Chest

Question 1

Larynx

Answer 1

C3 - C6
2” - 5cm long
Cartilagenous
9 cartilages
Thyroid Cartilage C5 largest
Cricoid cartilage - inferior margin of larynx - tracheotomies below this level
Epiglottis
Glottis - opening between folds of larynx - upper and lower folds - lower is true vocal cords

Question 2

Trachea

Answer 2

C6 - T5
1” diameter
4” long
16 - 20 c-shaped rings of cartilage in front - muscular and fibrous connective tissue in back

Question 3

Bronchi
Bronchus

Answer 3

Carina - where trachea bifurcates
Right main bronchus - wider, shorter, more vertical
3 secondary bronchi
Left main bronchus
2 secondary bronchi
Bronchioles
Terminal bronchioles - no longer contain cartilage
Bronchial tree has continual decrease in cartilage and increase in smooth muscle as it decreases in size

Question 4

Alveoli
Alveolus

Answer 4

Functional unit of lung
Exchange gases
Thin-walled and near capillaries
Millions in each lung
Emphysema - lungs are over inflated - loss of elasticity and dyspnea

Question 5

Costal surface

Answer 5

Rounded portion against ribs

Question 6

Hilum
Hilus

Answer 6

Medial surface, lung root
Where structures enter lungs
No movement in this area during respiration

Question 7

Costophrenic angles

Answer 7

Lateral lower aspect
Right hemidiaphragm higher to accommodate liver

Question 8

Cardiac notch

Answer 8

Concavity where heart rests against lung

Question 9

Lobes

Answer 9

Divided by fissures
Right - 3 lobes - Horizontal and Oblique fissures
Left - 2 lobes - oblique fissure
Each lobe divided into lobules

Question 10

Pleura

Answer 10

Double fold of serous membrane
Visceral against lung
Parietal against thoracic wall
Pleural space - contains some serous fluid to eliminate friction
pneumothorax - collapsed lung with air in pleural space
hemothorax - blood in pleural cavity
pleurisy inflammation of pleura
pleural effusion - accumulation of fluid in a cavity

Question 11

Parenchyma

Answer 11

Spongy, elastic tissue of lung
Allows for expansion and contraction during respiration

Question 12

Mediastinum

Answer 12

Located between lungs
All structures of thorax except lungs:
- heart
- great vessels
- trachea
- esophagus
- miscellaneous

Question 13

Thoracic skeletal landmarks

Answer 13

Jugular notch - manubrial notch / suprasternal notch
Vertebra prominens - C7
Xyphoid process

Question 14

Progression of air through respiratory system

Answer 14

Nose and mouth
pharynx
Larynx
Trachea
Bronchi
Bronchioles
Alveoli
Lung capillaries

Question 15

Respiration phases

Answer 15

Inspiration
Suspended
Expiration

Question 16

Body habitus types

Answer 16

Asthenic
Hyposthenic
Sthenic
Hypersthenic

Question 17

Sign of degree of sufficient inspiration for chest x-ray

Answer 17

10 ribs show

Question 18

Bronchitis

Answer 18

Inflammation of lining of bronchial tubes

Question 19

COPD

Answer 19

Chronic Obstructive Pulmonary Disease
Group of diseases that cause progressive airflow obstruction

Question 20

Cystic Fibrosis

Answer 20

Affects cells that produce mucus, sweat, and digestive juices
Causes thick, sticky mucus that plugs up passageways

Question 21

Dyspnea

Answer 21

Difficulty breathing
Shortness of breath

Question 22

Emphysema
Definition, appearance on x-ray and technique

Answer 22

Alveoli become inflated, air does not expel
Barrel-chest, increased lung dimensions, flattened diaphragm obscures costophrenic angles, elongated heart shadow
— Significant decrease in exposure factors

Question 23

Epiglottitis
Definition, appearance on radiograph, techinique

Answer 23

Children 2-5 most common
Narrowing of upper airway (edema or swelling of epiglottis)
Soft tissue lateral upper airway

Question 24

Neoplasm

Answer 24

Abnormal mass of tissue
Caused by cells dividing more rapidly than they should or not dying when they should

Question 25

Pleural effusion Definition, 2 types, appearance, technique

Answer 25

Abnormal accumulation of fluid in pleural cavity *Empyema - PUS - chest wounds, bronchial obstruction, ruptured lung abscess. May occur from pneumonia entering pleural space *Hemothorax - BLOOD - left-sided is from trauma, pulmonary infarct, pancreatitis, subphrenic abscess. Right-sided or bilateral from congestive heart failure, Lateral decub with affected side down OR erect positioning

Question 26

Pneumonia 4 types

Answer 26

Inflammation of lungs resulting in accumulation of fluid within certain sections of lungs creating increased radiodensities in these regions *Aspiration pneumonia - aspiration into lungs irritating bronchi causing edema *Bronchopneumonia - bronchitis of both lungs caused by Strep *Lobar pneumonia - confined to one or two lobes *Viral pneumonia - inflammation of alveoli and connecting structures appears radiodense at hila

Question 27

Pneumothorax

Answer 27

Accumulation of air in pleural space causing partial or complete lung collapse Immideiate severe shortness of breath and chest pain Cased by trauma or pathologic condition causing rupture of weakened lung area Appearance - lung displaced from chest wall. No lung markings in region of collapsed lung Positioning - ERECT - if pt cannot, then lateral decub with affected side UP

Question 28

Pulmonary edema

Answer 28

Excess fluid within the lung caused by backup in pulmonary circulation. Appearance - Diffuse increase in radiodensity in hilar regions fading toward the periphery of the lung Increased air-fluid levels HORIZONTAL BEAM PROJECTIONS in more severe conditions

Question 29

RDS

Answer 29

Respiratory Distress Syndrome Adult Respiratory Distress Syndrome (adults) ARDS Hyaline Membrane Disease (infants) HMD Injury or infection of alveoli and capillaries of lung Results in leakage of fluid and blood into the spaces between alveoli or into alveoli Appearance - increased density throughout lungs with granular pattern

Question 30

Tuberculosis

Answer 30

Contagious disease caused by airborne bacteria Primary tuberculosis - first-timers. Pleural effusion, Hilar enlargement, mediastinal lymph node enlargement Reactivation TB - adults. Appears bilaterally in upper lobes as calcifications that are mottled in appearance AP LORDOTIC PROJECTIONS

Question 31

Pneumoconiosis 3 types

Answer 31

Anthracosis - black lung pneumoconiosis - coal dust - radiographs as small opaque spots or masses Asbestosis - pulmonary fibrosis - may turn into cancer Silicosis - inhalation of silica (quartz) dust - makes pt susceptible to TB

Question 32

Severe pulmonary edema technique

Answer 32

Higher kV

Question 33

Severe emphysyma technique

Answer 33

Lower exposure factors

Question 34

Pleural effusion technique

Answer 34

Higher kV

Question 35

2 conditions to use a grid

Answer 35

Tissue thicker than 10cm Using high kV

Question 36

2 conditions for using a grid

Answer 36

Tissue thicker than 10cm Using high kV

Question 37

Pneumothorax positioning technique

Answer 37

Sitting/standing PA if possible Lateral decub with affected side up

Question 38

Hemothorax positioning technique

Answer 38

Upright PA if possible Lateral decub affected side down

Question 39

Exposure factors for chest X-ray MAs kVp SID

Answer 39

110 - 125 kVp 8 mAs 72” SID Grid 14 x 17 or 17 x 17 if possible

Question 40

3 reasons for erect chest position

Answer 40

Allows diaphragm to move farther down Demonstrates air-fluid levels Prevents engorgement of pulmonary vessels

Question 41

Routine chest positions

Answer 41

PA Lateral

Question 42

Special chest positions (5)

Answer 42

AP supine or semierect Lateral decub AP lordotic Anterior obliuqe Posterior oblique

Question 43

Average distance from jugular notch for CR position in AP projection

Answer 43

3 - 4 inches below jugular notch

Question 44

Average distance from vert prominens for CR position

Answer 44

7-8 inches

Question 45

CR position for PA chest (vertebra)

Answer 45

T7

Question 46

AP supine or semierect projection angle

Answer 46

~5 degrees caudal

Question 47

Lateral Upper Airway CR at which landmark Breathing instructions

Answer 47

CR at C6-7 Slow, deep inspiration

Question 48

AP Upper Airway CR position

Answer 48

T1-2

Question 49

Larynx is between which vertebra?

Answer 49

C3 - C6

Question 50

Thyroid cartilage (adams apple) at which vertebral level?

Answer 50

C5

Question 51

Trachea between which vertebral levels?

Answer 51

C6 - T5