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Flashcards in Chest X-ray Deck (82):
1

What type view is normally used for a chest x-ray?

PA view

2

In bedridden patients, what view is normally used?

AP view

3

What is the view where xray tube angled cranially. Used to evaluate suspected upper lobe pathology that may be obscured by 1st rib.

Apical lordotic view

4

What is a view where patients lies on their side. Evaluates for pleural effusion because fluid will layer. Lie them on the side in question.

Decubutis view

5

How does reticular interstitial disease appear?

Lines

6

How does nodular interstitial disease appear?

Dots

7

In what type of disease are bronchograms found?

Airspace disease

8

What type lines are found in interstitial lung disease?

Kerley's B lines (seen in periphery)

9

What is the most common interstitial lung disease?

Pulmonary interstitial edema (can be cardiogenic or non-cardiogenic)

10

Causes of cardiogenic edema

Related to heart failure (CHF)
Hemodynamic forces (Inc. pressure)
Usually associated with cardiomegaly
Engorged pulmonary veins

11

Causes of non-cardiogenic pulmonary edema

Increase in vascular permeability
Most patients are seriously ill
High mortality, especially for ARDS
Neurogenic
Drug related/ overdose
Drowning, aspiration
ARDS
Re-expansion (large volume thoracentesis, post-pneumothorax)

12

What is cephalization

Congested system
most blood vessels seen in the upper lobes
Often seen in cardiogenic pulmonary edema

13

Medication that predisposes to interstitial fibrosis.

Bleomycin
Busulfan,
Phenytoin
NItrofurantoin

14

What disease is "ground glass" common in?

Interstitial lung disease

15

When you see nodules, what three things should you be thinking?

Bronchogenic cancer
Metastasis to the lung
Lymphangitic carcinomatosis

16

What are 4 causes of an opacified hemithorax?

Atelectasis of entire lung
Very large pleural effusion
Large pneumonia
Pneumonectomy

17

With atelectasis there is shifting where?

Toward the side of opacification

18

If the affected side is being pushed toward the midline what is the problem?

There is something space occupying (fluid, mass)

19

What are 4 common causes of obstructive atelectasis?

Tumors
Mucous plugs
Foreign body- peanuts, toys, etc
Inflammation- scarring from TB

20

These are all examples of ______ that can cause effusions.
Increased capillary hydrostatic pressure or decreased osmotic pressure.
CHF
Hypoalbuminemia
Cirrhosis

Transudates

21

These are all examples of _____ that can cause effusions.
Malignancy
Empyema
Hemothorax
Chylothorax

Exudates

22

What can bilateral pleural effusions indicate?

CHF
Lupus

23

Left sided pleural effusions can be caused by what?

Pancreatitis, distal thoracic duct obstruction, Dressler syndrome

24

Right sided pleural effusions can be caused by what?

abdominal disease related to the liver or ovaries, rheumatoid arthritis, proximal thoracic duct abnormalities.

25

Pleural effusions on either side can be caused by what? (usually unilateral)

TB
Pulmonary embolism
trauma

26

If you can see a effusion on a frontal x-ray, how big is it?

At least 300 cc's

27

If you see a effusion on the lateral x-ray, how big is it?

About 75 ccs

28

Causes of pneumothorax

Barotrauma (patient on vent)
Trauma
Intervention (lung bx, line placement)
spontaneous
COPD
chronic fibrotic disease
Hyaline membrane disease

29

Signs of a Pneumo

Radiolucent air (dark)
Absence of lung markings
Pleural line
Shrunken lobe/ lung
Tracheal deviation
Mediastinal shift
Flattened hemi diaphragm

30

What is the cardiothoracic ratio?

measurement of the widest transverse diameter of the heart compared with the widest internal diameter of the rib cage
Should be less than 50%

31

Condition has fluffy indistinct, patchy airspace densities, cephalization. Abrupt in onset and quick to clear.

Pulmonary edema

32

In which type of pulmonary edema are Kerley B lines common?

Cardiogenic pulmonary edema

33

In which type of pulmonary edema is the heart enlarged?

Cardiogenic pulmonary edema

34

What is a thoracic aortic dissection that is in the ascending aorta and is treated surgically?

Standford A

35

What is a thoracic aortic dissection that is in the descending aorta and is treated medically?

Standford B

36

What can be seen with thoracic aortic dissection on an xray?

Not too sensitive but can see . Widening of the mediastinum, left pleural effusion, left apical pleural cap, loss shadow of the aortic knob

37

What are 4 different anterior mediastinum masses?

Substernal thyroid masses
Lymphoma
Thymoma
Teratoma

38

What disease is often associated with a thymoma?

Myasthenia Graves

39

What anterior mediatinal mass has all three germ layers and teeth can often be found?

Teratoma

40

Type of COPD- – destruction of bronchioles, assoc with cigarette smoking and most severe in upper lobes

Centriacinar

41

Type of COPD- lower lung zones, alpha 1 antitrpsin.

Panacinar

42

Type of COPD- lest common, distal airway structures, subpleural and may cause pneumothorax.

Paraseptal

43

What is a localized irreversible dilation of part of the bronchial tree?

Bronchiectasis

44

To assess for adequate penetration in a chest x-ray what should be visible through the heart?

Spine

45

To assess for adequate inspiration in a chest x-ray, how many posterior ribs should be visible?

8-9 posterior ribs

46

To assess for rotation on a chest x-ray what should you look at?

Spinous processes, clavicles

47

What type of disease is a rheumatoid lung?

Interstitial

48

What is an example of a mixed reticular and nodular interstitial disease?

Sarcoidosis

49

What is the best way to visualize interstital disease?

High resolution CT

50

What are the three types of atelectasis?

Subsegmental
Compressive
obstructive

51

What type of atelectasis is seen in patients with poor inspiration (looks like airspace disease)?

Compressive

52

What type of atelectasis is seen in patients who are splinting. There are linear densities parallel to the diaphragm.

Subsegmental

53

What type of atelectasis is associated with resorption of air from the alveoli. It is distal to an obstructing lesion. Lobes collapse in a fan like triangle.

Obstructive

54

What are 4 common causes of obstructive atelectasis?

Tumors
Mucous plugs
Foreign body
Inflammation (scarring from TB)

55

What causes pleural effusions?

Increased fluid formation (increased hydrostatic pressure/ increasing cap permeability)
Decreased rate of resorption (lymphangatic blockade or increased venous pressure)
Decreased pressure in the pleural space

56

Where is the proper placement of an ET tube?

3-5 cm from the carina

57

Where is the proper placement of a tracheostomy tube tip?

halfway b/w stoma and carina

58

Where is the proper placement for a central venous catheter (CVC)

tip in superior vena cava

59

Where is the proper placement of a PICC line?

Tip in superior vena cava

60

Where is the proper placement of a Swan-Ganz catheter?

Tip in proximal R or L pulmonary artery, within 2 cm from hilum

61

Where is the proper placement of a double-lumen (Quinton) catheter?

Tip in either superior vena cava or right atrium (or both)

62

Where is the proper placement for a pleural drainage tube for a pneumothorax?

Anterior/ suprerior

63

Where is the proper placement for a pleural drainage tube for a pleural effusion?

Posterior/inferior

64

Where is the proper placement for pacemaker leads?

Tip at apex of right ventricle; other lead(s) in right atrium and/or coronary sinus

65

Where is the proper placement of an automatic implantable cardiac defibrillator (AICD)?

One lead in superior vena cava, other lead in right ventricle and/or coronary sinus

66

Where is the proper placement for an intraaortic balloon pump (LABP)

tip about 1 cm from top of aortic arch in descending thoracic aorta

67

Where is the proper placement of an Nasogastric (levin) tube (NGT)?

Tip in stomach 10 cm from esophagogastric junction

68

Where is the ideal placement of a feeding (Dobbhoff) tube (DHT)?

Tip ideally in the duodenum but more frequently in the stomach

69

What is a carcinoma that is central, grows rapidly and produces bronchial obstruction or pneumonitis.

Squamous cell

70

What type of carcinoma is peripheral, bronchoalveolar cell type.

Adenocarcinoma

71

What type of carcinoma is central, paraneoplastic syndromes.

Small cell

72

What type of carcinoma grows rapidly and is a larger peripheral lesions.

Large cell

73

What type of carcinoma is apical lung cancer, squamous/ adenocarinoma, can invade the brachial plexus, Horner's syndrome may be seen.

Pancost

74

What can cause multiple nodules in the lung?

Metastasis- Breast, colon, bladder, lymphoma
Hamartomas
Granulomas
Autoimmune (wegners, sarcoid, RA)
infection- nodules

75

A distal thoracic duct obstruction would cause a what sided pleural effusion?

left sided

76

A proximal thoracic duct obstruction would cause a what sided pleural effusion?

Right sided

77

Rheumatoid arthritis is associated with what sided pleural effusion?

Right

78

Pancreatitis is associated with what type pleural effusion?

Left

79

A unilateral pleural effusion (either side) is associated with what three things?

TB
pulmonary embolism
trauma

80

If you suspect a pneumothorax what type x-ray should you get?

Expiratory upright PA chest xray

81

What causes a Pneumopericardium in kids?

Hyaline membrane disease

82

If you suspect a pulmonary embolism what study should you get?

CTPA (CT pulmonary angiography) if person is allergic than do a nuclear study