Chest X-ray

Question 1

What are the 4 stages when checking the quality of the chest X-ray?

Answer 1

RIPE
Rotation
Inspiration
Projection
Exposure

Question 2

What are you looking for when looking at the rotation of the chest x-ray?

Answer 2

The medial aspect of each clavicle should be an equal distance from the spine. Also the spinous processes should be in vertically orientated against the vertebral bodies

Question 3

What are you looking for when looking at the inspiration of the chest x-ray?

Answer 3

The 5-6 ribs, lung apices, both costophrenic angles and the lateral rib edges should be visible

Question 4

What projection should the chest x-ray be?

Answer 4

AP

Question 5

What are you looking for when looking at the exposure of the chest x-ray?

Answer 5

The left hemidiaphragm should be visible to the spine and the vertebrae should be visible behind the heart

Question 6

What is the stepwise acronym for interpretation of a chest x-ray?

Answer 6

A - airways
B - breathing
C - cardiac
D - diaphragm
E - everything else

Question 7

What could cause pushing cuasing tracheal deviation in a CXR?

Answer 7

Large pleural effusion or tension pneumothorax

Question 8

What could cause pulling to cause tracheal deviation in a CXR?

Answer 8

Lobar collapse

Question 9

What is the carina?

Answer 9

The cartilage situated at which the trachea divides into the left and right main bronchus

Question 10

How does the right bronchus appearon a CXR compared to the left?

Answer 10

wider, shorter and more verticle

Question 11

What is aspiration pneumonia?

Answer 11

When inhaled foreign objects become lodged - more common in right bronchus

Question 12

What does the hilar consist of?

Answer 12

Pulmonary vasculature and major bronchi - same size so if this changes then it indicates pathology.

Question 13

What pathology causes symmetrical changes in the lung fields?

Answer 13

pulmonary oedema

Question 14

What pathology does increased airspace shadowing indicate?

Answer 14

Consolidation/malignant lesion

Question 15

What pathology does the complete absence of lung markings indicate?

Answer 15

Pneumothorax

Question 16

When looking at the lungs and comparing each zone what should you been looking for?

Answer 16

Asymmetry

Question 17

What does the presence of pleural thickening indicate?

Answer 17

Mesothelioma

Question 18

What does an area of increased opacity on a CXR suggest?

Answer 18

Hydrothorax or haemothorax in the pleural space

Question 19

What is cardiomegaly?

Answer 19

When the heart occupies more than 50% of the thoracic width on a PA chest x-ray

Question 20

What does a reduced definition of the right heart border typically associate with?

Answer 20

right middle lobe consolidation

Question 21

What does a reduced definition of the left heart border typically associate with?

Answer 21

lingular consolidation

Question 22

Is the right hemidiaphragm higher or lower than the left and why?

Answer 22

higher due to the presence of the liver

Question 23

What happens in bowel perforation on a CXR?

Answer 23

Air accumulates under the diaphragm causing it to lift and become visibly separate from the liver

Question 24

What conditions can result in false impression of free gas under the diaphragm?

Answer 24

pseudo-pneumoperitoneum, including chilaiditi syndrome

Question 25

What does costophrenic blunting indicate?

Answer 25

Presence of fluid or consolidation in that area. COPD

Question 26

what does the reduced definition of the aortic knuckle contours indicate?

Answer 26

can occur in the context of an aneurysm

Question 27

What can the loss of the aortopulmonary window result from?

Answer 27

The mediastinal lymphadenopathy

Question 28

Where are the review areas?

Answer 28

The lung apices, the reterocardiac region, behind the diaphragm, the peripheral region of the lungs, the hilar regions