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Flashcards in Chest Deck (39)
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1

28-yo man with a 10 day history of mild cough and low fever. No significant PMH and otherwise healthy. No sputum production or hemoptysis. Chest exam is normal. Next best step in management?

Symptomatic management

2

In which patients should you order f/u imaging in pneumonia?

older, current/former smokers, recurrent pneumonias

3

Atypical pneumonias on CXR appear with which of the following characteristics?

1) B/L
2) Ground glass appearance
3) Kerley B Lines (septal lines- thickening of interlobular septa)
4) Relative sparing of bases and apices

4

Which imaging modalities can be used for radiographic diagnosis of pleural effusions?

CXR Right lateral decubitus
US
CT (for loculated and complex pleural collections)

5

Which patients need preoperative CXR?

1) Patients with cardiorespiratory signs and symptoms
2) Patients over 65 with stable cardiorespiratory disease and no CXR for six months

6

Single pulmonary nodules management?

Comparison important to assess stability >2yrs
CT if suspicious for malignancy or many risk factors

7

Single pulmonary nodule concerning characteristics

size: greater than 1cm or increasing in size
edge: lobulated, spiculated, ill-defined
pattern of calcifications

8

Single pulmonary nodule patient risk factors

h/o lung disease
>40 yrs
smoking history
granulomatous disease
h/o malignancy

9

Lung cancer screening?

low dose CT, current/former smokers or other high risk pts
f/u in-determinants with pet before bx

10

Best choice of imaging to evaluate for a subtle pneumothorax?

erect expiratory CXR (Increased lung density and decreased thoracic volume)
right lateral decubitus CXR

11

CXR signs of a tension pneumothorax:

-Mediastinal shift AWAY
-Diaphragmatic depression on side of pneumothorax
-Complete lung collapse typical

12

Clinical signs of tension pneumothorax:

-Hypoxia
-Hypotension
-Pulsus paradox
-Hyper-resonance on side
-Decreased respiratory excursions on side
-Absent breath sounds on side of pneumothorax

13

Management of tension pneumothorax:

IMMEDIATE temporary relief of by inserting a large-bore needle into the second left interspace in the mid-clavicular line

14

What pathophysiology correlated to the CXR finding: faint "veil-like" opacification of the middle 2/3 of the left hemithorax?

Atelectic left upper lobe that retracts anteriorly

15

What pathophysiology correlated to the PA CXR finding: Tracheal shift to the left, diaphragmatic elevation, and loss of the left heart border

Volume loss in the left hemithorax

16

What pathophysiology correlated to the lateral CXR finding: Sharp edge with opacification over the anterior chest/heart

Left upper lobe collapses against the anterior chest wall

17

Differential diagnosis of complete opacification of a hemithorax?

complete lobe atelectasis (collapse)
Hemi-pneumonectomy (look for clues: rib resections, clips, volume shift)
large pleural effusion
large mass
large pneumonia

18

What is a typical x-ray 'trauma series'?

AP supine CXR
Lateral C-spine
AP supine pelvis

19

Common radiographic findings seen in traumatic aortic injury (TAI)?

Widening mediastinum (>8cm)
Mediastinal deviation to the right
No 'lateral aortic silhouette'
No aortic knob

20

What is a typical CT 'trauma series'?

CT w/o Head
CT C-spine
CT Chest/Abd/Pelvis with contrast

21

Appropriate radiologic aorta evaluation?

CT with Contrast
Transesophageal echo (if contrast contraindicated)
MRI (time permitting, if contrast contraindicated)

22

Recognition of a pneumothorax on supine CXR?

Deep Sulcus Sign- one costophrenic angle appears much 'deeper' and more lucent than the other

23

Radiographic evaluation of chest tube placement?

anterior and apical for a pneumothorax
posterior and basal for a pleural effusion

24

Radiographic evaluation of endotracheal tube placement?

3-5 cm above the carina

25

Radiographic evaluation of enteric (NG) tube placement?

Feeding tube: third portion of the duodenum or duodenal-jejunal junction
Regular NG/OG: Stomach (confirmed by auscultation)

26

Considerations for obtaining baseline CXR for patients with chronic dyspnea of suspected pulmonary origin?

age, lung cancer risk, suspicion for- pulmonary fibrosis, COPD, pneumonia, pleural effusion, pneumothorax.

27

CXR signs of COPD?

CXR NOT sensitive or specific for COPD...but
-hyperinflation
-mediastinal narrowing
-enlarging central pulmonary arteries
-increase lucency (darkness)

28

Confirmatory test for CXR suspicious for COPD?

Pulmonary function tests
FEV1/FVC 45% predicted (c/w severe obstruction)

29

Imaging options for suspected aortic dissection?

#1 Contrast enhanced CT angiogram of the entire aorta
#2 MRI (if stable)
#3 Transesophageal echo

30

BEST imaging test to confirm the diagnosis of pulmonary emboli?

#1 CT angiography EXCEPT in patients with contraindications to intravenous contrast (allergy/renal)
#2 Nuclear medicine V/Q scanning