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111 Cards in this Set
- Front
- Back
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What does reticular mean
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a net like pattern
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What is a common neoplastic cause of expansile ribs
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multiple myeloma
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What do you say if the patient didnt take a deep breath
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low lung volumes
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What happens to the quality of a cxr if the patient doesnt take a deep breath
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makes vascularity more prominent and causes crowding of the lung parenchyma
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Where is a common area that is mistaken for pathology on a cxr
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right pulmonary vascular
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if a baby has busy symmetric perihilar region can you call bronchial wall thickening
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yes, even if you dont see peribronchial cuffing
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What is a ddx for cystic lung lesion
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IPF, CVD, pulmonary langerhans histiocytosis, lymphangiomyomatosis, emphysema, PCP
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What is usually more prominent in pulmonary edema; veins or arteries
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pulmonary veins
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What is more prominent in cephalization
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pulmonary arteries
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What is the cause of cephalization in CHF
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remodeling of the lower lung vasculature
Long standing CHF Mitral valve stenosis with CHF |
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What is typically more prominent on an upright plain film
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the veins of the lower lung field.
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What perihilar vasculature is higher; right or left
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the left because the left pulmonary artery will go over the left main stem bronhus
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What is the sequence of events in pulmonary edema
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prominent pulmonary veins, interstial edema, alveolar edema, pleural effusion.
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What makes up the right pulmonary knotch
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the superior portion of the knotch is the lateral border of the superior pulmonary vein and the inferior portion is interlobar pulmonary artery
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What happens to the top portion of the right pulmonary notch when there is pulmonary edema
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the angle of the knotch lessens bc of prominence of the superior pulmonary vein
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Is the left paratracheal stripe usually visualized
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no, it is usually obscured by great vessels
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Where is a common location for hidden pna
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behind the heart, cant see easily on frontal (look for blurring of heart-diaphragm border), easily seen on lateral film
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How would you dictate a pulmonary fibrosis pattern?
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generalized accentuation of interstial pattern
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How would you describe a COPD pt with lucent lungs
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hyperaeration
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Who tends to have elevated right hemidiaphragms
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older people bc of a genetic predispostion of weaking of the muscle
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What is the easiest way to find the mainstem bronchus
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trace the trachea down
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Does peribronchial cuffing have an association with disease?
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no, it has to do with inflammation around the surrounding interstitium
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What is an air bronchogram
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an air-filled bronchus is rendered visible because it is surrounded by fluid filled lung
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What is an air alveologram
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some alveoli within a region of airspace filling remain aerated. This
causes the radiographic opacity to appear mottled and inhomogeneous. |
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What are 3 patterns of pulmonary opacification
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air space filling
interstial patterns Atelectasis |
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What are 3 types of interstial pattern
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reticular
reticulo nodular nodular |
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What is another turn for a diffuse small nodular pattern
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miliary
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What are two descriptive terms used to describe a reticular pattern
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fine or coarse
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What is the two basic patterns used to describe pathology
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interstial and airspace filling
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Is there a strong correlation between radiographic pattern and pathologic entity
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no
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Are mixed interstial and airspace patterns common?
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yes
for example interstial pneumontis often has a fluid or cellular accumulation within airspace. |
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What is a problem with having a mixed pattern
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airspace disease will mask interstial pattern
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What the categories of airspace disease
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segmental or diffuse
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What are causes of segmental airspace disease
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pneumonia
pulmonary embolism neoplasm atelectasis |
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Why does pulmonary embolism cause airspace disease
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because of infarction of the lung parenchyma or intrapulmonary hemorrhage
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What are the neoplastic causes of airspace disease
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post-obstructive, BAC, lymphoma
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What are some things that can be mistaken for airspace disease
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overlying soft tissue
skeletal lesions pleural effusion poor inspiration |
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Does lymphoma cause air space disease
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yes, suspect this if there is chronic airspace disease
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How does alveolar sarcoid or alveolar proteinosis appear on chest x ray
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chronic airspace disease
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If there is shifting of the mediastinum towards an opacified hemithorax what should u suspect
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post pneumonectomy
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What are 3 things that may cause a cavitary lesion in the lungs
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TB, carcinoma and abscess
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What part of the lung does silicosis, eosinophilic granulomatous disease, and ankylosing spondylitis affect
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the upper lungs
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What pattern does asbesetosis, sickle cell and scleroderma have
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interstial (bibasilar)
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Micronodular lung disease
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miliary TB, sarcoid, pneumoconiosis, mets
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Can rheumatoid present as small cavitary lesion
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yes
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what are causes of miliary pattern on CXR
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tb, fungal nocardia, varicella, silicosis, coal workers lung, sarcoid, eosinophilic granuloma, neoplastic
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Can septic emboli, multiple AVMs and wegners have the appearance of multiple lung nodules
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yes
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What is the bat wing distribution pattern seen with
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pulm edema (CHF, renal)
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What are the causes of acute reticular pattern
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pulm edema (early on)
viral or mycoplasma infection |
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What are the causes of chronic reticular pattern
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PIGNICS
Pneumoconiosis Interstial lung disease Granulomatous Neoplastic Idiopathic fibrosis CVD Sarcoid |
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What is the radiographic description of honeycombing
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coarse reticular pattern
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Besides end stage pulm fibrosis pt with honeycombing what other patients may have coarse reticular pattern
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emphysema pt with pna or pulm edema
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What happens to the infiltrates with polyarteritis nodosa, viral pna and ABPA
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they shift
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Does asthma have shifting infiltrates
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yes
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Does a pt with frequent aspiration have shifting infiltrates
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yes
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What are the causes of shifting infiltrates
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loefflers
ABPA Asthma aspiration polyarteritis nodosa viral pna |
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What is the acronym for chronic interstial disease
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pignics
Pneumoconiosis Interstial pna granulomatous dz (eosinophilic) neoplastic idiopathic fibrosis CVD Sarcoid |
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Can obstructive emphysema cause a unilateral hypolucent lung
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yes
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What is a classic finding in swyer james syndrome
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a hypolucent lung
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Is it technically correct to call a gastric tube an NG tube
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no it may be an OG tube (cant tell if it originages from the mouth or the nose)
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What is complication of an endotracheal tube in the right main stem bronchus
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collapse of the left lung
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What vetebral level is the bifurcation of the trachea usually at
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T6
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What are 3 indications for chest tubes
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pneumo
hemothorax pleural effusion |
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What is important to check for when determining if a chest tube is placed correctly
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if the second lucent line is with in the thoracic cavity
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What is the correct location of a central line
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SVC or right atrium
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What are some examples of central line
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CVC
picc line portacath |
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When a miliary pattern is seen and TB is suspected what other clues should be looked for that would hint towards TB
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LAD, fibrosis, loss of lung volume, pleural effusion
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What are 4 additional ddx of miliary
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sarcoid, other fungal, mets, pneumoconiosis
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What are 2 major hints a pt has COPD
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large lung volume
lucent lung volume |
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On the lateral chest x ray what is indicative of COPD
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a barrel shaped chest with increased AP diameter
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What does a collapse RML look like on lateral view of the chest xray
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anterior triangle opacity
raised right hemidiaphragm |
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What fissure is on the bottom of the right middle lobe
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the major fissure (oblique fissure)
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What fissure is on top of the RML
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the minor fissure (horizontal fissure)
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What 3 segments of the RLL border the RML
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the superior segment, anterior basal segment and the medial segment (but posterior behind the heart)
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What are two ways to differentiate a collapsed middle lobe from a complete consolidation
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loss of volume (elevation of hemidiaphragm)
displacement of fissure (the horizontal fissure is no longer horizontal) |
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Are there any airbronchograms in a collapse lobe of a lung
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no
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What happens to the horizontal fissure on a AP view
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it will move inferiorly
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What are 3 clues to a RML collapse on a AP film
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inferior displacement of the horizontal fissure
elevation of the hemidiaphragm silohuette of the right heart border |
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Why does asthma cause lobar collapse
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mucous plugging
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What is the complicaton if a lobe remains collapsed for a long time
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fibrosis
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What are the rib measurements for a normal lung volume
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9-10 posterior rib
5-7 anterior rib |
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Can a foriegn body cause unilateral increase in lung volume
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yes, it may act as a stop cock
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What are 3 common causes of low lung volumes
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obesity
pregnancy poor inspiratory effort |
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Does fibrosis cause decreased lung volume
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yes
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What is a common cause of increased cardiac size on plain film
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small lung volume secondary to poor inspiratory effort
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What are the 2 mcc of pleural effusion
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pna, chf
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If the patient is in the supine postion where does a pleural effusion show up first
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costophrenic angle
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What happens to the definition the vessels in early phase of pulmonary edema
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loss of clear definition
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What is the mc benign extrapleural chest mass
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a lipoma
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Where is the mc location of cyst in alpha 1 antitrypsin
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lower lobes
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Where is the mc location of cyst in eosinophilic granuloma
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upper lobes
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What is the most common histology of hodgkins lypmphoma of the lung and mediastinum
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nodular sclerosing
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What is the most common bacterial infection to occur in alveolar protienosis
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nocardia
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Where is the mc location of rounded atelectasis
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posterior segments of the lower lobe
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What is the MC lung tumor in pt under 16
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bronchial adenoma
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What is the MC benign lung tumor
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hamartoma
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What is the MCC of SVC syndrome
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small cell carcinoma
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What is the most common type of emphysema
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centrilobular
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What is the most common cause of respiratory distress in full term infants
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meconium aspiration
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What is the MC lung manisfestion of blunt trauma
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pulmonary contustion
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What is the most common cause of bronchopneumonia
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staph
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What is the mc pulmonary finding in lupus
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pleural effusion
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What is the mc pulmonary finding in rheumatoid
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pleural effusion
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What is the mcc of hemorrhagic mets to the lung
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choriocarcinoma or angiosarcoma
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What is the mc segment and lobe for a pulmonary sequestration
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posterior basal left lower lobe
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What lung and lobe is mc involved in congenital lobar emphysema
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left upper lobe
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What is the mc type of CCAM
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type 1 with single or multiple large cyst
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Where does metastatic calcification most commonly occur in the lungs because of renal disease
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upper lobes
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What is the mc primary chest wall malignancy
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chondrosarcoma
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What is the most common radiographic manifestation of wegners
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pulmonary nodules
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What are the MC ribs to fracture
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4-9
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