3.2 practice questions

Question 1

Which is NOT one of the 3 Ts of the anterior mediastinum?
a) Thyroid mass
b) Teratoma
c) Thymoma
d) Tracheal carcinoma

Answer 1

d) Tracheal carcinoma

Question 2

How do you diagnose a Substernal Thyroid Mass?
a) Ultrasound
b) CT w. IV contrast
c) Radioisotope thyroid scans
d) Biospy

Answer 2

c) Radioisotope thyroid scans

Question 3

Lymphoma is often ___________ and found in many nodes; it is often lobulated, bilateral and asymmetrical
a) painful
b) painless

Answer 3

b) painless

Question 4

What thing arises near junction of the heart and great vessels in middle aged folks (often with MG)?
a) Thyroid mass
b) Teratoma
c) Thymoma
d) Tracheal carcinoma

Answer 4

c) Thymoma

Question 5

The most common mediastinal teratoma is _________ and contains all three germinal layers
a) Cystic
b) Lipoma
c) Meningioma
d) Schwannomas

Answer 5

a) Cystic

Question 6

< _____ cm is a nodule; greater than this is a mass

Answer 6

<3 cm

(small may be solid or subsolid)

Question 7

This “ground glass” appearance of some subsolid small masses refers to increased attenuation (whiter area) on CT, in which the vessels and lung tissue are ______________
a) destroyed
b) preserved

Answer 7

b) preserved

Question 8

Which requires no further imaging?
a) Solid and unchanged mass for over 2 years
b) Subsolid and unchanged mass for over 5 years
c) All of the above

Answer 8

c) All of the above

(subsolid may represent adenocarcinoma)
(important; starred slide)

Question 9

T/F: Calcification usually indicates being benign

Answer 9

True

Question 10

What lobe location may indicate malignancy?
a) Upper
b) Lower
c) Right middle

Answer 10

a) Upper

Question 11

Hamartoma = _____________ tumors of disorganized tissue containing fat and calcium
a) Rheumatoid
b) Histoplasmotic
c) Central
d) Peripheral

Answer 11

d) Peripheral

Question 12

How do you determine the source of metastatic neoplasm in the lung?
a) CT and U/S with Bx
b) Ultrasound with Bx
c) Bronchoscope with bx
d) CT angiogram

Answer 12

c) Bronchoscope with bx

Question 13

Atelectasis and pneumonitis are the two sequelae of what?
a) Obstruction via Teratoma
b) Constriction via Teratoma
c) Constriction via Bronchogenic Carcinoma
d) Obstruction via Bronchogenic Carcinoma

Answer 13

d) Obstruction via Bronchogenic Carcinoma

Question 14

What do you need for a pulmonary embolus Dx?
a) CT and U/S with Bx
b) Ultrasound with Bx
c) Bronchoscope with bx
d) CT angiogram

Answer 14

d) CT angiogram

(saddle PE and peripheral clot)

Question 15

__________ are large air-containing lesions in the lung, visible on CXR that are > 1 cm and usually associated with emphysema
a) Blebs
b) Bulla
c) Pneumatoceles
d) Cavities
e) Bronchiectasis

Answer 15

b) Bulla

(blebs are more often at apex)

Question 16

A spot looks like a bulla, but the walls are thicker. You see it on CT scan, but not on CXR. What should be at the top of your DDx list?
a) Bronchogenic carcinoma
b) Lung cyst (pneumatocele)
c) Cavity
d) Bleb
e) Bronchiectasis

Answer 16

b) Lung cyst (pneumatocele)

Question 17

What occur in the parenchyma, usually result from a necrotic process, and are the thickest walls of all air containing lesions?
a) Bronchogenic carcinoma
b) Lung cyst (pneumatocele)
c) Cavity
d) Bleb
e) Bronchiectasis

Answer 17

c) Cavity

Question 18

“Tram-tracks” on CXR of the lower lobes is indicative of?
a) Bronchogenic carcinoma
b) Lung cyst (pneumatocele)
c) Cavity
d) Bleb
e) Bronchiectasis

Answer 18

e) Bronchiectasis

Question 19

Fractures of ribs ______ are common and can cause a pneumothorax if the bone is displaced
a) 1-3
b) 4-9
c) 10-12
d) All of the above

Answer 19

b) 4-9

(1-3 are rare, 10-12 are associated with trauma to the liver (right) or spleen (left))

Question 20

T/F: Subcutaneous Emphysema is serious, and air will not generally reabsorb on its own

Answer 20

False (typically benign and will resolve on its own)

Question 21

How may asthma cause a PTX?
a) Often develop from rupture of an apical, subpleural bleb or bulla. Commonly occur in tall thin men 20-40 yo.
b) Blunt or penetrating or complication of line/device placement
c) Decrease lung compliance
d) Rupture of an alveolus or bronchiole

Answer 21

d) Rupture of an alveolus or bronchiole

(A = Spontaneous, B = traumatic, C = Chronic fibrotic disease)

Question 22

The presence of an air-fluid interface in the pleural space indicates what?
a) Pneumothorax
b) Pleural effusion
c) Pulmonary embolism
d) Pulmonary interstitial emphysema

Answer 22

a) Pneumothorax

Question 23

Visualization of the visceral pleural line is a must for the diagnosis of what?
a) Pneumothorax
b) Pleural effusion
c) Pulmonary embolism
d) All of the above

Answer 23

a) Pneumothorax

Question 24

Which are signs of PTX? Select all that apply
a) Convex curve of the visceral pleural line paralleling the contour of the chest wall
b) Absence of lung markings distal to the visceral pleural line
c) The deep sulcus sign of an inferiorly displaced costophrenic sulcus seen on a supine chest
d) The presence of an air-fluid interface in the pleural space
e) All of the above

Answer 24

e) All of the above

Question 25

Traumatic pneumatocele, which can take weeks to months to clear, may be masked by a ___________ for the first few days after a trauma a) PTX b) Contusion c) Laceration d) Dentation

Answer 25

b) Contusion

Question 26

A pulmonary _____________ will appear as a solid, usually ovoid mass if it is completely filled with blood a) PTX b) Contusion c) Laceration d) Dentation

Answer 26

c) Laceration

Question 27

If it is partially filled with blood/ partially with air, it may contain a visible air-fluid level or demonstrate a crescent sign as the blood begins to form a clot and pull away from the wall of the _______________ a) PTX b) Contusion c) Laceration d) Dentation

Answer 27

c) Laceration

Question 28

When the extra-alveolar air is confined to the interstitial network of the lung it = what? a) PTX b) Pulmonary embolism c) Pulmonary laceration d) Pneumatocele e) Pulmonary interstitial emphysema

Answer 28

e) Pulmonary interstitial emphysema

Question 29

When this finding is noted, it confers high risk for impending pneumothorax; however, it may also indicate asthma or barotrauma. What is it? a) Pulmonary embolism b) Pulmonary laceration c) Pneumatocele d) Pulmonary interstitial emphysema

Answer 29

d) Pulmonary interstitial emphysema

Question 30

Which describes pneumomediastinum? Select all that apply a) Apical bleb b) Linear, streak-like lucency associated with a thin white line paralleling the left heart border c) Streaky air outlining the great vessels (aorta, superior vena cava, carotid arteries) d) Linear streaks of air parallel to the spine in the upper thorax extending into the neck and surrounding the esophagus and trachea e) Continuous diaphragm sign

Answer 30

a) Apical bleb

Question 31

____________________ produces a continuous band of lucency that encircles the heart that extends no higher than the root of the great vessels a) Pulmonary embolism b) Pulmonary laceration c) Pneumomediastinum d) Pneumopericardium e) Aortic Trauma

Answer 31

d) Pneumopericardium

Question 32

What is most frequently caused by deceleration injuries from MVAs? a) Pulmonary embolism b) Pulmonary laceration c) Pneumomediastinum d) Pneumopericardium e) Aortic Trauma

Answer 32

e) Aortic Trauma

Question 33

T/F: Lobulation, spiculation, and shagginess all suggest malignancy a) True b) False

Answer 33

a) True

Question 34

What is the most common cause of mediastinal mass overall? a) Cardiomegaly b) Thyroid goiter c) Lymphadenopathy d) Teratoma

Answer 34

c) Lymphadenopathy

Question 35

T/F: There are NOT may false negatives on CXR for pulmonary embolisms a) True b) False

Answer 35

b) False

Question 36

The key word of _______________ is “tram tracks” a) Emphysema b) Pneumatoceles c) Cavities d) Bronchiectasis

Answer 36

d) Bronchiectasis

Question 37

A Bronchus larger than its associated pulmonary artery is called? a) Emphysema b) Cavities c) Donut sign d) Signet ring sign

Answer 37

d) Signet ring sign

Question 38

A pt with a PTX has prior emphysema. What is the PTX Dx? a) Primary b) Secondary c) Simple d) Tension

Answer 38

b) Secondary

Question 39

The most frequent parenchymal complications of blunt chest trauma are what? a) PTXs b) Pulmonary embolisms c) Pulmonary Contusions d) Parenchymal contusions

Answer 39

c) Pulmonary Contusions

Question 40

Pulmonary interstitial emphysema is confined to the interstitial network of the lung and is more common ____________ yo a) <40 y/o b) >40 y/o

Answer 40

a) <40 y/o