Thorax/Abdomen/Spine/Pelvis Flashcards
- UPPER RESP. CONSIST OF:
- LOWER RESP. CONSIST OF:
- LODGED ITEMS TYPICALLY LOCATED:
- WHY? - WHICH LUNG HAS MORE LOBES?
- UR: NOSE PHARYNX & LARYNX (NOL)
2.LR: TRACHEA, BRONCH TREE & LUNG - RIGHT BRONCHUS (B/C WIDER)
- R = 3 LOBES
- L = 2 LOBES
- WHY IS CHEST X-RAYS DONE ERECT?
- ROUTINE:
- ADVANCED:
- DIAPHRAGM DOWN
- AIR-FLUID LEVELS
- PREVENT ENGORGEMENT OF VESSELS
2.R: PA, LATERAL & SEMIERECT
3. A: OBLIQUE, LORDOTIC & LATERAL DECUB.
PA CHEST:
1. CR:
2. RESPIRATION:
3. IR LOCATION:
4. ANATOMY:
LATERAL CHEST:
1. CR:
2. RESPIRATION:
3. IR LOCATION:
4. ANATOMY:
PA CHEST:
1. CR: MSP @ T7
2. RESPIRATION: 2ND FULL INSPIRATION
3. IR LOCATION: 1.5-2 IN ABOVE SHOULDERS
4. ANATOMY: 10 POST RIBS ABOVE DIAPH.
LATERAL CHEST:
1. CR: MID THORAX @ T7
2. RESPIRATION: 2ND FULL INSPIRATION
3. IR LOCATION: 1 IN LOWER PA
4. ANATOMY: R & L RIBS NEAR SUPERIMP, R RIBS & COST. ANGLE SLIGHT POSTERIOR
- WHY 72 SID?
- HOW FIND T7?
- WHEN IS INSPIRATION & EXPIRATION PREFORMED FOR CXR?
- SIGNS OF TILTING ON CXR:
- DECREASE MAG. OF HEART (HEART LESS OID)
- PA: 7-8 IN BELOW C7
- AP: 3-4IN BELOW JUG NOTCH - PNEUMOTHORAX & FOREIGN BODY
- A. MANUBRIUM HIGHER T4 = POSTERIOR, LOWER T4 = ANTERIOR
- B. LUNGS & HEART FORESHORTENED = POSTERIOR, ELONGATED = ANTERIOR
- C. MORE 1in ABOVE APICIES = ANTERIOR, LESS 1in OF APICIES ABOVE CLAVICLES
- WHAT ERRORS FOR PA CHEST X-RAY:
IMAGE A:
IMAGE B : - HOW TO TELL CHEST X-RAY ROTATION ON LATERAL?
- A = ROTATION: LEFT SIDE CLOSER IR IN IMAGE
(STERNUM LEAST SUPERIMPOSED BY STERNUM WITH SPINE IS SIDE FURTHER FROM IR)
B = TILTING: POSTERIOR MCP TILT
(MANUBR. HIGHER T4, LUNG/HEART FORESHORT & LESS 1IN ABOVE APICIES) - A. IDENTIFY GASTRIC BUBBLE (UNDER L HEMID)
B. MORE 1/2in SEP. POSTERIOR RIBS
C. LUNG TISSUE ANTERIOR STERNUM ONLY SHOWN WHEN RIGHT LUNG IS ROTATED ANTERIOR
- AP SUPINE / SEMIERECT CR: T7
- OBLIQUE CHEST ROTATION:
- WHICH OBLIQUES? - CARDIAC SERIES ROTATION?
- IS SEMIERECT CHEST GOOD FOR AIR/FLUID LEVELS?
- PERP. LONG AXIS STERNUM @ T7
- 45* OBLQIUES
- AP = RPO & LPO = SIDE CLOSER IR
- PA = RAO & LAO = SIDE FURTHER IR
PA AWAY - 55-60* ROTATION
- NO - NEED HORIZONTAL BEAM, DO ERECT OR DECUB.
AP/PA OBLIQUE RIBS:
1. CR:
2. ROTATION:
3. SIDE OF INTEREST FOR PA:
- AP:
4. HOW DOES SIDE INTEREST LOOK?
- PERP T7 - BTWN MSP & LATERAL MARGIN THORAX
- 45* ROT
- RAO = LEFT. / LPO = LEFT
- LAO = RIGHT / RPO = RIGHT
PA AWAY - SIDE INTEREST ELONGATED ON IMAGE
- 2X SIZE OF OTHER
AP LORDOTIC CXR
1. CR:
2. IR:
3. ANATOMY
4. ALTERNATIVE:
- CR:
5. CLINICAL IND:
AP R/L DECUBITUS CXR
1. CR:
2. ANATOMY:
3. MARKER:
AP LORDOTIC CXR
1. PERP. MIDSTERNUM, 3-4 IN BELOW JUG NOTCH
2. IR: 3IN ABOVE SHOULDERS, 1 FOOT AWAY IR
3. ANATOMY: APICIES FREE LUNG SUPERIMP BY CLAVICLES && CLAVICLES NEAR HORIZONTAL
- ALTERNATIVE: AP SEMIAXIAL
- CR: 15-20* CEPHALAD @ MIDSTRN - CLINICAL IND: CALCIF/MASSES UNDER CLAV IN APICIES
AP R/L DECUBITUS CXR
1. CR: HORIZONTAL @ T7
2. ANATOMY: AIR ON UPSIDE, FLUID ON DOWNSIDE
3. MARKER: DECUB MARKER & UPSIDE IS MARKED
- A. WHICH ARE TRUE RIBS?
- B. WHICH ARE FALSE?
- C. FLOATING? - JOINT BETWEEN RIBS & VERTEBRAL COLUMN:
- CONNECTED ANT OR POST? - TYPE JOINT?
- FIRST SEVEN (CONNECT DIRECT STERNUM)
- B. 8-12 (CONNECT 7TH)
- C. 11 & 12 FLOATING - COSTOTRANSVERSE / COSTOVERTEBRAL
- POSTERIORLY - SYNOVIAL & DIARTHRODIAL
- HOW DO YOU DEMONSTRATE RIBS ABOVE DIAPHRAGM?
- BELOW? - CR FOR ABOVE:
- CR FOR BELOW: - WHAT PROJECTION SHOWS AXILLARY?
- SIDE INTEREST POSITIONED TO IR? - HOW DECIDED AP OR PA RIBS?
- ABOVE = ERECT ON INSPIRATION
- BELOW: RECUMBENT ON EXPIRATION - ABOVE = T7 (3-4IN ANT JUG NOTCH)
- BELOW = BTWN XIPHOID & LOWER MARGIN) - OBLIQUE = AXILLARY
AP: SIDE CLOSER IR
PA: SIDE AWAY - AP = POSTERIOR RIB PAIN
- PA = ANTERIOR RIB PAIN
(SIDE INTEREST CLOSER IR)
- RIB PROJECTIONS:
- PROJECTIONS RULEOUT POSSIBLE PNUEMOTHORAX, HEMOTHORAX & OTHER CHEST PATHOLOGY?
- RIB SID?
- AP/PA UPPER & LOWER
- AP OBLIQUES (RPO & LPO)
- PA OBLIQUES (RAO & LAO) - ERECT PA & LATERAL CHEST
- 40 SID
AP/PA RIBS:
1. CR ABOVE:
- CR BELOW:
2. ANATOMY ABOVE:
- ANATOMY BELOW:
- WHAT IS APART OF BOTH DIGESTIVE & RESPIRATORY?
- WHAT IS PNUEMOTHORAX?
- WHAT IS PNUEMONIA?
AP/PA RIBS:
1. CR ABOVE: T7
- CR BELOW: BTWN XIPHOID & LOWER RIB MARGIN
2. ANATOMY A: RIBS 1-9 AFTER INSP.
- ANATOMY B: RIBS 10-12 AFTER EXPIRATION
- PHARYNX
- PNUEMOTHORAX = AIR
- PNUEMONIA = FLUID
1 OBLIQUE ROTATION:
- WHY?
2. IDENTIFY EACH IMAGE POSITION / RIBS OF INTEREST:
- 45*
- MOVE SPINE AWAY FROM INJURY - A: RPO = RIGHT AXILLARY POST. RIBS
- B: RAO = LEFT AXILLARY ANT. RIBS
- C: LPO ABOVE = LEFT AXILLARY RIBS
- D: LPO BELOW = LEFT AXILLARY RIBS
- AXILLARY RIGHT RIBS = _______ OR ______
- AXILLARY LEFT RIBS = _______ OR ______
- Which two projections must be taken for an injury to the right anterior, upper ribs?
- What projection should be obtained on a patient with right axillary ribs injury on the posterior side?
- R = RPO & LAO
- L = LPO & RAO
- PA & LAO
- AP OBLIQUE - RPO
- DO ANTERIOR RIBS ATTACH DIRECTLY TO STERNUM?
- FLOATING RIBS ARE:
- WHICH BEST DEMONSTRATE AXILLARY LEFT RIB?
A. AP. B. RPO. C. LPO. D. LAO - Which joints articulate with a vertebra?
A. Costovertebral. B. Costotransverse
C. Costochondral
- A. 1 & 2 - B. 1 & 3. - C. 2 & 3. - D. ALL
- NO - THROUGH COSTALCART.
- DONT ATTACH ANTERIOR / 11 & 12TH RIB
- C. LPO
(AXILLARY = OBLIQUE, LEFT RIB = RAO & LPO)
4.
- BONY THORAX CONSIST OF:
- PARTS OF STERNUM:
- MEDIASTINUM CONSIST OF:
- LOCATED: - LOCATION FOR:
A. JUGNOTCH
B. STERNAL ANGLE:
C. XIPHOID TIP:
D. LOWER RIB MARGIN:
- RIBS STERNUM & THORACIC VERT.
- MANUBRIUM, BODY & XIPHOID TIP
- MEDIASTINUM CONSIST OF: HEART, GREATER BLOOD VESSELS & THYMUS &TRACH/ESOPH
- LOCATED BTWN LUNGS - LOCATION FOR:
A. JUGNOTCH = T2-T3
B. STERNAL ANGLE: T4-T5
C. XIPHOID TIP: T9-T10
D. LOWER RIB MARGIN: L2-L3
- PLUERA VS PERITONIUM?
- LAYERS: - STERNUM PROJECTIONS:
- SID:
- WHY ISNT AP/PA DONE?
- WHY IS RAO DONE?
- PLEURA = DOUBLE LUNG
- PERITONEIUM = DBL ABDOMEN
- LAYERS: VISCERAL = INNER // PERI = AROUND // CAVITY = BETWEEN - RAO & LATERAL (R OR L)
- RAO = 40 && LAT = 72
- STERNUM SUPERIMP BY T-SPINE
- RAO MOVE STERNUM LEFT, AWAY FROM SPINE & TO PROJECT STERNUM OVER HEART
RAO STERNUM
1. CR:
2. OBLIQUE:
- RULE THUMB:
3. RESPIRATION:
4. ANATOMY:
LATERAL STERNUM:
5. CR:
6. RESPIRATION:
7. POSITION
RAO STERNUM
1. CR: T7, 1IN LATERAL ELEVATED SIDE
2. OBLIQUE: 15-20*
- LARGER PT = LESS ROT
3. RESPIRATION: ORTHOSTATIC
4. ANATOMY: STERN OVER HEART, ANT TO SPINE
LATERAL STERNUM:
5. CR: T7
6. RESPIRATION: SUSPEND INSPIRATION
7. ARMS BEHIND BACK
- PROJECTION VS POSITION:
- IF PATIENT CANT ORTHOSTATIC IN RAO STERNUM, WHAT ALTERNATIVE:
- WHAT 3 FOLLOW THE PA AWAY RULE:
- PROJECTION = PATH OF BEAM (IF ENTER ANTERIOR AND EXIT POSTERIOR = AP)
- POSITION = PATIENT BODY WITH IR (IF LEFT POSTERIOR SIDE TO IR = POSTERIOR OBLIQUE) - NO ORTHO = SUSPEND EXPIRATION
- CHEST, RIBS & LUMBAR
- SOFT TISSUE NECK EXAMINES WHAT?
- PROJECTIONS FOR SOFT TISSUE NECK?
- SID?
- CLINICAL INDICATIONS:
- UPPER AIRWAY
- AP & LATERAL (R OR L)
- AP = 40. && LAT = 72
- PATHOLOGY OF LARYNX & TRACHEA
- UPPER AIRWAY FB
- LATERAL = R/O EPIGLOTTIS
- WHICH PROJECTION RULES OUT EPIGLOTTIS?
- LARYNX EXTENDS FROM ___ TO ___
- TRACHEA EXTENDS FROM _____ TO ____
- WHAT IS CARINA & WHERE LOCATED:
- CARLIDGE IN LARYNX INCLUDES: (3)
- LATERAL SOFT TISS. NECK
- C3 - C6
- C6 - T4/T5
- END TRACHEA, T4/T5 - WHERE BIFICATES TO RIGHT & LEFT
- EPIGLOTTIS, THYROID CART & CRICORD
AP SOFT TISSUE NECK
A. CR:
B. RESPIRATION:
LATERAL:
C. CR:
D. RESPIRATION:
AP:
A. T1-T2 (1IN ABOVE JUG NOTCH)
B. SLOW DEEP INSPIRATION
LATERAL:
C. LARYNX & UPPER = C5
- TRACHEA & MEDISTINUM = T1 - T2
- HOW AND WHY DO CR CHANGE IN LATERAL SOFT TISSUE NECK?
- WHAT IS RESPIRATION AND WHY FOR SOFT TISSUE NECK?
- Why is the RAO sternum preferred to the LAO position?
a. The RAO produces less magnification of the sternum.
b. The RAO projects the sternum over the shadow of the heart.
c. The RAO reduces dose to the thyroid gland.
d. The RAO projects the sternum away from the hilum and heart.
- AREA OF INTEREST
- LARYNX/UPPER = C5, TRACHEA/LOWER = T1-T2 - SLOW DEEP INSPIRATION TO ENSURE FILLING OF TRACHEA & UPPER AIRWAY WITH AIR
- b. The RAO projects the sternum over the shadow of the heart.
- IR CENTERED FOR PA OBLIQUE STERNUM?
- RESPIRATION FOR LATERAL STERNUM?
- STERNUM RAO OBLIQUITY FOR ASTHENIC PATIENT?
- IR CENTERED = CR
- T7 - SUSPEND INSPIRATION (PROTRUDE STERNUM FORWARD)
- THIN PATIENT = MORE ANGLE
20*
(RULE THUMB STERNUM = LARGE PT = LESS ANGLE)
- The internal prominence or ridge in which the trachea bifurcates into the right and left
bronchi is termed the: - AT WHAT LEVEL IS ABOVE?
- When performing the lateral projection of the upper airway, exposure should be made during a slow, deep inspiration rather than at the end of the inspiration.
a. True. b. False
- CARINA
- T5-T6
- TRUE
- HOW MANY BONES IN ADULT VERTEBRAL COLUMN?
- WHAT ARE THE CURVATURES OF SPINE?
- SPINAL CURVE: DESCRIBE EACH & WHERE LOCATED
- 26
- LORDOTIC & KYPHOTIC
- LORDOTIC = CONCAVE (C & L)
- KYPHOTIC = CONVEX (T & S/C)
LKLK
- WHAT IS ANOTHER NAME FOR SLIPPED DISK?
- TWO PARTS OF INTERVETEBRAL DISK ARE __________ & _____________
- WHICH IS INNER? OUTER?
- WHICH PART OF COLUMN HAS NO DISK BETWEEN SEGMENTS?
- HERNIATED NUCLEUS PULPOSUS (HNP) - CLINICAL IND. FOR MYLOGRAPHY
- ANNULUS FIBROSUS & NUCLEUS PULPOSUS
- ANN = OUTTER. // NUCL = INNER
- AT C1/C2 & SACRUM/COCCYX SEGMENTS
- TWO MAIN PARTS OF VERTEBRA ARE:
- WHAT PASSES THROUGH VERTEBRAL FORAMINA?
- WHAT ARE UNIQUE FEATURES OF CERVICAL VERTEBRAE?
- BODY & ARCH
2.. SPINAL CORD - TRANSVERSE FORAMINA IN TRANSVERSE PROCESS’
- BIFID SPINOUS PROCESS = C3 THROUGH C6
- OVERLAPPING VERT. BODIES
- ARTICULAR PILLARS (LATERAL MASS OF C1)
- ANOTHER NAME C1:
- UNIQUE FEATURES: - ANOTHER NAME FOR C2:
- UNIQUE FREATURES: - ARTICULATION BETWEEN C1 & C2:
- BEST PROJECTION TO SEE THIS:
- C1 = ATLAS
- NO VERT. BODY OR SPINOUR PROCESS
- HAS LATERAL MASSES - C2 = AXIS
- EXTRA TOOTH-LIKE PROCESS CALLED DENS / ODONTOID (ART. WITH C1) - ATLANTOAXIAL JOINT
- OPEN MOUTH
- LABEL THE IMAGE
- WHAT PROJECTION IS THIS?
A. ODONTOID / DENS
B. TRANSVERSE C1
C. LATERAL MASS C1
D. INFERIOR ART. C1
E. ATLANTOAXIAL JOINT
F. BODY C2
G. SUP. ART SURFACE
- OPEN MOUTH
- WHAT IS PART OF LAMINA BETWEEN SUPERIOR & INFERIOR ARTICULAR PROCESS’
- WHAT IS SPONDYLOSIS?
- WHAT IS SPONDYLOLISTHESIS?
- WHERE DO THESE EFFECT?
- PARS INTERARTICULARIS
- LYSIS = BONY DEFECT (SEPERATION OR STRESS FX) IN PARS ARTIC.
- THESIS = ANTERIOR DISPLACEMNT OF ONE VERT. OVER ANOTHER.
- PARS ART.
- WHEN IS PARS INTERARTICULARIS SEEN ON T-SPINE X-RAY?
- DOES EACH THORACIC VERTEBRAE HAVE FACETS ON VERTEBRAL BODY?
- WHICH JOINT DO FACETS FORM WITH RIBS?
- WHICH T-SPINE VERT DO NOT HAVE FACETS ON TRANSVERSE PROCESS?
- OBLIQUE
- YES - EACH HAS FULL FACET & 2 PARTIAL FACETS (DEMIFACETS) EACH SIDE
- FACET ACCEPT HEAD OF RIB TO FORM COSTOVERTEBRAL JOINT
- T11 & T12
T1-T10 FACET ART. WITH RIBS FOR COSTOTRANSVERSE JOINT
- WHAT ARE ZYGAPOPHYSEAL JOINTS?
- WHAT PROJECTIONS SHOW THIS?
- WHAT IS INTERVERTEBRAL FORAMINA?
- WHICH PROJECTION SHOW THIS?
- JOINT BETWEEN SUPERIOR AND INFERIOR ARTICULAR PROCESS OF ADJACENT VERTEBRA
- LATERAL C-SPINE,
- T (70-75) & L-SPINE (30-50) OBLQIUE - OPENING BETWEEN SUPERIOR AND INFERIOR VERTEBRAL NOTCHES OF ADJACENT VERTEBRAE
- OBLQIUE C-SPINE (45*)
- LATERAL T & L SPINE
- Z-JOINT ANGLE IN C SPINE:
- T-SPINE
- L-SPINE: - IVF ANGLE IN C-SPSINE:
- T-SPINE:
- L-SPINE: - WHAT SHOULD BE SEEN ON ACCURATELY POSITION L-SPINE OBLIQUE?
- THREE OBLIQUES FOLLOW AP AWAY RULE:
- 90* / LATERAL
- T = 70-75*
- L = 30-50* - C-SPINE: 45*
- T & L = 90* / LAT - SCOTTY DOGS
- C-SPINE, SI JOINTS & BE OBLIQUES