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CHEST ANSWERS
1. Respiratory problems of early
life now allowing survival intoadulthood: Concepts for radiologists. N Thorne
Griscom. AJR, 158, 1-8, Jan 1992.
 | (a) T This results from an abnormality of ion exchange and the respiratory
mucus contains less water than normal and has an increased viscosity. This
results in the lungs being unable to clear mucus or aspirated
bacteria. |
| (b) T Recurrent or incompletely resolving pneumonia is another early sign.
Later on bronchitic changes occur with thickening of the bronchial walls and
of the interstitium as well as bronchiectatic changes. Irregular aeration of
the lung fields is also common with areas of alternating air trapping and
atelectasis. |
| (c) T A late complication seen in patients with cystic fibrosis called
botryomycosis. Hypersensitivity bronchopulmonary aspergillosis is another
late manifestation |
| (d) F In older patients it tends to be larger at inspiration and unduly
collapsible. This leads to momentary collapse and obstruction during rapid
change in intrapleural pressure, making coughing ineffective. |
| (e)F Both ventilation and perfusion are abnormal and patchy with
ventilation often more affected than perfusion. |
2. Diagnostic Radiology ; An anglo american textbook of imaging(Churchill and
Livingstone) R.G GRAINGER and D.J. ALLISON,1992 , vol 1, section 3, 688-690.
| (a) F Most a-v fistulae become clinically apparent after the 3rd or
4th decade, although 10% may present in the first decade. Most lesions are
commonly basal and multiple. |
| (b) T Other causes include liver disease and metastases from
thyroid carcinoma. |
| (c) F Approximately 50% of patients have hereditary haemorrhagic
telangiectasia. |
| (d) T . |
| (e) F The Mueller manoeuvre increases the size of lesions while the
valsalva manoeuvre decreases them. |
3. Diagnostic Radiology ; An Anglo American textbook of Imaging(Churchill and
Livingstone) R.G GRAINGER and D.J. ALLISON,1992 , vol 1, section 3, 688-690.
| (a) T Other associations include rubella, Williams
syndrome ( supravalvar aortic stenosis, mental
retardation abnormal facies), valvular pulmonary stenoses and Fallots
tetralogy |
| .(b) T Approximately 2/3 of all patients have other cardiac
anomalies. |
| (c) T Septic embolization or extension of lung parenchymal
infection are the commonest causes ( infected ventriculo-atrial shunts ,
subacute bacterial endocarditis , septic thrombophlebitis and tuberculosis).
These lesions have a tendency to enlarge and rupture. Other less common
causes of aneurysm in the pulmonary circulation include hypertension and
trauma. |
| (d) T This anomaly is almost always associated with cyanotic heart
disease particularly Fallots. The dilated artery may cause respiratory
distress due to compression of the bronchial tree. |
| (e) T They are a recognised cause of peripheral coin lesions and
may demonstrate pulsation on fluoroscopy. |
4. Bronchiolitis obliterans organising pneumonia with migratory pulmonary
infiltrates. David M Ebstein and Michael R Bennet. AJR 158 515-517 march 1992
| (a) F Bronchiolitis obliterans is an uncomon fibrotic lung disease
that involves the small conducting airways, often sparing a considerable
part of the interstitium. The disorder results due to a variety of different
causes which result in damage to the endobronchial epithelium , this and the
repair with excessive granulation tissue extending into the alveoli results
in Bronchiolitis obliterans organising pneumonia. Men and woman are affected
equally and most patients present between the ages of 50-70. Major symptoms
include persistent non productive cough , flu like illness, sore throat ,
malaise and up to 50% have dyspnoea. |
| (b) F Peak flow may be normal or show a restrictive type pattern
with reduction in lung volume and impaired gas exchange. |
| (c) F Radiological appearances include a ground glass appearance
with densities that begin focally and progress bilaterally. diffuse small
linear or nodular opacities are seen in less than 10% . Cavities , effusions
and hyperinflation are uncommon. Peripheral airspace shadowing may be seen
similar to chronic eosinophilic pneumonia which may have a migratory
pattern. |
| (d) F See c. |
| (e) T These patients often respond to steroids within a few days
and the response may be dramatic. So it is important to differentiate this
from idiopathic pulmonary fibrosis and interstitial pneumonitis from which
it can be difficult to distinguish histologically and radiologically and who
have a poorer prognosis. |
TAKE ME BACK TO THE LIST OF MCQ BOOKS .... I'M
THINKING OF PURCHASING ONE ! |
