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What is the functional unit of the lung?
Secondary pulmonary lobule
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What are the components of a secondary pulmonary lobule?
Terminal bronchiole
Pulmonary artery branch
Pulmonary veins at periphery
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What is the difference between bronchi and bronchioles?
Bronchi have cartilaginous support
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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
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What is the pulmonary acinus?
The part of the lung distal to the terminal bronchiole
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What does the right main stem bronchus divide into?
Right upper lobe bronchus
Bronchus intermedius (supplies RML + RLL)
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What does the left main stem bronchus divide into?
Left upper lobe bronchi
Left lower lobe bronchi
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What are the different types of cells that line the pulmonary alveolus?
Type I and type II pneumocytes
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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
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What are the most commonly seen accessory fissures?
Inferior accessory fissure
Superior accessory fissure
Azygous fissure
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What does the inferior accessory fissure separate?
Separates medial basal segments from rest of the lower lobe
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What does the azygous fissure separate?
Invagination of right apical pleura by azygos vein
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What does the superior accessory fissue separate?
Right superior segments from right lower segments of lower lobe (looks like continuation of minor fissure)
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What is the "aortic nipple"?
Left superior intercostal vein
Drains intercostals
Connects left brachiocephalic with accessory hemiazygos
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What is Mendelson's syndrome?
Acute massive aspiration of gastric acid in patients with CNS impairment (trauma, alcoholics, etc) leading to severe alveolar hemorrhage
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What are the primary sites of involvement for Wegener's granulomatosis?
Lungs
Kidneys
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What the chest film findings in hypersensitivity pneumonitis?
Mid and lower bilateral pulmonary opacities
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What are the methods by which Talc can cause injury to the lungs?
Inhalation
Injection
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What is the difference between asbestosis and asbestos?
Asbestosis is lung disease due to asbestos exposure
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What are findings of Stage IV sarcoidosis?
Fibrosis
Linear opacities radiating from hila
Upper and mid lung distribution
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What are characteristic radiographic thoracic findings in lupus?
Pleural and pericardial effusions
- Acute lupus pneumonitis
- - Bibasilar retiular opacities
- - Improve with corticosteroids
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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
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What is the distribution of pathology in IV pulmonary talcosis?
Nodules in centrilobular distribution
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What are the top two types of primary tracheal neoplasms?
- Squamous cell CA
- Adenoid cystic carcinoma
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How does non-specific interstial pneumonia involve the region adjacent to the pleural compared with usual interstial pneumonia?
NSIP typically spares the subpleural region
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What are typical findings in NSIP?
Bilateral lower lobe ground glass
Subpleural sparing
Reticular interstitial abnormalities
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What are ways to differentiate asbestos exposure from malignant mesothelioma?
Mediastinal involvement
Nodularity
Circumferential involvement
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What disease is associated with lower lung predominant emphysema?
Alpha a1 antitrypsin deficiency
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What is the most common pleural tumor in teenagers/young adults?
Askin tumor
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What are the four types of disease patterns that can result from aspergillus infection?
Aspergilloma
Invasive aspergillosis
Semi-invasive aspergillosis
Allergic aspergillosis
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What are the top 2 causes of pulmonary ARTERIAL hypertension?
COPD
Chronic thromboembolic disease
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What is the most common pleural neoplasm?
Metastases (90%)
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What are characteristic plain film findings of scleroderma involvement of the lungs?
Interstitial pattern at the bases
Dilated esophagus
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What region is the recurrent laryngeal nerve found on a chest film?
Aorticopulmonary window
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What is tracheobronchomalacia?
Excessive collapse of the trachea and bronchi
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Where are bronchogenic cysts most commonly found?
Around the carina
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What is the treatment for pulmonary alveolar proteinosis?
Whole lung lavage
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What are classic imaging findings in mycobacterium avium complex infection?
Right middle lobe and lingula bronchiectasis
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When do opportunistic infections tend to occur in post-transplant patients?
30-90 days
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What types of infections tend to occur in patients in the first 30 days post lung transplant?
Invasive aspergillosis
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What types of infections tend to occur in patients 30-90 days after lung transplant patients?
CMV
Pneumocystis jiroveci
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What is the major risk factor for invasive aspergillosis?
Neutropenia
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What are two of the major complications after transplantion?
- Bronchioliits obliterans (BOOP)
- Cryptogenic organizing pneumonia
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What is scimitar syndrome?
Right lung hypoplasia
Pulmonary vein entering into IVC
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What is the pathophysiology of lymphangiomyomatosis?
Proliferation of smooth muscle cells along lymphatics leading to cystic destruction of lung parenchyma
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What is the demographic profile of a patient with lymphangiomyomatosis?
Woman of child bearing age
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What is the pathophysiology of the tree in bud sign?
Mucous plugging of distal airways followed by wall thickening and bronchial dilatation
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Which connective tissue disorder is associated with pericardial or pleural effusions?
Lupus
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What types of workers develop berylliosis?
Workers in aircraft and space industries
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What is the pathogenesis of silicosis?
Inhalation of inorganic mineral dusts
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What are the imaging findings of bronchial atresia?
Round perihilar mass with distal hyperinflation
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What is the most common location for bronchial atresia?
Left upper lobe
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What are characteristic imaging findings of langerhans cell histiocytosis?
Irregular nodular pattern in upper and mid lungs
Spontaneous pneumothorax in 25%
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What types of patients get Langerhans cell histiocytosis of the lungs?
Heavy smokers
Ages between 20-40s
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What are the imaging findings associated with neurenteric cysts?
Intraspinal cyst
Vertebral fusion/segmental abnormalities
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What are the major broad categories of lung cancer?
Non-small cell lung cancer (85%)
Small cell lung cancer (15%)
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What are the different types of non-small cell lung cancers?
Adenocarcinoma (40%)
Squamous cell carcinoma (30%)
Large cell carcinoma (15%)
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What types of diaphragm tears are more common - left or right?
Left sided diaphragm tears are more common
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What is the most common site of involvement of AIDS related lymphoma?
Central nervous system
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How can one differentiate AIDS related lymphoma of the chest from Kaposi's sarcoma?
Kaposi's sarcoma - No uptake of gallium
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What is the most common cause of spontaneous pneumothorax?
Rupture of apical bleb
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Mounier-Kuhn syndrome - dilatation of trachea and mainstem bronchi
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What is the definition of a thoracic aortic aneurysm?
4 cm
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Popcorn calcification
Fat
Hamartoma
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Bronchogenic cyst
Location - right paratracheal, subcarinal
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History of metastatic disease - likely primary?
- Calcified metastases
- - Mucinous cancer (colon, ovary)
- - Thyroid
- - Osteosarcoma
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