Anwser,s6

Wednesday, April 12, 2023

Anwser,sDr :ANAS SAHLE

1. Chest xr cases.2. Chest clinical case.

3. Chest ct cases.4. MRCP exam.

:http://www.facebook.com/dranas224

chest xr casesDr :anas sahle

http://www.facebook.com/dranas224

Cxr-18

Diagnosis is??:

Cxr-18

Diagnosis is??:

S Curve of GoldenWhen there is a mass adjacent to a fissure, the fissure takes the shape of an "S ."

The proximal convexity is due to a mass, and the distal concavity is due to atelectasis .Note the shape of the left oblique fissure in the lateral view below .

This example represents a LUL mass with atelectasis .

Cxr-19

SIGN NAME IS…:

Cxr-19

SIGN NAME IS…:

Wedge Shaped DensityThe wedge's base is pleural and the apex is towards the hilum, giving a triangular shape .

You can encounter either of the following:Vascular wedges:

Infarct Invasive aspergillosis

Bronchial wedges: Consolidation

Atelectasis

Wedge Shaped DensityThis case

represents a pulmonary infarct .

Cxr-20

Acinar or interstitial nodules?Name DDX.……:

Cxr-20

Acinar NodulesDDX:

1. ALVEOLAR CELL CARCINOMA2. PULMONARY EDEMA3. ALVEOLAR PROTEINOSIS

Cxr-21

DDX???:

Cxr-22

this sign name is.…:

Cxr-22

this sign name is: Inverted Comma This is an example of an azygous lobe

Cxr-23

Cxr-23

Mass density is seen in the lateral view, but not in the PA view . This finding suggests a chest wall or external problem.In the film below, an amputated shoulder is projecting as a mass .

Cxr-24

DDX…:

Cxr-24

DDX…:1. Dilated esophagus 2. Paravertebral

nodes 3. Osteophytes This example is due to

paravertebral nodes .

CXR-25

Name which anatomic lobe affect when silhoutte sign obscured: A\B\C\D\E\F

CXR-25

Silhouette Adjacent Lobe/Segment

Right diaphragm RLL/Basal segments

Right heart margin RML/Medial segment

Ascending aorta RUL/Anterior segment

Aortic knob LUL/Posterior segment

Left heart margin Lingula/Inferior segment

Descending aorta LLL/Superior and medial segments

Left diaphragm LLL/Basal segmentsA: Ascending aortaB: Left heart marginC: Left diaphragmD: Aortic knobE: Right heart marginF: Right diaphragm


chest clinical casesA 27-Year-Old With a Non-

Resolving Cavitary Lung Lesion

Submitted byLokesh Venkateshaiah, MDFellowDivision of Pulmonary, Critical Care and Sleep MedicineCase Western Reserve UniversityCleveland, OhioJ. Daryl Thornton, MD MPHAssistant ProfessorDivision of Pulmonary, Critical Care and Sleep MedicineCase Western Reserve UniversityCleveland, Ohio


History• A 27-year-old man presented to the pulmonary clinic for evaluation of a non-resolving lung

cavity. • Four months earlier, he had been diagnosed with pulmonary tuberculosis and was started on

four-drug anti-tuberculous directly observed therapy. • A PPD placed at that time measured 22 mm of induration.• During the pulmonary clinic visit, the patient stated that over the last year and a half he had a

cough occasionally productive of minimal blood-streaked sputum. • He had denied other symptoms including nocturnal diaphoresis, anorexia, weight loss, or

fevers. • The patient’s past medical history was remarkable for an abnormal chest radiogram that was

noted one and a half years ago and one episode of malaria. • Other than his recent antituberculous therapy he took no regular medications. • He smoked one-half pack daily for the past 12 years. • He occasionally snorted cocaine but did not use alcohol or other recreational drugs. • He emigrated from Malaysia to the United States 8 months ago. • He was originally from Burma but was a refugee in Malaysia.• It was in Malaysia that he was noted to have an abnormal chest radiogram. • He underwent additional investigations while there but was not given a diagnosis nor

treatment.


Physical Exam

• The patient appeared comfortable and was in no acute distress. • Vital signs were unremarkable. • The cardiac exam demonstrated regular rate and rhythm, a

normal S1 and S2, and no murmur, gallop or rub. • Breath sounds were equal bilaterally and absent of adventitious

sounds. • The abdomen was soft and without organomegaly. • The patient’s extremities were without clubbing or edema. • There was a scar on the left upper arm from a prior BCG

injection.• No other skin lesions were noted.


Lab

• White blood cell count was 10,000 per mm3 with 66% Neutrophils, 14% Lymphocytes and 12% eosinophils

• Hematocrit 49%• Platelet count was 309,000 per mm3• Urea nitrogen was 12 mg /dl, and serum creatinine was

0.7 mg/dl• Liver function tests were within normal limits• Stools and sputum for ova and parasites were negative• Sputum for AFB times five was negative


Chest computed tomography 4 months prior to current presentation


at presentation (4 months following initiation of antituberculous therapy)


Question 1

• What is the diagnosis? • A. Pulmonary tuberculosis • B. Acute Bronchitis • C. Paragonimiasis • D. Schistosomiasis


• Cysts for Paragonimus were identified on BAL and transbronchial biopsy. • Paragonimiasis is caused by lung flukes of the genus Paragonimus. • There are 43 species of Paragonimus, 12 of which infect humans. • Paragonimus westermani is the most prevalent, especially in eastern and Southeast Asia. • Infection with these organisms occurs worldwide but predominantly in several parts of Central

and South America, West Africa, and Asia (1). • In the United States, the disease is diagnosed most commonly in immigrants from endemic

countries (2). • Endogenous infections do occur and usually are caused by Paragonimus kellicot mainly in the

midwestern and eastern United States (3-6).• Pulmonary tuberculosis is less likely given several negative sputum AFB stains and cultures.• Alveolar lavage by bronchoscopy elso exhibited negative AFB stain and culture.• In addition, the cavitation worsened on computed tomography despite receiving multidrug direct

observed therapy. • Acute bronchitis is not a common cause of pulmonary cavitation.• Pulmonary manifestations of chronic schistosomiasis are generally found in patients with a heavy

infectious burden and significant clinical symptoms. • Schistozome eggs may embolize from the liver to the pulmonary circulation where they may lead

to granulomatous endarteritis, pulmonary hypertension, and cor pulmonale.


Question 2

• How do humans acquire Paragonimiasis?• A. Inhalation • B. Ingestion• C. Innoculation • D. Inconclusive


life cycle


Question 3

• What is the drug of choice in the treatment of Paragonimus westermani?

• A. Peptobismol • B. Cipro • C. Praziquantel • D. Albendazole


Treatment

• Praziquantel is the drug of choice to treat paragonimiasis.

• The recommended dosage of 75 mg/kg per day orally, divided into 3 doses over 2 days has proven to eliminate P. westermani in adults and children .

• Praziquantel should be taken with liquids during a meal.

• Patients with chronic empyema due to paragonimiasis may require decortication in addition to anthelmintic treatment .


chest ct cases-5Dr :anas sahle

http://www.facebook.com/dranas224

HRCT-1

HRCT-1• What is the major abnormality in this case?• a) Linear opacities• b) Nodules• c) Consolidation• d) Ground-glass opacity• 2. Which lung is involved?• a) Left• b) Right• c) Both

HRCT-1

• What is the distribution of the lesions?• a) Bronchovascular interstitium• b) Interlobular septa• c) Centrilobular region• d) Pleura

HRCT-1

HRCT-1

• Find multiple, connected, thickened interlobular septa in the right lung.

• Find an example of thickened bronchovascular interstitium in the right lung.

• Find 2 examples of polygonal lobules with centrilobular nodules in the right lung.

HRCT-1

HRCT-2

HRCT-2

• Find the thickened fissural pleura in the right lung.

• Find 2 lobules with thickened interlobular septa and centrilobular nodules in the right lung.

• Find an example of thickened bronchovascular interstitium in the right lung.

HRCT-2

Differential diagnosis

• Differential diagnosis of thickened bronchovascular, interlobular septal, and pleural interstitium on HRCT:……..

Differential diagnosis• Differential diagnosis of thickened

bronchovascular, interlobular septal, and pleural interstitium on HRCT:

• Lymphangitic tumor, • Lymphoma. • Kaposi's sarcoma.• edema.

• The uni-laterality would be very unusual for Kaposi's sarcoma or edema.

Diagnosis

Lymphangitic tumor

Summary

Summary of diagnostic features of lymphangitic tumor on HRCT:

• Thickening of • bronchovascular, • interlobular septal, • centrilobular, and • pleural interstitium

• Smooth or nodular thickening • Lack of architectural distortion Comment: • Unilateral lymphangitic tumor is most commonly seen in

cases of primary pulmonary adenocarcinoma, as in this case.


04/12/202347

MRCP EXAMRespiratory

04/12/202348

Q1• Regarding community acquired

pneumonia in infancy:A -Streptococcus pneumoniae is the most

common pathogen.

B- It may be caused by Staphylococcus aureus.

C- Ciprofloxacin is an appropriate treatment if blood cultures are negative.

D- Bordatella pertussis infection is usually mild.

E- It may be caused by mycoplasma urealiticum.

04/12/202349

A1 • Regarding community acquired pneumonia in

infancy:A -Streptococcus pneumoniae is the most common

pathogen. (False) B- It may be caused by Staphylococcus aureus.

(True)

C- Ciprofloxacin is an appropriate treatment if blood cultures are negative. (False)

D- Bordatella pertussis infection is usually mild. (False) E- It may be caused by mycoplasma urealiticum.

(True)


Q2 • The following are true of cystic fibrosis:

A -Infertility in men is a result of testicular atrophy.

B- In children under one year of age the commonest cause of pneumonia is Staphylococcus.

C -10% of patients will not require pancreatic enzyme supplementation.

D -In neonates 10 - 10% present with meconium ileus.

E -In the school age child, it usually presents with hepatic fibrosis.


A2 • The following are true of cystic fibrosis:

A -Infertility in men is a result of testicular atrophy. (False) B- In children under one year of age the commonest

cause of pneumonia is Staphylococcus. (False)C -10% of patients will not require pancreatic enzyme

supplementation. (True)

D -In neonates 10 - 10% present with meconium ileus. (True)

E -In the school age child, it usually presents with hepatic fibrosis. (False)


Q3 • The following are recognised complications

of foreign body inhalation:

A- Pulmonary abscess

B- Asthma

C- Angioneurotic oedema

D- Hyperinflation of the affected lung

E- Hyperinflation of the opposite lung


A3 • The following are recognised complications of

foreign body inhalation:

A- Pulmonary abscess (True)

B- Asthma (False)C- Angioneurotic oedema (False)D- Hyperinflation of the affected lung

(True)

E- Hyperinflation of the opposite lung (True)


Q4 • Which of the following statements are true of

childhood asthma.

A- over 90% of patients show exercise-induced bronchoconstriction

B- hypercapnia is the first physiological disturbance in status asthmaticus

C- infants are unresponsive to bronchodilators

D- spontaneous cure occurs before adolescence

E- cough may be the only symptom


A4 • Which of the following statements are true of

childhood asthma.

A- over 90% of patients show exercise-induced bronchoconstriction (True)

B- hypercapnia is the first physiological disturbance in status asthmaticus (False)

C- infants are unresponsive to bronchodilators (True)

D- spontaneous cure occurs before adolescence (False)E- cough may be the only symptom (True)


Q5 • Regarding inhaler devices:A- Metered dose inhalers can usually be used

from the age of about 7 years.

B- The Spinhaler requires co-ordination of device actuation with inhalation.

C- The Turbohaler can usually be used from about 3 years of age.

D- Salbutamol can be used with the Nebuhaler.

E- A face mask can be attached to a spacer, so that it can be used in infants.


A5 • Regarding inhaler devices:A- Metered dose inhalers can usually be used from

the age of about 7 years. (False) B- The Spinhaler requires co-ordination of device

actuation with inhalation. (False)C- The Turbohaler can usually be used from

about 3 years of age. (True)

D- Salbutamol can be used with the Nebuhaler. (False)E- A face mask can be attached to a spacer, so

that it can be used in infants. (True)


Q6 • Concerning Cystic Fibrosis:A- There is a carrier frequency of 1/220 in the

general population.

B- A sibling of an affected individual has a 2/3 chance of being a carrier.

C- It can usually be diagnosed antenatally in a family with a surviving affected member.

D- Linkage disequilibrium probes may be useful in epidemiological studies.

E- In suspected cases, the sweat test is the most appropriate first investigation.


A6 • Concerning Cystic Fibrosis:A- There is a carrier frequency of 1/220 in the general

population. (False)B- A sibling of an affected individual has a 2/3 chance of

being a carrier. (False) C- It can usually be diagnosed antenatally in a family

with a surviving affected member. (True)

D- Linkage disequilibrium probes may be useful in epidemiological studies. (True)

E- In suspected cases, the sweat test is the most appropriate first investigation. (True)


Q7 • Hypoxaemic respiratory failure (Type I):

A- Can be caused by respiratory muscle weakness and fatigue.

B- Is found in mountain sickness.

C- Can lead to pulmonary hypertension.

D- Can lead to CO2 retention if treated with 100% oxygen.

E- Can lead to ventricular failure.


A7 • Hypoxaemic respiratory failure (Type I):

A- Can be caused by respiratory muscle weakness and fatigue. (False)

B- Is found in mountain sickness. (True)

C- Can lead to pulmonary hypertension. (True)

D- Can lead to CO2 retention if treated with 100% oxygen. (False)

E- Can lead to ventricular failure. (True)


Q8 • Regarding idiopathic primary pulmonary

haemosiderosis:

A- It is inherited as an autosomal recessive.

B- The absence of digital clubbing is usual.

C- Fever is generally absent.

D- Patients usually have associated polycythaemia.

E- There is often immunoglobulin of complement deposition in the histology of lung biopsies.


A8 • Regarding idiopathic primary pulmonary

haemosiderosis:

A- It is inherited as an autosomal recessive. (False) B- The absence of digital clubbing is usual. (False) C- Fever is generally absent. (False) D- Patients usually have associated polycythaemia.

(False)E- There is often immunoglobulin of complement

deposition in the histology of lung biopsies. (False)


Q9 • Which of the following may cause

pulmonary hypertension?• A- coarctation of the aorta• B- pulmonary stenosis• C- patent ductus arteriosus• D- kyphoscoliosis• E- schistosomiasis


A9 • Which of the following may cause

pulmonary hypertension?• A- coarctation of the aorta (False)• B- pulmonary stenosis (False)• C- patent ductus arteriosus (True)• D- kyphoscoliosis (True)• E- schistosomiasis (True)


Q10 • Frequent episodic asthma:• A- Is suffered by 42% of all children with

asthma. • B- Is defined as an attack rate of ever 2-4

months. • C- Should be treated with inhaled regular

prophylactic therapy, such as inhaled steroids.• D- Is characterised by normal growth rate. • E- Usually requires a burst of oral steroids to

bring under control.


A10 • Frequent episodic asthma:• A- Is suffered by 42% of all children with asthma.

(False) • B- Is defined as an attack rate of ever 2-4 months.

(False) • C- Should be treated with inhaled regular

prophylactic therapy, such as inhaled steroids. (True)

• D- Is characterised by normal growth rate. (True) • E- Usually requires a burst of oral steroids to bring

under control. (False)


Comments:• Types of chronic asthma include:

• • Infrequent episodic asthma: affects 75% of asthmatic children, with fewer than 4 episodes per

• year. Intermittent bronchodilators are given.

• • Frequent episodic asthma: 20%, symptoms 2-4 weekly. Low dose inhaled prophylactic therapy

• plus intermittent bronchodilator.

• • Persistent asthma: 5%, high dose inhaled prophylaxis plus intermittent bronchodilators ± longacting

• bronchodilators such as salmeterol. These children need regular monitoring in an asthma

• clinic and recording of growth and asthma diary.

• • Exercise-induced: pre-exercise bronchodilator. The British Asthma Society Guidelines have

• recently been updated (1997), and you are strongly advised to familiarise yourself with the step

• up and step down approach.


Date post:	27-May-2015
Category:	Health & Medicine
Upload:	anas-sohle
View:	192 times
Download:	0 times

Anwser,s6

Health & Medicine