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Chest Flashcards

(48 cards)

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1
Q

What is the ABC approach to examining the chest?

A 
airway and abdomen
bones
cardiac
diaphragm
effusions
Fields (lung)

LOOK AT EVERYTHING AND NOT JUST LUNG PATHOLOGY

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2
Q

On the PA film what chambers of the heart are not visible edges?

A

RV and LA

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3
Q

On lateral CXR- what 3 things make up the posterior border?

A

IVC, LV, LA

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4
Q

What is the hoffman Rigler’s sign?

A

assess LV enlargement- 2cm up from IVC,heart junction and 2 cm back. If heart past this then it is enlarged.

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5
Q

How can we tell if RV is enlarged on lateral film?

A

> 1/3 sternal length is abutted by the RV

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6
Q

What are the 3 knobs of the left heart

A

aorta, pulmonary trunk, LV

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7
Q

if there is a 4th mogul, what is the problem?

A

LA enlargement

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8
Q

If you see a prominent bulge in 3rd mogul…?

A

LV aneurysm

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9
Q

How many anterior ribs should we see in adequate inspiration/

A

6 ant. ribs

8 or more suggests hyperinflation

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10
Q

For adequate penetration- what should be seen thru cardiac shadow…

A

intervertebral disks and pulmonary vessels

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11
Q

What false signs are seen in AP portable technique?

A

cardiac enlargement and vascular crowding

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12
Q

Pathology in the anterior mediastinum is most likely what 4 things?

A

thymoma
teratoma
thyroid
terrible lymphoma

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13
Q

Pathology in the middle mediastinum is most likely what?

A 
heart- pericardial cyst
asc. aorta- dissection TAA
esophagus- mass duplication cyst
bronchus: mass duplication cyst
lymph nodes- lymphoma, TB, sarcoid, etc.
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14
Q

Posterior mediastinum problems include?

A

neural tumors- schwannomas, neurofibroma, neuroblastoma, ganglioneuroma
spine malignancy

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15
Q

What two things help us work up nodules?

A

determine age (>2 years stable = benign)

evaluate qualities

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16
Q

If nodule is soft tissue in density, what does it mean?

A

probably malignancy

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17
Q

If nodule is fat, what is it probably?

A

hamartoma

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18
Q

What is the size difference between mass and nodule?

A

3cm

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19
Q

How do we know that a hamartoma is what we are looking at…

A

compare density to subQ fat

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20
Q

Is contrast enhancement of nodules predictive of malignancy?

Study These Flashcards
A

No- it is suggestive- it is difficult with small nodules, cavitary lesions, central necrosis

21
Q

What is so good about PET, what is the size limit, when is the False +

Study These Flashcards
A

sensitivity and spec >90

difficult if

22
Q

What are the 2 stages of pulm edema?

Study These Flashcards
A

congestion, interstitial and frank

23
Q

What are the 4 signs of congestion?

Study These Flashcards
A

-loss of 1:1 arterial-bronchial ratio
- development of peribronchial cuffing
- cephalization
loss of vascular border

24
Q

What are the 2 big signs for interstitial edema?

Study These Flashcards
A

Kerley B lines

Bat wing

25
What is different about frank edema?
air space component--> spilling into alveoli symmetric bilateral pleural effusions
26
How big is azygos in upright PA normally?
27
If it is air-space what should we be thinking?
cotton, fluffy blood, pus, tumor, water infection, pulmonary edema, hemorrhage
28
If it is interstitial what should we be thinking?
linear, lacey fibrosis, pulmonary edema early, scarring, viral infection
29
What lobe abuts the left heart border?
LUL- lingular
30
what lobe abuts ascending aorta?
RUL
31
Main difference between abscess and empyema?
abscess- cavitary, usually round, airfluid level Empyema- loculated, lentiform, in the plearual space
32
In a contrast study differentiating abscess from loculated empyema what is the diffence in shape? margin? angle with chest wall? effect on lung?
Shape: E = oval; A = round Margin: E = thin, smooth; A = thick, irregular Angle with chest wall: E = obtuse; A = acute Effect on lung: E = compression; A = consumption
33
What way does atelectasis shift mediastinum?
toward side of collapse obliteration of heart or diaphragm borders with lobar collapse
34
What can we see on lateral CXR for RML collapse?
shift of the minor fissure downward- on pa we saw loss of right heart border
35
Increased retrocardiac density suggests what?
LLL problems- possibly collapse
36
Wat is virchow's triad?
venous stasis intimal injury hypercoaguable state
37
What are the 3 major/classic symptoms of PE?
dyspnea pleuritic pain cough However,
38
What are the embolic origins of PE?
lower extremetiy DVT>>>>>iliac vein thrombosis, IVC thrombosis
39
What is hampton's hump?
Lung infarct, loss of alveolar integrity collapse =infarct- rate of resolution of these densities is the best way to judge if lung tissue has been infarcted
40
What is westermark's sign?
area of decreased vascularity and perfusion distal to a large PE Presumed to be secondary to near complete loss of blood flow
41
T-F- hampton's hump and westermarks sign are sensitive for PE
FAlse- neither are- infarcts may have not had time to evolve, blood supply may not be completely compromised
42
What is used for perfusion in the V/Q scan? what is used for ventilation?
Perfusion- TC-99m macroaggregated albumin Ventilation Tc99M DTPA aerosol or xenon 133 gas
43
Ona V/Q scan, what is seen on mismatch?
lung is ventilated but not perfused
44
What are the 4 probabilites of V/Q results?
high probability- 87 intermediate probability- 30 low probability- 14 Normal- 0% High prob with high clinical suspicion=95% low prob+ low suspicion= 4%
45
In PE is VQ very specific?
no like 10%, CT is sens and specific
46
If CT is better than V/Q...why use V/Q?
- CT contraindicated in pregnancy - contrast load has potential for renal failure - patients with contrast allergy
47
What is the pressure in the pleural space normally?
5 cm of water below atmospheric
48
What is sometimes the only clue to a pneumothorax that we should not forget?
deep sulcus sign

Radiology (8 decks)

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