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;
65 Cards in this Set
- Front
- Back
|
adjectives for alveolar process (4)
|
hazy, fluffy, coalescent (alveoli bumping into one another), ill-defined
|
|
|
3 devices for long term venosu access
|
portacath, Hickman, PICC line
|
|
|
what are other terms for "bilateral perihilar" distribution? (2)
|
batwing, butterfly; nonspecific to etiology (infection, pulmonary edema, drowning)
|
|
|
what does "diffuse" mean?
|
located widely in both lings (NOT hazy, confusing, alveolar, etc.)
|
|
|
left-sided analog of R middle lung lobe
|
lingula
|
|
|
what lobe involved if L heart border obscured?
|
LUL, incl lingula if middle part of L heart border obscured
|
|
|
MCC lobar alveolar consolidation
|
s. pneumo: MCC pneumonia overall, usu involves only one (or part of one) lobe, no cavitation
|
|
|
what is the "spine sign"
|
when spine does NOT get darker as you move down toward diaphragm --> ?lower lobe PNA
|
|
|
which diaphgragm obscured by heart on lateral view?
|
left
|
|
|
how to ID left diaphgragm on lateral?
|
meets smaller ribs at CP angle, stomach bubble, anterior portion obscured by lower heart border
|
|
|
PNA + volume loss --> ?
|
rarely with simple PNA -- could be post-obstructive PNA 2/2 tumor --> get CT
|
|
|
how to assess volume loss with PNA?
|
look for changes in fissure location / ?tracheal deviation?
|
|
|
infectious etiologies of multilobar consolidation
|
legionella, G-, aspiration, aspergillus (in I/C); NOT pneumococcus
|
|
|
what does air-crescent suggest?
|
invasive aspergillus
|
|
|
what kind of tumor can look just like alveolar PNA (sometimes even with air broncograms)?
|
bronchoalveolar cell carcinoma
|
|
|
most specific finding for alveolar process
|
air bronchograms
|
|
|
most specific finding for interstitial process
|
kerley B lines
|
|
|
what pathogens produce diffuse interstitial pattern in PNA?
|
if IMMUNOCOMPETENT: viruses (influenza, parainfluenza, adeno), mycoplasma, "walking PNA"; IMMUNOCOMPROMISED: PCP, other viruses (CMV)
|
|
|
causes of diffuse interstitial pattern (5)
|
CHF, infection, lymphangitic tumor spread (breast, prostate, BAC), resolving hemorrhage, fibrosis
|
|
|
what does PCP look like
|
diffuse interstitial process
|
|
|
MCC chest infection with adenopathy
|
TB; others: histo/blasto/cocco, plague, anthrax, tularemia
|
|
|
what lung infections can calficy? What non-infectious processes?
|
TB!!; others: histo, cocci, blasto; ddx: sarcoidosis, silicosis
|
|
|
what is a Ghon (or Ranke) complex?
|
Ghon focus (calcification in lunge) + draining hilar node
|
|
|
characteristics of primary TB
|
lobar/multifocal, alveolar, LN involvement
|
|
|
characteristics of reactivation TB
|
apical scarring, cavitations, volume loss, calcifications, usu no adenopathy
|
|
|
diff b/w TB and pneumococcal PNA
|
no adenopathy in pneumococcal!
|
|
|
ddx for cavitary lung lesion
|
abscess, TB, necrotic tumor, vascultis, other (RA, wegeners)
|
|
|
what type of PNA particularly prone to form abscess?
|
aspiration PNA
|
|
|
what to worry about if pt has abscess in lung?
|
need an explanation! ?structural issue?
|
|
|
types of structural issues predisposing to aspiration PNA
|
bronchial obstruction (tumor, foreign body, congenital malformation); TE fistula; Esophageal abnormalities (aspiration): achalasia, stricture, tumor
|
|
|
what features of PNA are worrisome?
|
no clin improvement, cavitation, adenopathy, bronchiectasis, recurrence in a single lobe (?draining issue?)
|
|
|
multiple cystic areas in complicated lung infection -->?
|
bronchiectasis! (makes you worried --> CT?)
|
|
|
loculated fluid a/w PNA
|
?empyema --> may need to tap
|
|
|
what view to order if can't tell between LLL consolidation vs L sided effusion?
|
bilateral decubitus views -- LLD for ?layering, RLD to assess LLL
|
|
|
calcification, pleural thickening, and volume loss -- what dz?
|
TB
|
|
|
ddx of diffuse pleural thickening (5)
|
TB/other empyema, pleural hemorrhage, mesothelioma, pleural mets, pleural fibrosis
|
|
|
characteristics of empyema
|
unusually shaped fluid collections, septation, high attenuation, ?foreign body
|
|
|
defn simple pneumothorax
|
PTX of < 1/3 of thoracic volume and relatively ASYMPTOMATIC patient
|
|
|
radiographic features suggesting tension pneumothorax
|
1) >1/3 volume; 2) expansion of ipsilateral hemithoraix (mediastinal shift, splaying of ribs, depression/inversion of ipsilateral hemidiaphragm)
|
|
|
small pneumothorax seen better with what type of CXR?
|
end-EXPIRATION upright film
|
|
|
CXR: PTX vs skin fold
|
PTX: thin white line seperating black on either side; SKIN FOLD: line defines white/black interface, often with peripheral lung markings
|
|
|
white line in apical PTX vs apical bullous
|
convex vs concave line
|
|
|
lung cancer and bullae
|
increased risk of lung cancer around bullae
|
|
|
why important to differentiate hydrothorax from hydropneumothorax?
|
hydrothroax is not a surgical emergency; hydroPNEUMOthorax might be
|
|
|
difference in appearance of hydrothroax and hydropneumothorax on CXR
|
hydrothorax: fluid meniscus; hydroPNEUMOthorax: straight (horizontal) air-fluid line
|
|
|
whats different about pneumothorax in normal vs consolidated lung?
|
black/black interface in nl lung, black/white in consolidated lung
|
|
|
what 2 signs suggest PTX on supine films
|
"deep sulcus sign" and "medial costophrenic sulcus sign"
|
|
|
tx of PTX
|
depends on size; SMALL: obs, O2 (nitrogen diffusion); MEDIUM (20-30%): chest tube; TENSION: emergency chest tube +/- needle decompression; REPEATED: chemical pleurodesis/partial pleurectomy
|
|
|
what imaging to assess chest tube placement
|
just frontal plain film
|
|
|
best view for ptx
|
bolt upright frontal CXR at full end expiration
|
|
|
MCC pneumopericardium
|
IATROGENIC (heart surg, pericardiocentesis, CPR); OTHERS: trauma, fistula, infxn
|
|
|
pneumopericardium vs pneumomediastinum
|
in pneumopericardium, air cannot extend above aortic knob
|
|
|
when does cervical emphysema occur?
|
usu 2/2 pneumomediastinum; can also be primary, due to cervical insult (intubation, trauma)
|
|
|
name the three compartments that can communicate air up and down the length of the spine
|
pneumoretroperitoneum --> pneumomediastinum --> deep cervical emphysema
|
|
|
isolated air compartments (4)
|
1) PERICARDIAL sac; 2) PLEURAL space; 3) PERITONEAL cavity; 4) SUBCUtaneous tissue; [air in these compartments stay In that compartment]
|
|
|
defn infiltrate
|
used to describe non-specific increase in density in the lungs
|
|
|
on what view do you see a retrosternal infiltrate?
|
lateral -- not seen on frontal
|
|
|
elevated left hemidiaphragm
|
always abnormal (? L volume loss)
|
|
|
ddx for rounded density with air bronchograms
|
MCC: rounded PNA, but bronchiolar alveolar carcinoma on the differential
|
|
|
bibasilar patchy infiltrates --> ?
|
aspiration PNA
|
|
|
cause of lobar collapse
|
PERIPHERAL: pneumonia; CENTRAL: 1) LUMEN (foreign body, mucus, blood); 2) WALL: tumors; 3) OUTSIDE: masses, LAD
|
|
|
RML collapse vs consolidation
|
collapse --> triangular RML wedge decreases to almost linear density due to compensatory hyperinflation of RUL and RLL
|
|
|
causes of total lung whiteout
|
total lung collapse or massive pleural effusion
|
|
|
lung collapse vs pleural effusion
|
mediastinal shift: If deviation toward whiteout, collapse; else, effusion (or other space-occupying process)
|
|
|
mgmt of total lung collapse w/o tension ptx
|
emergent bronchoscopy
|
