An ICU patient is intubated. Which of the following statements are true.
10. The ET tube cuff prevents aspiration
11. The ET tube will move in a cranial direction with neck flexion
12. Left main stem intubation is more common than right
13. An LPO CXR would be useful to evaluate possible esophageal intubation.

ANS: F, F, F, T

The use of high kVP technique for chest radiography
14. Better bone detail
15. Lower patient dose
16. Better visualization of epicardial fat pad
17. Better contrast
18. Greater latitude

ANS: F, T, F, F, T (?)

A patient in the ICU has a small pneumothorax. Which of the following might you see?
19. A tongue-like contour of the cardiophrenic angle
20. The hilum overlay sign
21. Lucency at the lung base
22. Rounded contour of the pericardial fat pad.

ANS: T, F, T, T

Regarding the ductus arteriosus:
23. Calcification in the ductus indicates pulmonary hypertension
24. There can be widening of the aortic pulse pressure if it is patent
25. Indomethacin causes closure of the ductus arteriosus
26. The recurrent laryngeal loops underneath the ductus arteriosus

ANS: F, T, T, F (?- Under aorta)


SINGLE BEST ANSWER

27. Recurrent laryngeal nerve goes around what structure
A. Aortic arch
B. Site of ductus arteriosus
C. Pulmonary artery
D. Bronchial artery
E. Bill Clinton's pecker

ANS: A

28. Most common mediastinal mass in a child?
A. Lymphoma
B. Neuroblastoma
C. Ganglioneuroblastoma
D. Bronchogenic cyst
E. Ganglioneuroma

ANS: B
Neurogenic tumors are most common. But individually are they more common ????
Ped Req (Page 41) states that Posterior mediastinal masses comprise 40% of all pediatric mediastinal tumors. 90% of these are neurogenic tumors. Neuroblastoma is by far the most common, followed by ganglioneuroblastoma, and ganglioneuroma.

29. CT densitometry is useful for
A. Alveolar proteinosis
B. Microlithiasis
C. Loeffler’s
D. Sarcoid

ANS: B


30. Worst prognostic sign in a patient 3 days post MI
A. Persistant pulmonary edema
B. Left lower lobe atelectasis
C. Enlargement of the left atrium
.
ANS: A


31. PCP risk is highest when the CD count falls to
A. 20000/mm3
B. 2000/ mm3
C. 200/ mm3
D. 20/ mm3

ANS: C






32. Which of the following anatomical relationships are true?
A. Pulmonary trunk is normally parallel to the aorta
B. Something else incorrect
C. Right renal artery is anterior to right renal vein
D. Common iliac artery posterior to iliac vein


ANS: C

33. The most common cause of pneumomediastinum is
A. Pneumopericardium
B. Penetrating trauma
C. Pneumothorax
D. Rupture of a main or large bronchus
E. Rupture of alveolus

ANS: E

34. A 31 year old female experiences bright red hemoptysis and has a 1 cm somewhat poorly defined pulmonary nodule (cavitating) in the left upper lobe. Diagnosis?
A. Pneumonia
B. Bronchogenic carcinoma
C. Atelectasis
D. Tuberculosis
E. French fried onion rings.

ANS: D (?)

35. A 61-year-old male develops SVC syndrome and mediastinal widening. Diagnosis?
A. Bronchogenic carcinoma
B. Mediastinal lipomatosis
C. Mediastinal fibrosis
D. Lymphoma

ANS: A

36. Which of the following statements is true regarding MRI versus CT
A. MR! is superior to CT in evaluation of a solitary pulmonary nodule?
B. MR! is superior to CT in evaluation of a superior sulcus tumor as regards invasion of the brachial plexus.

ANS: B

37. Most common associated lesion seen in a patient S/P Tracheoesophageal fistula repair.
A. Anal atresia
B. Midgut malrotation
C. Limb anomaly

ANS: C
Musculoskeletal 24%, Cardiac 15-39%, GI 20%, GU 12%.
.

38. Increases the risk of complication during lung biopsy
A. Platelet count of 100,000 ml
B. Emphysema

ANS: B

39. Round atelectasis is most commonly seen following
A. Pneumonia
B. Atelectasis
C. Pleural effusion
D. Pulmonary infarction
E. Pneumothorax

ANS: C

40. A 50 year old man presents with facial swelling bilateral upper extremity swelling internal jugular venous distention and widened superior mediastinum. The likely diagnosis is:
A. Bronchogenic carcinoma
B. Non-Hodgkin's lymphoma
C. Fibrosing mediastinitis

ANS: A

41. Regarding the cricopharyngeus muscle:
A. The lowest part in the cervical esophagus
B. Used in phonation
C. Lies just inferior to the mouth of Zenker's diverticulum

ANS: C
Originate in the midline of the posteror wall of the hypopharynx at an anatomic peak point known as Killian’s dehiscence. At this location, immediately above the cricopharyngeus, there is a divergence between the fibers of this muscle and the inferior pharyngeal constrictor. During swallowing, increase intraluminal pressure forces mucosa to herniate through. The etiology is not firmly established, but premature contraction or motor incoordination of cricopharyngeus muscle is thought to play a major role. Their development presumably takes time-they have not been reported in children.

42. Regarding endotracheal tubes:
A. The cuff prevents aspiration
B. The endotracheal tube moves inferiorly when the neck is flexed
C. Tracheal granulomas occur on the posterior wall

ANS: B






43. Regarding the most common malignancy that presents in the laryngeal papillomatosis:
A. Adenocarcinoma
B. Squamous carcinoma
C. Bronchoalveolar carcinoma
D. Small cell
E. Carcinoid

ANS: B

44. A 31 year old woman presents with a 1 cm left upper lobe cavitary lesion with massive hemoptysis. The most likely etiology is:
A. Tuberculosis
B. Bronchoalveolar carcinoma
C. Pulmonary infarct
D. Sarcoidosis
E. Atelectasis

ANS: A

45. Regarding FNA of lung lesions
A. There is a higher risk of pneumothorax in patients with emphysema
B. Indicated for intrabronchial lesions
C. Not indicated after negative bronchoscopy biopsy

ANS: A

46. What is the least likely chest x-ray finding in a patient with rheumatoid arthritis?
A. Basilar fibrosis
B. Hilar adenopathy
C. Pleural effusion
D. Honeycomb lung
E. Cavitary nodules

ANS: B

47. The definition of vital Capacity is:
A. The volume remaining after maximal expiration
B. The volume between maximal inspiration and maximal expiration
C. The volume between normal breaths
D. The volume remaining after maximal inspiration


ANS: D




MATCHING

Match the associated infection with each of the following

48. Cystic Fibrosis
49. Sarcoidosis
50. Silicosis
51. Sickle cell anemia

A. Pseudomonas
B. Pneumococcal pneumonia
C. Tuberculosis
D. Saprophytic aspergillis

ANS: A, D, C, B

Regarding bronchial lesions, match the following
52. Atelectasis
53. Bronchiectasis
54. Positive bronchus sign


A. Mucoid impaction
B. Bronchoalveolar carcinoma
C. Inflammatory and infectious
D. Interstitial and alveolar infiltrate

ANS: A, C, B
1997 -CHEST
TRUE/FALSE
Apical lordotic views:
1. Right heart appears more rounded and pronounced
2. Aorta appears more prominent than pulmonary artery
3. Can see pulmonary arteries en face
4. Elevates cardiac apex
5. The heart appears enlarged
6. Pulmonary valves are seen in tangent

ANS: T, F, T, T, T, F
Pulmonary valves are seen in tangent on PA view. (Cardiac Req, p. 143)
No good source found

Regarding lung CA :
7. AdenoCA is most likely to cavitate
8. Pancoast syndrome is most likely due to large cell tumor
9. A spiculated mass is less likely to be malignant than a smooth mass of similar size
10. Squamous cell presents in central airway
11. Squamous cell is usually located peripherally

ANS: F,F,F,T, F
SCCA is more likely to cavitate and is most common cause of Pancoast tumor.

Regarding pulmonary embolus:
12. Larger ones are more likely to cause pulmonary infarct
13. Usually results in infarction
14. Most commonly affect the lower lobes
15. Majority do not resolve

ANS: T,F,T, F
Dahnert: More than 50% occur in lower lobes. 90% do not cause infarction. Majority resolve at least partially. *Popular topic.

Patients with Cystic Fibrosis are commonly infected with :
16. Klebsiella
17. Pseudomonas
18. H. Influenza
19. Staph Aureus
20. Strep Pneumonia
21. Cystic fibrosis:
22. Is more common in blacks than whites.

ANS: F, T, T, T, F, F

Regarding Wegener's granulomatosis:
23. Commonly presents with renal insufficiency
24. More common in adults than in children
25. Multiple pulmonary nodules with cavitation
26. Pulmonary and sinus disease are the most common presentations
27. Acute onset with rapidly progressive course

ANS: F, T, T, T, T

Which can have enlarged lung volumes (Increased pulmonary compliance)?
28. IPF
29. EG
30. RA
31. Scleroderma
32. Lymphangioleimyomatosis
33. Neurofibrosis

ANS: F,T, F, F, T, T
Increased Lung Volume: Emphysema, Cystic Fibrosis, LAM, EG, NF (Dahnert)

Lymphatics are present in the following locations:
34. Tissue surrounding the pulmonary veins
35. Tissue surrounding the pulmonary arteries
36. Tissue surrounding the bronchi
37. Visceral pleura
38.
ANS: T, T, T, T
Visceral pleural lymphatics reside in the innermost (vascular) layer of the visceral pleura. They form a network over the surface of the lung that parallels the margins of the secondary pulmonary lobule and penetrate centrally within the interlobular septa along with the pulmonary veins toward the hilum. (Kerley B lines)
Parenchymal lymphatics originate in proximity to alveolar septa (juxtaalveolar lymphatics) and continue centrally with the bronchoarterial bundle. The perivenous and bronchoarterial lymphatics communicate via obliquely oriented lymphatics within the central regions of the lung. (Kerley A lines) [Armstrong]

Type II alveolocytes:
39. Are more numerous than Type I alveolocytes
40. Regenerate after lung damage
41. Produce surfactant

ANS: F, T, T

Kaposi’s Sarcoma:
42. Does not take up gallium
43. Is more common in homosexuals than in drug abusers
44. Pulmonary Kaposi’s is more common than pulmonary lymphoma.

ANS: T, T, T
Kaposi’s 15%, Pulmonary lymphoma 5%.

Which of the following pulmonary disease processes involve predominantly the upper lobes?
45. Sarcoidosis
46. Lymphangiomyomatosis
47. DIP
48. Extrinsic allergic alveolitis
49. Radiation
50. Asbestosis

ANS: T, F, F, T, T, F
R CASSETTE (Radiation, CF, AS, Sarcoidosis, silicosis, EG, TB, Extrinsic Allergic Alveolitis) [Dahnert]

SINGLE BEST ANSWER

51. Patient with AIDS and multiple pulmonary nodules and a negative Gallium scan:
A. Kaposi’s Sarcoma
B. CMV
C. PCP
D. Lymphoma

ANS: A

52. Most typical appearance of Legionella Pneumonia:
A. Unilobar opacification
B. Unilateral opacities
C. Bilateral opacities
ANS: C
Patient may present with watery diarrhea and confusion (in 1/3). White count is normal to mildly elevated. 5% adenopathy. At presentation, patchy or confluent lower lobe consolidation is present which over time becomes multilobar. 30-50% have pleural effusions. Dense consolidation persists despite therapy with erythro., but eventually improves. (ACR 27, pp. 259-)


53. Woman with unilateral lymphangitic carcinoma of lung. Most likely primary is:
A. Breast
B. Lung
C. Pancreas
D. Cervix

ANS: B


54. Woman with marked hypoglycemia and large right chest mass:
A. Metastasis
B. TB
C. Fibrous tumor of the pleura
D. RA

ANS: C
Hypoglycemia in 4% (AFIP)!


55. The most commonly community acquired pneumonia in an elderly patient:
A. Klebsiella
B. H. influenza
C. Strep Pneumonia
D. Staph Aureus
E. Pseudomonas

Ans: C


56. Round pneumonia is caused by what organism?
A. Staph aureus
B. Klebsiella
C. Mycoplasma
D. Strep pneumonia

ANS: D








57. The most common fungal disease in AIDS is?
A. Cryptococcosis
B. Histoplasmosis
C. Coccidiomycosis
D. Aspergillosis

ANS: A
Cryptococcosis is the most common fungal infectio in AIDS patients but crypto-meningitis is more frequent than cryptococcal pneumonia. Cryptococcal pneumonia presents with ill-defined focal reticulonodular pattern. Cavitation, lymph node enlargement and pleural fluid are common. (Armstrong) Dahnert states that cavitation and nodes occur in 12-15%.

58. A child with AIDS who presents with nodular opacities on a CXR but is asymptomatic has:
A. Miliary TB
B. Lymphocytic interstitial pneumonitits
C. PCP
D. KS
ANS: LIP
59. The most typical appearance of legionella pneumonia is:
A. Unilobar opacification
B. Unilateral opacification
C. Bilateral opacification

ANS: C (Bronchopneumonia)

MATCHING
Regarding spirometry: B
60. Vital capacity
61. Tidal volume
62. Residual volume A
63. Functional residual volume C D

ANS: B,A,C,D




Match the cell type with the tumor:
64. Squamous cell carcinoma
65. Adenocarcinoma

A. Pancoast
B. Peripheral
C. Central

ANS: A/C, B
Adenocarcinoma is most common (50%). Occurs in women. May be asymptomatic. Pathologic features: slow-growing, early mets, associated with fibrosis, peripheral/subpleural, mucin. Radiographic features: Peripheral, solitary nodule or mass, spiculated border.
Bronchoalveolar cell may present with severe bronchorrhea. Radiographic features: Solitary nodule (most common), hazy, ill-defined, “ground-glass” on CT, air bronchogram, consolidation, multiple nodules.
Squamous cell: best prognosis, 1/3 of lung ca, Pancoast syndrome, ectopic parathormone production. Path: central/endobronchial, local mets to nodes, central necrosis. Radiographic features: 2/3 central-endobronchial lesion best seen on CT/Atelectasis/post obstructive pneumonitis. 1/3 peripheral-thick-walled, cavitary mass. Solitary nodule. (Thoracic Req)
Match the following with associated pleural effusion:
66. Pleural neoplasm
67. Congestive heart failure
68. Nephrotic syndrome
69. Pneumonia
70. Hilar lung cancer without pleural seeding

A. Exudative
B. Transudative


ANS: A, B, B, A, A
Exudate: Empyema, paraneoplastic, TB, fungi, parasites, rickettsia, mycoplasma, malignancy, emboli, pancreatitits, Boerhaave’s, collagen vascular, traumatic.
Transudate: CHF, constrictive pericarditis, decreased colloid-oncotic pressure (cirrhosis), protein loss, hypervolemia, nephrotic syndrome, peritoneal dialysis, hypothyroidism, and chylous effusion. (Dahnert)








Match the following:
71. Central
72. Peripheral
73. Parenchymal

A. Bronchial thickening
B. Kerley A
C. Kerley B
D. Ground glass changes

ANS: A, C, D
1995 CHEST/CV QUESTIONS

TRUE/FALSE

Signs of small pneumothorax on a supine film include
1. Deep sulcus sign
2. Elevation of ipsilateral diaphragm
3. Translucency over inferior hemithorax
4. Epicardial fat pad appears rounded
5. Hilum overlay sign

Ans: T, F, T, T, F.
Thoracic Req pp. 497-8. Visceral pleural line separated from chest wall by gas without vessels is typical finding in EPA film, esp. apex. Lung opaque only occurs with complete collapse. Tension ptx involves mediastinal shift and depression of hemidiaphragm. 30% of ptx on supine films are missed. On supine film the medial recess-juxtacardiac recess air,is artery, anterior junction line, superior pulmonary vein, heart vorder, IVC, deep anterior C/P sulcus, pericardial fat pad.
Pericardial air is limited by normal pericardial reflections and extends seen as the “deep; sulcus” sign outlining the medial hemidiaphragm under the heart. Lucent triangle located medially at lung base previously thought to be due to air in pulmonary ligament, now known to lie posteriory represents a ptx. Pneumothorax may lie in major or minor fissures also. Translucency may also occur over upper abdomen. Double diaphragm sign occurs when dome and anterior portions of diaphragm are outlined by lung and pleural air respectively. Improved visualization of aortic arch and cardiac margin may be noted.
Sharp delination of mediastinal contours: SVC, Azygous vein, L subclavian superiorly to proximal ascending aorta and main pulmonary artery.

Concerning pulmonary hypertension
6. Normal wedge pressure
7. COPD most common cause
8. Pulmonary artery calcification is indicative of long standing disease

ANS: F, T, T (As in Eisenmenger’s) No one wants to come out and state #7 but I think it’s true.
Precapillary hypertension is artrial caused primarily by increased resistance (obstructive,
obliterative, or constrictive) or Increased flow (shunts).
Postcapillary hypertension is venous caused acutely by left ventricular failure and chronically by mitral disease, anomalous pulmonary venous return, mediastinal, fibrosis, idiopathic, or primary veno-obstructive disease; combined pre-and postcapillary hypertension, or diffuse pulmonary AV shunting complicating chronic lung disese-emphysema-shunt syndrome.
Pulmonary arterial hypertension includes systemic pulmonary artery pressure greater than 30mHg or a mean pulmonary artery pressure greater than 20mmHg. Causes in general may occur secondary to one of three basic mechanisms: (1) increased flow of blood through the pulmonary vessels, (2) decreased cross-sectional area of the pulmonary vasculature (chronic pulmonary embolism, primary pulmonary hypertension, peripheral pulmonary stenosis, Eisenmenger’s syndrome, pulmonary vasculitis).





Most cases of PAH occur secondaruy to a known cause, referred collectively as secondary PAH. Causes include: Increased pulmonary blood flow (left-to right shunts and increased total blood volume), Decreased cross sectional area of pulmonary vasculature (Chronic PE, primary pulmonary hypertension, periphaeral pulmonary stenosis, Eisenmenger’s syndrome, pulmonary vasculitis) Pulmonary or pleural disease (Emyphysema, Fibrosis, granulomatous infections, bronchietasis, neoplasm, postpneumonectomy, fibrothorax, chest wall deformity) , Vasoconstriction from hypoventilation (Obesity/hypoventilation syndrome, upper airway obstruction, high altitude, neuromuscular disorders), or increased resistance to pulmonary venous drainage (pulmonary vein abnormalities left atrial abnormalities, mitral disease, left ventricular failure, constrictive pericarditis, sclerosing mediastinitis). Thoracic Requisitesp. 404. On EPA films the normal transverse diameter of the right interlobar artery as it descends adjacent to the bronchus intermedius is less than or equal to 16mm (14mm in women) With Eisenmenger’s, pulmonary arterial calcification may occur.
Pulmonary venous hypertension occurs at capillary wedge pressure >15 mm Hg. (12 mmHg is upper limit)
The heart is normal-sized but right ventricular enlargement is present. The pulmonary trunk is prominent. The left atrium is normal in size. Rheumatic mitral valve stenosis +/- regurgitation is present in 99%.


Concerning BOOP after bone marrow transplant
9. Does occur after autologous bone marrow transplant
10. Occurs most frequently in 4-12 months
11. Presents with shortness of.breath and cough
12. Quickly responds to steroids

ANS: F, F, T, T
BOOP is characterized by granulation tissue in lumen of bronchioles and alveolar ducts and presence of associated patchy areas of organizing pneumonia. Most are idiopathic but may be seen with viral/bacterial pneumonias, extrinsic allergic alveolitis, chronic eosinopnilic pneumonia and collagen vascular disease. Typically they present with 1 to 3 months of dry cough, low-grade fever, SOB. PFT’s show a restrictive pattern. Patients usually respond well to steroids. ACR #40 and Thoracic Req.

Which of the following could be seen on a pathology specimen of LAM
13. Lymphatic dilatation
14. Lymphatic proliferation
15. Cyst formation
16. Smooth muscle proliferation

ANS: F, F, T, T
Proliferation of immature smooth muscle in lungs and mediastinum along the lymphatics (P & J). 25 to
50 years old. Almost all patients have been women. Rare disease which accounts for fewer than 10% of cases of chylothorax. Lungs are involved in 100%, 75% develop chylothorax, and 40% develop pneumothorax. Radiographs sho a diffuse reticular pattern. Cystic lesions are present in 20% and best seen by CT. The cysts have slightly thicker walls than emphysematous bullae. Lung volume is normal or increased. ACR 40. Forme fruste of tuberous sclerosis??? ( P and J)



Concerning cardiac size on a PA radiograph
17. Directly proportional to cardiac volume
18. Decreased with lordotic projection
19. Directly related to shunt in ASD
20. Enlarged with bradycardia
21. Normal people have 1 cm or less change from systole to diastole

ANS:F, F, F,T, T
Change in heart width between systole and diastole is typically less than 1 cm. (Cardiac Req, p. 6)
Marathon runners may have bradycardia physiologic dilatation of heart.
The lordotic production results in apparent elevation of diaphragm and poor visualization of basal diseae. Also the aortic arch may be poorly defined, an apparent superior mediatinal widening may be present , the left heart border may be indistinct and the left hilum is projected caudally and may be hidden by the heart.
The AP supine view may obscure basilar processes when the tube is angled cephalad.
The Mueller maneuvre – forced inspiration with closed glottis in supine position may be used to decrease intrathoracic pressure and increase size of thin walled vascular structures.


Which of the following are encompassed by the pericardium
22. Aortic root
23. Proximal right and left pulmonary arteries
24. The SVC following the insertion of the azygous
25. The azygous vein just before it inserts into the SVC

ANS: T, F, T, F
The parietal pericardium attaches anteriorly to the superior pericardiosternal ligament, inferiorly to the central tendon of the diaphragm, and posterior ly to the esophagus and descending aorta. The transverse sinus of the pericardium is posterior to the heart behind the ascending aorta, and pulmonary arteries, and it extends from the SVC on the right side to the strip of pericardium above and behind the left pulmonary veins. The oblique sinus separates the posterior wall of the left atrium from the posterior pericardium over the esophagus; it is bounded by the IVC inferiorly, the pulmonary veins lateral, and the strip of pericardium between the right and left superior pulmonary veins superiorly. The superior pericardial recess connects the upper level of the transverse sinus between the ascending aorta and the main and right pulmonary arteries.

Regarding cystic fibrosis:
26. 1 out of 20 white adults is a heterozygote carrier
27. There are increased nucleic acids in bronchial secretions
28. Diagnosis is made by increased sodium in sweat
29. Rectal polapse is a rare associated finding
30. Infertility is more common in men

ANS: T, F, T, F, T



Regarding large conglomerate masses seen in silicosis:
31. They tend to be in upper lobes
32. They retract toward the hila
33. They are premalignant
34. They are discoid in shape
35. They are secondary to superimposed TB

ANS: T, T, F, T, F

Regarding Swyer-James syndrome:
36. The mediastinum deviates away from the effected lung on expiration
37. The effected side can be larger than the contralateral normal lung
38. It is secondary to bronchiolitis obliterans
39. The segmental bronchi terminate abruptly
40. Pathologic specimens demonstrate anthracotic changes.

ANS: T, F, T, ???, F
The vasculature terminates abruptly. The disease does affect subsegmental bronchioles but I’m not sure they terminate abruptly.


SINGLE BEST ANSWER

41. Most common presentation of bronchial alveolar cell carcinoma
A. Multiple foci of air space disease
B. Single focus of airspace disease
C. Multiple nodules
D. Single nodule
E. Lymphangitic spread

ANS: D
Age 40 to 70. Mucinous (80%) and nonmucinous (20%) Risk: pulmonary fibrosis (TB or infarct) in 27%, diffuse fibrotic disease (scleroderma), previous exogenous lipid pneumonia. H/o heavy smoking in 25 – 50%. Bronchorrea (5-27%).
60-90% local form- ground-glass attenuation. Single mass (43%). Diffuse form (pneumonic form) 10-40%. Diffuse consolidation (30%). Multinodular (27%). Pleural effusion (8-10%) (D. P.390).








42. Most sensitive sign of aortic laceration
A. NG tube deviated to right
B. Apical cap
C. Lost of normal aortic contour
D. Inferior displacement of left mainstem bronchus
E. First and second rib fractures

ANS: C

43 40 y.o. female with yellow nails and lower extremity lymphedema CXR finding is:
A. Pleural effusions
A. Bilateral hilar adenopathy
B. Multiple pulmonary nodules
C. Single pulmonary nodule

ANS: They say “A” but why??? Bronchiectasis??

44. CD4 level associated with increased incidence of PCP
A. 2000
B. 1000
C. 500
D. 200
E. 50

ANS: D

45. Most common community acquired pneumonia in elderly
A. S. aureus
B. H. Flu
C. S. pneumonia
D. Klebsiella
ANS: C


46. MRI compared to CT is most useful for evaluating:
A. Solitary pulmonary nodule
B. Mediastinal adenopathy
C. Superior sulcus tumor
D. Pleural effusion
ANS: C

47. Least likely to cause multiple pulmonary metastases
A. Breast
B. Renal
C. Prostate
D. Sarcoma

ANS: C

48. 34 year old construction worker had exudative effusion that showed no growth on cultures. 6 months later CXR showed no pleural effusion but a new right lung mass.
A. Silicosis
B. Asbestosis
C. TB
D. Primary lung cancer
E. PE

ANS:

49. Which does not involve the upper lobes predominately
A. Histoplasmosis
B. Alpha-l-antitrypsin deficency
C. Silicosis
D. Sarcoidosis
E. TB
ANS: B

50. Large left atrium is most associated with
A. Situs inversus
B. Right atrial myxoma
C. Atrial fibrillation
D. Pulmonary venoocclusive disease
E. Pulmonary arterial hypertension

ANS: C???? check


51. Not associated with CHF
A. Cephalization of flow
B. Pruning of pulmonary arteries
C. Elevated wedge pressure
D. Increased left atrial size

ANS: B

52. 60 year old male is 2 years status post single vessel CABG. The patient had a preop angio that showed a proximal RCA short segment occlusion and a left dominate system. At that time, a nuclear medicine study showed no evidence of infarction. Now the patient presents with chest pain* associated with EKG changes. A nukes study done at this time shows a posterior wall ischemia. What is the most likely cause?
A. Graft occlusion
B. Occlusion distal to the graft
C. Acute artery stenosis
D. New left coronary artery stenosis
E. LAD stenosis

ANS: C does not specify the fact that the posterior descending artery arises from the left coronary,but it’s probably the best answer in this series. (I think it was better stated on ’97 exam).

53. 40 y.o. female is recently s/p replacement of tricuspid and pulmonic valves.What is the most likely DX?
A. Rheumatic heart disease
B. Lung carcinoid
C. Small bowel carcinoid with hepatic metasases
ANS: C
Right-sided endocardial fibroelastosis (35%) resulting in tricuspid regurgitaiton and pulmonary valve stenosis. This is seen in carcinoid syndrome which occurs in 7% of small bowell carcinoids with liver mets. This may also occur with primary pulmonary carcinoid (but probably wouldn’t effect the right side of the heart as much).











54. A 52 year-old man presents with fever and cough. He has patchy lung opacities and laboratory tests are positive for anti-nuclear cytoplasmic antibodies (ANCA-1). Which of the following is the most likely diagnosis?
A. Aspergillosis
B. Wegener’s
C. Lymphangioleiomatosis
D. Lymphomatoid granulomatosis
E. Goodpasture’s disese

ANS: B

55. Which is least likely to metastasize to chest?
A. Osteosarcoma
B. Renal cell carcinoma
C. Prostate
D. Melanoma

ANS: C


56. In a 34 y.o. asymptomatic construction worker a routine CXR reveals unilateral pleural effusion which resolves on its own in 6 weeks. Six months later the patient presents with a focal upper lobe opacity. What is most likely cause?
A. Lung cancer
B. PE
C. TB
D. Lymphoma
E. Viral infection
F. Asbestosis

ANS: C


57. PCP is not usually seen until the CD4 count falls to what level
A. 200
B. 500
C. 1000
D. 2000

ANS: A






Matching:
A. Histoplasmosis
B. Hamartoma
C. Pulmonary varix

58. Popcorn calcification
59. Lamilated calcification

ANS: B, A

Matching:
Concerning staging of lungcarcinoma
A. Stage I
B. Stage II
C. Stage III A
D. Stage III B
E. Stage IV

60. Mass with post obstructive pneumonitits
61. Endobronchial mass within 2 cm of carina
62. 2 cm right upper lobe mass with subcarinal and ipsilateral adenopathy

ANS: A, C, C
TNM
T0, no evidence of primary tumor
T1, < 3 cm, limited to lung
T2, >3 cm, > 2cm from carina
T3, Tumor of any size with direct extension to: chest wall, suprior sulcus, diaphragm, pleura, pricardiu, or within 2 cm of carina
T4, mediastinal organs, carinal, vertebral body invasion, or malignant effusion

N0, no LN involvement
N1, ipsilateral hilar
N2, ipsilateral mediastinal or subcarinal
N3, ontralateral hilar or mediastinal nodes; supraclavicular nodes

M0, no mets
M1, distal mets

Unresectable if T4, N3, or M1
Stage 3b: N3, M0, any T OR T4, M0, any N
Stage 4: M1, any T, any N











Matching:
A. Total lung capacity
B. Vital capacity
C. Functional residual capacity
D. TV
E. Residual volume

63. Volume remaining after normal expiration at rest
64. Maximum amount of gas exhaled after maximum inhalation

ANS: C, B.

Matching:
65. IHSS
66. Dilated
67. Restrictive


A. Familial
B. Alcohol
C. Amyloid
D. All of the above

ANS: A, B, C.