Chest Review

  1. What is the functional unit of the lung?
    Secondary pulmonary lobule
  2. What are the components of a secondary pulmonary lobule?
    Terminal bronchiole

    Pulmonary artery branch

    Pulmonary veins at periphery
  3. What is the difference between bronchi and bronchioles?
    Bronchi have cartilaginous support
  4. What is the difference between a terminal and a respiratory bronchiole?
    Respiratory bronchioles contain alveoli

    Terminal bronchioles are the airways right before the first respiratory bronchioles
  5. What is the pulmonary acinus?
    The part of the lung distal to the terminal bronchiole
  6. What does the right main stem bronchus divide into?
    Right upper lobe bronchus

    Bronchus intermedius (supplies RML + RLL)
  7. What does the left main stem bronchus divide into?
    Left upper lobe bronchi

    Left lower lobe bronchi
  8. What are the different types of cells that line the pulmonary alveolus?
    Type I and type II pneumocytes
  9. What is the difference between a type I and type II pneumocyte?
    Type I pneumocytes - squamous epithelial cells that line 95% of alveolar surface, do NOT regenerate

    Type II pneumocytes - source of new type I pneumocytes
  10. What are the most commonly seen accessory fissures?
    Inferior accessory fissure

    Superior accessory fissure

    Azygous fissure
  11. What does the inferior accessory fissure separate?
    Separates medial basal segments from rest of the lower lobe
  12. What does the azygous fissure separate?
    Invagination of right apical pleura by azygos vein
  13. What does the superior accessory fissue separate?
    Right superior segments from right lower segments of lower lobe (looks like continuation of minor fissure)
  14. What is the "aortic nipple"?
    Left superior intercostal vein

    Drains intercostals

    Connects left brachiocephalic with accessory hemiazygos
  15. What is Mendelson's syndrome?
    Acute massive aspiration of gastric acid in patients with CNS impairment (trauma, alcoholics, etc) leading to severe alveolar hemorrhage
  16. What are the primary sites of involvement for Wegener's granulomatosis?

  17. What the chest film findings in hypersensitivity pneumonitis?
    Mid and lower bilateral pulmonary opacities
  18. What are the methods by which Talc can cause injury to the lungs?

  19. What is the difference between asbestosis and asbestos?
    Asbestosis is lung disease due to asbestos exposure
  20. What are findings of Stage IV sarcoidosis?

    Linear opacities radiating from hila

    Upper and mid lung distribution
  21. What are characteristic radiographic thoracic findings in lupus?
    Pleural and pericardial effusions

    • Acute lupus pneumonitis
    •     -  Bibasilar retiular opacities
    •     - Improve with corticosteroids
  22. What are the categories and types of drugs that cause pulmonary toxicity?
    • Cytotoxic
    •     -Bleomycin, Cyclophosphamide, Methotrexate, Carmustine, Busulphan

    • Non-cytotoxic
    •     -Amiodarone, Nitrofurantoin, Gold, Penicillamine, Sulfasalazine
  23. What is the distribution of pathology in IV pulmonary talcosis?
    Nodules in centrilobular distribution
  24. What are the top two types of primary tracheal neoplasms?
    • Squamous cell CA
    • Adenoid cystic carcinoma
  25. How does non-specific interstial pneumonia involve the region adjacent to the pleural compared with usual interstial pneumonia?
    NSIP typically spares the subpleural region
  26. What are typical findings in NSIP?
    Bilateral lower lobe ground glass

    Subpleural sparing

    Reticular interstitial abnormalities
  27. What are ways to differentiate asbestos exposure from malignant mesothelioma?
    Mediastinal involvement


    Circumferential involvement
  28. What disease is associated with lower lung predominant emphysema?
    Alpha a1 antitrypsin deficiency
  29. What is the most common pleural tumor in teenagers/young adults?
    Askin tumor
  30. What are the four types of disease patterns that can result from aspergillus infection?

    Invasive aspergillosis

    Semi-invasive aspergillosis

    Allergic aspergillosis
  31. What are the top 2 causes of pulmonary ARTERIAL hypertension?

    Chronic thromboembolic disease
  32. What is the most common pleural neoplasm?
    Metastases (90%)
  33. What are characteristic plain film findings of scleroderma involvement of the lungs?
    Interstitial pattern at the bases

    Dilated esophagus
  34. What region is the recurrent laryngeal nerve found on a chest film?
    Aorticopulmonary window
  35. What is tracheobronchomalacia?
    Excessive collapse of the trachea and bronchi
  36. Where are bronchogenic cysts most commonly found?
    Around the carina
  37. What is the treatment for pulmonary alveolar proteinosis?
    Whole lung lavage
  38. What are classic imaging findings in mycobacterium avium complex infection?
    Right middle lobe and lingula bronchiectasis
  39. When do opportunistic infections tend to occur in post-transplant patients?
    30-90 days
  40. What types of infections tend to occur in patients in the first 30 days post lung transplant?
    Invasive aspergillosis
  41. What types of infections tend to occur in patients 30-90 days after lung transplant patients?

    Pneumocystis jiroveci
  42. What is the major risk factor for invasive aspergillosis?
  43. What are two of the major complications after transplantion?
    • Bronchioliits obliterans (BOOP)
    • Cryptogenic organizing pneumonia
  44. What is scimitar syndrome?
    Right lung hypoplasia

    Pulmonary vein entering into IVC
  45. What is the pathophysiology of lymphangiomyomatosis?
    Proliferation of smooth muscle cells along lymphatics leading to cystic destruction of lung parenchyma
  46. What is the demographic profile of a patient with lymphangiomyomatosis?
    Woman of child bearing age
  47. What is the pathophysiology of the tree in bud sign?
    Mucous plugging of distal airways followed by wall thickening and bronchial dilatation
  48. Which connective tissue disorder is associated with pericardial or pleural effusions?
  49. What types of workers develop berylliosis?
    Workers in aircraft and space industries
  50. What is the pathogenesis of silicosis?
    Inhalation of inorganic mineral dusts
  51. What are the imaging findings of bronchial atresia?
    Round perihilar mass with distal hyperinflation
  52. What is the most common location for bronchial atresia?
    Left upper lobe
  53. What are characteristic imaging findings of langerhans cell histiocytosis?
    Irregular nodular pattern in upper and mid lungs

    Spontaneous pneumothorax in 25%
  54. What types of patients get Langerhans cell histiocytosis of the lungs?
    Heavy smokers

    Ages between 20-40s
  55. What are the imaging findings associated with neurenteric cysts?
    Intraspinal cyst

    Vertebral fusion/segmental abnormalities
  56. What are the major broad categories of lung cancer?
    Non-small cell lung cancer (85%)

    Small cell lung cancer (15%)
  57. What are the different types of non-small cell lung cancers?
    Adenocarcinoma (40%)

    Squamous cell carcinoma (30%)

    Large cell carcinoma (15%)
  58. What types of diaphragm tears are more common  - left or right?
    Left sided diaphragm tears are more common
  59. What is the most common site of involvement of AIDS related lymphoma?
    Central nervous system
  60. How can one differentiate AIDS related lymphoma of the chest from Kaposi's sarcoma?
    Kaposi's sarcoma - No uptake of gallium
  61. What is the most common cause of spontaneous pneumothorax?
    Rupture of apical bleb
  62. Image Upload 1
    Mounier-Kuhn syndrome - dilatation of trachea and mainstem bronchi
  63. What is the definition of a thoracic aortic aneurysm?
    4 cm
  64. Image Upload 2
    Popcorn calcification


  65. Image Upload 3
    Bronchogenic cyst

    Location - right paratracheal, subcarinal
  66. History of metastatic disease - likely primary?
    Image Upload 4
    • Calcified metastases
    • - Mucinous cancer (colon, ovary)
    • - Thyroid
    • - Osteosarcoma
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Chest Review
Chest Review