basic radiographic diagnostics

Question 1

consolidation

Answer 1

region of compressible lung tissue filled with liquid

Question 2

atelectasis

Answer 2

collapse or incomplete expansion of the lung or part of the lung (snapping sound when opening)

Question 3

complications for atelectasis

Answer 3

cystic fibrosis
inhaled foreign objects
lung tumors
fluid in the lung 
respiratory weakness 
chest injuries

Question 4

AP view

Answer 4

x-ray picture beam pass from front to back (anteroposterior)

Question 5

PA view

Answer 5

standard chest x-ray (posterioranterior) and lateral chest x-ray

Question 6

PA scapula and clavicles

Answer 6

scapula seen in periphery of thorax

clavicles project over lung fields

Question 7

AP scapula and clavicles

Answer 7

scapula seen over lung fields

clavicles above the apex of lung fields

Question 8

why get the lateral view

Answer 8

PA view
The triangular shape below the left ventricle will hide a lot of “bad things” and a lateral view is the only way to see it. It is blocked by the heart

Question 9

chest x-ray for decubitus

Answer 9

helpful in assessing the volume of pleural effusion and demonstrate whether a pleural effusion is mobile or loculated

Question 10

kerley lines

Answer 10

thin linear pulmonary opacities caused by fluid or cellular infiltration into the interstitium of the lungs

Question 11

sarcoid

Answer 11

sarcoidosis - disease involving abnormal collections of inflammatory cells forming granulomas aka: nodules

Question 12

labs that aid in sarcoid dx

Answer 12

elevated serum Ca
normal parathyroid hormone
elevated serum ACE level
DX: should be one of exclusion

Question 13

lofgren syndrome

Answer 13

type of acute sarcoidosis

Question 14

lofgren syndrome s/sx

Answer 14

fever, large lymph nodes, arthritis and rash (erythema nodosum)
additionally patients may present with wheezing, cough, SOB and chest pain
so if patient comes in for flu and you see erythema nodosum - get a picture

Question 15

erythema nodosum

Answer 15

inflammatorycondition
aka: sub-acute migratory panniculitis of vilanova and pinol

characterized by inflammation of the fat cells under the skin, resulting in tender red nodules or lumps.

Question 16

causes of erythema nodosum

Answer 16

It can be caused by a variety of conditions such as IBD, Strep, TB, Cat Scratch Fever, and Sarcoid

Question 17

air bronchogram

Answer 17

refers to the phenomenon of air filled bronchi (dark) being made visible by the opacification of the surrounding alveoli

basically large airway becomes more visible

Question 18

causes of air bronchogram

Answer 18

lung consolidation
pulmonary edema
nonobstructive pulmonary atelectasis
severe interstitial disease
neoplasm
normal expiration

Question 19

interstitial

Answer 19

anatomy relating to or situated in the small narrow spaces between tissues or parts of an organ
interstitial cells
interstitial fluid

Question 20

pleural or pulmonary effusion

Answer 20

buildup of fluid in pleural space

-area between the layers of tissue that line the lungs of the chest cavity

Question 21

two types of pleural effusions

Answer 21

transudative

exudative

Question 22

transudative pleural effusion

Answer 22

fluid leaking into the pleural space from increased pressure in the blood vessels or a low blood protein count.
Think in terms of fluid overload

Question 23

exudative pleural effusion

Answer 23

blocked blood vessels or lymph vessels
Inflammation
lung injury
tumors.

Question 24

pneumothorax

Answer 24

air in the cavity between the lungs and chest wall causing a collapse of the lung

Question 25

closed pneumothorax

Answer 25

air in the pleural space | can be spontaneous

Question 26

open pneumothorax

Answer 26

guns knife ect

Question 27

tension pneumothorax

Answer 27

air in pleural cavity and is trapped during expiration air pressure within the thorax mounts higher atmospheric pressure and compressing the lung displace the mediastinum and its structures towards the opposite

Question 28

hemothorax

Answer 28

blood in the pleural space

Question 29

solitary pulmonary nodule

Answer 29

SPN aka coin lesion mass in lung usually smaller than 3 cm in diameter 10-20% of patients with granulomas are diagnosed with lung cancer

Question 30

color of images

Answer 30

black-air gray- muscle, fat, fluid white- bone, metal, contrast media

Question 31

limitations of chest x -ray

Answer 31

- show only conditions that change the side of tissue in the chest or how the tissue absorbs radiation - limited to two dimension pictures - very small areas of cancer and blood clots in the lungs usually not visible

Question 32

many reasons to get a chest x-ray but dr hatch specifically mentioned

Answer 32

post tube and line insertions

Question 33

approach to imaging steps 1-4

Answer 33

- check patient details (name DOB) - check film orientation (L&R is view AP or PA) - check additional info (enough inspiration expansion or expiration compression) - check rotation (measure distance from medial end of each clavicle to the spinous process of the vertebra at the same level- SHOULD BE THE SAME)

Question 34

approach to imaging steps 5-7

Answer 34

- check for adequacy of inspiration (9 pairs of ribs) - check penetration (thoracic vertebra should be visible behind heart) - check exposure (ID both costophrenic angles and lung apices)

Question 35

ABCDEFGHI of chest x -ray

Answer 35

``` Assessment of quality Bones and soft tissues Cardiac Diaphragm Effusions Fields and Fissures Great Vessels Hilum / mediastinum Impression ```

Question 36

cardiac on chest x-ray

Answer 36

heart should be 50% of the chest diameter on PA films

Question 37

diaphragm on chest x-ray

Answer 37

check hemi-diaphragms for position and shape (right is slightly higher than left) (may be flat in asthma and COPD) -look below the diaphragm for free air (gastro perforation)

Question 38

pleural effusions on chest x-ray

Answer 38

- Pleural effusions may be large and obvious or small and subtle. - Always check the costophrenic angles for sharpness (blunted angles may indicate small effusions). - Check a lateral film for small posterior effusions

Question 39

epidural

Answer 39

pt fine for a few minutes then progressively worse above the dura looks like a lemon

Question 40

subdural

Answer 40

under the dura progressive unconscious looks like a banana

Question 41

kids suspect pneumonia but CXR is negative

Answer 41

admit and hydrate and then re-film in the morning