7a. Trauma Evaluation - Chest Flashcards

1
Q

how many anterior ribs is good inspiration for PA chest

A

5 ant ribs

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2
Q

what shows good positioning for PA chest in terms of rotation

A

medial clavicles equidistant to spinous processes

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3
Q

what shows good positioning for PA chest in terms of lordosis/kyphosis

A

clavicles should be projected over the 3/4th post ribs

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4
Q

what are the 5 common densities on a CXR

A
bone
soft tissue
fat
air
iatrogenic
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5
Q

what does iatrogenic

A

placed in by doctor

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6
Q

what are the 4 locations of interest for evaluation in a CXR

A

mediastinum
lungs
pleura
chest wall

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7
Q

what 4 things create densities

A

water
pus
blood
cells

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8
Q

what creates lucencies

A

air

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9
Q

what are 2 common pathologies of the lung

A

consolidation

tumors

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10
Q

what are 2 common pathologies of the pleura

A

pleural effusion

pneumothorax

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11
Q

what are 2 common pathologies of the mediastinum

A

enlarged heart

mediastinal nodes

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12
Q

what are 2 common lung densities

A

consolidations and masses/nodes

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13
Q

what is an example of what a consolidation can be in the chest

A

infection

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14
Q

what is an example of what masses and nodes can be in the chest

A

cancer

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15
Q

what is a silhouette sign

A

loss of normal borders between 2 adjacent soft tissue structures (eg losing the heart border)

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16
Q

what is the silhouette sign used for

A

locating area of consolidation

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17
Q

if there is a right paratracheal stripe in the xray which lobe of the lung is the consolidation in

A

right upper lobe

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18
Q

if the right heart border is obscured in the xray which lobe of the lung is the consolidation in

A

right middle lobe

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19
Q

if the right hemi diaphragm is obscured in the xray which lobe of the lung is the consolidation in

A

right lower lobe

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20
Q

if the aortic knuckle is obscured in the xray which lobe of the lung is the consolidation in

A

left upper lobe

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21
Q

if the left heart border is obscured in the xray which lobe of the lung is the consolidation in

A

lingula segments of the left upper lobe

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22
Q

if the left hemi diaphragm or descending is obscured in the xray which lobe of the lung is the consolidation in

A

left lower lobe

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23
Q

can you tell the difference on images between blood, pus, water and tumor cells from an xray

A

no you need clinical history

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24
Q

what is the air bronchogram sign

A

air filled bronchi remain patent and visible on image as there is contrast between the air in the bronchi and the fluid in the alveoli

sign of bronchi that are not filled with fluid and are filled with air and run through infection

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25
Q

what is the air bronchogram used for

A

occur with conditions such as cancers but are most commonly associated with infective consolidations such as pneumonia

shows its not a solid mass so likely to be a infection

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26
Q

what is the bulging lobar margin sign due to

A

formation of large amounts of inflammatory exudate (pus/fluid) results in local expansion of lung

27
Q

what does bulging lobar margin indicate

A

infection or inflammation

28
Q

what are 2 common mediastinal pathologies

A

enlarged glands and heart

29
Q

what is the definition of an enlarged heart

A

heart size is usually less than 50% of the thoracic diameter

30
Q

when does upper lobe diversion happen

A

early heart failure

31
Q

what is upper lobe blood diversion

A

incompetence of heart forces blood to go to upper lobes

32
Q

what does the batwing presentation indicate

A

cardiac infarct

33
Q

what does the batwing presentation look like

A

edges/corners of lung near diaphragm are blackened

34
Q

what is a pleural effusion

A

fluid in pleural cavity

35
Q

what is pneumothorax

A

air in the pleural cavity

36
Q

what does the deep sulcus sign indicate

A

supine pneumothorax

37
Q

besides all normal chest checks what are the 4 things needed to be checked

A

deep sulcus sign
pneumothorax on patient with shoulder and rib #
check for other bony #
widened mediastinum

38
Q

in a supine patient with normal lungs the distribtution of blood would be

A

equal throughout the lungs due to gravity

39
Q

what is a flail chest

A

2 or more ribs fractured in 2 or more places

40
Q

in the normal chest the left hilum lies where relative to the right hilum

A

1-2cm above the right

41
Q

the medial ends of the clavicles should be equidistant to what in an unrotated image

A

spinous proceses of the vertebra

42
Q

a good inspiration should have how many anterior ribs

A

5-6

43
Q

what does the silhouette sign indicate

A

loss of normal borders between 2 adjacent structures because of consolidation in the lung which appears white

the whiter lung area alongside the white solid organ outline means that the borders cannot be distinguished

44
Q

what is the apical zone

A

above the clavicles

45
Q

what is the upper zone

A

below the clavicles and above the cardiac silhouette

46
Q

what is the mid zone

A

level of hilar structures

47
Q

what is the lower zone

A

bases of the lung

48
Q

what is the air bronchogram sign

A

fluid/consolidation present in air spaces/alveoli, it appears white on radiograph, any fluid in alveoli appears white on radiograph

bronchi is visible in abnormal case as branching black lines the air filled bronchi remain patent and visible as there is contrast between the air in the bronchi and the fluid in the alveoli

49
Q

what are air bronchograms most commonly associated with

A

infective consolidations such as pneumonia

50
Q

what are the 2 types of pneumonia

A

bronchopneumonia and lobar pneumonia

51
Q

what is bronchopneumonia

A

initially inflammation of the bronchioles and bronchi later affecting the alveoli resulting in a more patchy appearance

52
Q

what is lobar pneumonia

A

a part or whole of one lobe is affected

53
Q

what are the 2 types of lung cancers

A

metastases or primaries

54
Q

what is the most common type of lung cancer

A

metastatic

55
Q

what are the 2 main types of primary lung cancers

A

small cell

non small cell

56
Q

what are the 3 most common non small cell primary lung cancers

A

adenocarcinomas
squamous cell carcinomas
large cell carcinomas

57
Q

what are the 4 things to look for in terms of lung nodules and masses

A

tracheal shift
smooth outlines
popcorn lesions
lack of air bronchograms

58
Q

what is tracheal shift in context of nodules and masses

A

trachea is often pushed or pulled by a neoplasm usually a primary lesion

59
Q

what happens with mild pulmonary edema

A

upper lobe blood diversion

60
Q

what 4 things happens with moderate pulmonary edema

A

upper lobe blood diversion

bronchial wall thickening

blurring of bronchovascular densities due to fluid in supporting tissues

blunting of costophrenic angles

61
Q

what happens with severe pulmonary edema

A

edema fills alveoli and results in air space opacification

62
Q

what is interstitial edema

A

increased interstitial densities including septal lines/interlobular septa are visible

63
Q

what is the batwing distribution indicate and what part of the lung is not affected

A

severe pulmonary edema - myocardial infarct

outer 3rd of lungs commonly spared