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70 Cards in this Set

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ddx: posterior mediastinal mass
neurogenic tumor
foregut duplication cyst
vascular lesion
lateral thoracic meningocele
esophageal lesion
lymphadenopathy
extramedullary hematopoesis
ddx: middle mediastinal mass
lymphadenopathy(TB, fungus, sarcoid, tumor)
bronchogenic cyst
vascular
primary lung tumor
ddx: mediastinal and hilar lymphadenopathy
lymphoma
bronchogenic ca
sarcoid
TB/fungus
renal ca
testicular ca
head and neck squamous ca
ddx: pericardial effusion
HICCUP

-heart attack (post mi, dressler's syndrome)
-infection
-cancer
-collagen vascular disease
-uremia
-post-op
what characterizes a thymoma (5)
most common adult anterior mediastinal mass
calcify infrequently
peak age 40-60
1/3 have myasthenia gravis
40% with myasthenia gravis have thymoma
intra- vs extralobar sequestration
extra has: own pleura
systemic venous drainage
persent earlier (infancy)
what are causes of pulmonary arterial HTN
L to R shunt
L sided valvular lesion
chronic lung disease
chronic PE
idiopathic
ddx: global cardiac enlargement
dilated cardiomyopathy
multivalvular disease
ebstein's anomaly
what are patterns of pulmonary sarcoid
90% bilateral perihilar small nodules
3% large nodules
3% pleural disease
ddx: cavitary lesion
CAVITY(E)
cancer
abscess
vasculitis (wegener's)
infarct
TB/fungus
emboli
what are causes of eosinophilic pneumonia
loeffler's syndrome
chronic eosinophilic pneumonia
hypereosinophilic syndrome
churg-strauss
ABPA
parasitic
drug reaction
what infections are associated with alveolar proteinosis
nocardia
cryptococcus
aspergillus
ddx: CXR out of proportion to clinical findings
sarcoid
pneumoconiosis
alveolar proteinosis
alveolar microlithiasis
BOOP
ddx: unilateral interstitial pattern
lymphangitis carcionomatosa
pulmonary edema (atypical)
aspiration
XRT
ddx: endobronchial metastasis
renal
breast
colon
ddx: cardiophrenic angle mass
pericardial cyst
fat pad
lipoma
lymph node
hernia
aneurysm (ventricle or aorta)
what are patterns of involvement of lung by rheumatoid
nodules
interstitial disease
pleural effusion
what is caplan's syndrome
rheumatoid arthritis and pneumoconiosis with nodules
ddx: dilated cardiomyopathy
MIA TAG

myocarditis
ischemia
alcohol
thyroid/thiamine deficiency
adiamycin
glycogen storage disease
ddx: pleural effusion
TINCUP

trauma
infection
neoplasm
collagen vascular disease
uremia
pancreatitis
what is the most common cancer to cause a pancoast syndrome
squamous cell lung ca
what is the most common cancer to cause SVC syndrome
small cell ca
what are the causes of SVC syndrome
neoplasm
fibrosing mediastinitis

*pearl* lymphoma usually does not obstruct
ddx: cardiac mass
thrombus, myxoma
lipoma
rhabdomyoma
fibroma
teratoma
angiosarcoma
rhabdomyosarcoma
metastasis

*pearl* mets are 20x more common than primary malignancy
what are paraneoplastic syndromes of...
- squamous cell
- small cell
- carcinoid
hypercalcemia = squamous cell
SIADH, cushing's syndrome = small cell
carcinoid syndrome = carcinoid

*pearl* also remember any cancer may cause neuromyopathy, thrombophlebitis, hypertrophic pulmonary osteoarthropathy
what is the most common cause of unilateral pleural effusion worldwide
TB
what are causes of pulmonary mass with an air bronchogram
lymphoma
bronchoalveolar cell ca
sarcoid
what features make a pulmonary mass benign
stable in size over 2 years
calcification over 200 HU
fat density
what cancers cause lymphangitis carcinomatosa
lung
breast
stomach
pancreas
ddx: tracheobronchial lesion
3 benign:
papilloma
hemangioma
hamartoma

3 malignant:
squamous cell ca
adenoca
mets (melanoma, thyroid, esophageal)
ddx: chronic air space disease
VER(Y) FAT BALLS

vasculitis
eosinophici pneumonia
Rx (drugs)
fungus
alveolar proteinosis
TB
BOOP/bronchoalveolar cell ca
actinomycosis
lipoid pneumonia
lymphoma
sarcoid
ddx: tracheomalacia
primary
post intubation/trauma
COPD
trauma
infection
relapsing polychronditis
ddx: multiple pulmonary nodules
MARS BE WHAT

mets
AMV
rheumatoid
sarcoid
BOOP
emboli (septic)
wegener's
histoplasmosis
amyloid
TB
ddx: acute air space disease
A HEIDI

AIDS/aspiration
hemorrhage
edema
infection
drugs
inhalational injury
ddx: lymphadenopathy in chest
TB/fungus
lymphoma
sarcoid
metastasis
bronchogenic carcinoma
castleman's disease
ddx: high resolution CT mosaic pattern
alveolar proteinosis
bronchoalveolar ca
PCP
DIP/UIP
vasculitis
what are causes of pleural effusion in AIDS
lymphoma
TB
kaposi's
community acquired pneumonia
what are findings in kaposi's sarcoma
nodular lesions
interstitial lung disease
lymphadenopathy
effusions
what are pulmonary complications of AIDS (10)
PCP
TB
MAI
fungus
community acquired pneumonia
viral
kaposi's sarcoma
lymphoma
lymphocytic interstitial pneumonitis (peds)
interstitial pneumonitis
what are features of LIP
widespread reticulonodular infiltrates
lymphadenopathy rare
pleura spared
present in non-AIDS patients (sjogren's)
ddx: benign lung nodule
hamartoma
amyloidoma
leiomyoma
lipoma
fibroma
chondroma
pseudotumor
ddx: non-cardiogenic pulmonary edema
NOT CARDIAC

-near drowning
-oxygen toxicity
-transfusion/trauma
-CNS shock
-allergic alveolitis/ARDS
-renal
-drugs (TCAs, cocaine, cheomtherapy, PCN)
-inhalation (hydrocarbon, N02, CO)
-aspiration
-collagen vascular disease
ddx: interstitial lung disease
PC LIPS ARE BAD

pulmonary edema
collagen vascular disease
lymphangitis carcionmatosa
idiopathic pulmonary fibrosis
pneumoconiosis
sarcoidosis
aspiration
recurrent hemorrhage (hemosiderosis)
eosinophilic pneumonia
BOOP
alveolar proteinosis/asbestosis
drugs (chemotherapy)
how does one differentiate causes of a mosaic lung pattern on high resolution CT
vascular disease: decreased vessel size and number, no air trapping
small airways disease: decreased vessel size and number, air trapping
primary lung disease: uniform vessel size and number, no air trapping
ddx: bronchiectasis
infection (viral, TB, recurrent bacterial)
aspiration
immunde deficiency (agammablobulinemia, granulomatous disease of childhood)
abnormal struction (williams-campbell)
abnormal mucus (CF)
abnormal clearance (immotile cilia/kartagener's)
obstruction
ABPA
noxious fumes
pulmonary fibrosis
ddx: aortic root dilatation
HOMIE

homocystinuria
osteogenesis imperfecta
marfan's
idiopathic
ehrlers-dahnlos
ddx: lymph node calcification
TB
radiated lymphoma
thyroid mets
squamous cell mets
mucinous adenoca mets
granulomatous disease
what are pulmonary radiation changes
4 acute:
-infiltrate with non-anatomic margins
-minimal volume loss
-4-6 weeks post treatment
-subclinical

*pearl* if < 3 weeks think infection/recurrence

2 chronic:
-fibrosis with straight margins
-6-12 months post treatment

*pearl* if volume increase or effusion think infection/recurrence
ddx: upper lobe interstitial pattern
CASSET P

cystic fibrosis
ankylosing spondylitis
silicosis
sarcoidosis
eosinophilic granuloma
TB
PCP
ddx: lower lobe interstitial pattern
BADLAS

bronchiectasis
asbestosis
drugs
lymphangitis
aspiration
SLE/collagen vascular disease
ddx: egg shell nodal calcification
TLASS

TB/fungus
lymphoma
amyloid
sarcoid
silicosis
what are thoracic presentations of sarcoid
nodular
alveolar
lymphadenopathy
pneumothorax
cysts +/- TB or myecetoma
cardiac (25%)
what is the garland triad
right paratracheal and bilateral hilar adenopathy in sarcoid
what is the appearance of sarcoid on HRCT
central, nodular density
cystic component
bronchoalveolar pattern
upper lobe predominant
what characterizes necrotizing granulomatosis
noncavitating, multiple masses in lungs only
what characterizes churgg-strauss
aka allergic angitis
young patients
asthmatics
eosinophilia
radiographically mimics EG
what percentage of patients with sarcoid have pleural effusion
2%
what factors suggest an improved prognosis in sarcoid (6)
young age
erythema nodosum
white race
normal PFT
low stage
lofgren's syndrome
what factors suggest a bad prognosis in sarcoid (2)
black race
lupus pernio
what extra thoracic sites are involved in sarcoid
bone - cystic or sclerotic lesions
abdomen - hepatosplenomegaly, liver/spleen nodules
skin - lupus pernio, erythema nodosum
muscle - myositis
myocardium - restrictive cardiomyopathy
CNS - vasculitis, leptomeningeal disease
salivary glands, kidney
stomach - masses
what are indications for steroid therapy in sarcoid
rapid onset
hypercalcemia
splenic, orbital, CNS, myocardium masses
what test are used to diagnose sarcoid
acetylcholinesterase
kveim-sitzbach
hypercalcemia
decreased FRC on PFTs
what is the prognosis in sarcoid
75% resolve with hilar adenopathy alone
10% mortality overall
what percentage of patients with sarcoid are symptomatic
20-50%
what are eponyms used with TB
garland triad - bilateral hilar and right paratracheal adenopathy
boeck sarcoid
lofgren syndrome - bilateral hilar adenopathy, erythema nodosum, arthralgia
what characterizes bronchocentric granulomatosis
ABPA like radiographically
unilateral
upperlobe
associated with asthma
what distinguishes limited wegener's from wegener's
no renal or sinus involvement
better prognosis
females predominant
ddx: multiple thoracic masses in AIDS
mycobacteria
kaposi's
fungus
lymphoma
PCP
metastasis
ddx: high density mediastinal masses
hypervascular mets
aneurysm
aberrant vessel
castleman's disease
paraganglioma
what are epopnyms used with TB
ranke complex - parenchymal opacity and hilar node
simon complex - healed apical lesion
ghon focus - primary TB
rasmussen aneurysm
empyema necessitans - TB with chest wall penetration