus c. RUL bronchus seen more often than LUL bronchus d. Pulmonary venous confluence is seen inferior to bilateral upper lobe bronchi e. LUL bronchus sup to LPA |
Answer: Pulmonary venous confluence is seen inferior to bilateral upper lobe bronchi
Posterior wall of bronchus intermedius is well seen. LUL bronchus is more commonly seen than the RUL bronchus. Left pulmonary artery is superior to the LUL bronchus. Left pulmonary vein is anterior to the left main stem bronchus. Left superior pulmonary vein is anterior to the left upper lobe bronchus. Pulmonary artery is anterior to RUL bronchus. Things seen on lateral: Trachea, bronchus intermedius and its posterior wall, RML bronchus, RUL/LUL bronchus. |
|
|
|
Where do nodules (granulomas) of sarcoid occur?
a. Bronchovascular lymphatics b. Alveoli c. Subpleural d. Septal |
Bronchovascular lymphatics
|
|
