Intro

Question 1

who discovered x-rays and how

-what was the first xray?

Answer 1

Wilhelm Conrad Roentgen; while investigating emissions from a Crookes tube;
wife’s hand

Question 2

what is an x-ray?

Answer 2

a form of of electromagnetic radiation (energy of extremely short wavelengths)
-volts

Question 3

the ____ the wavelength, the ____ its energy and the _______ the ability to penetrate various material

Answer 3

shorter; greater; greater

Question 4

define attenuation and example

Answer 4

the degree to which xrays are absorbed/deflected by the body part
ex: bones attenuate more radiation than tissue so they have heavier “shadows” on film.
—–
the lower the atomic weight/density the more transparent it is
ex: lungs are see throughish
—-
vice versa: the GREATER the density of anatomy = the greater absorption

Question 5

shadow on xray film means… vs black

Answer 5

white i.e. bone

black: xray reached the film

Question 6

what are the 4 types of radiographic densities from darkest to shadow

Answer 6

• gas (air)
• fat
• water (mucus, vessels)
• bone

Question 7

factors affecting image quality (5)

Answer 7

• thickness of the body part
• motion
• scatter
• magnification
• distortion

Question 8

how does scatter affect xrays?

Answer 8

scatter causes deflection; is seen between the body and film of which the xray absorbs

• want scatter as reduced as possible
• a grid is used to reduce scatter

Question 9

when the object is not perpendicular to the xray beam, this is known as…

Answer 9

need to line it up to get the right angle/image

Question 10

fluoroscopy film

Answer 10

real-time motion

ex: heart, diaphragm, abdomen, guiding GI tube placement

Question 11

what is contrast used for

Answer 11

better to distinguish what you’re looking at

Question 12

contraindication of contrast examination

Answer 12

pt allergic or renal failure

Question 13

tomography and examples

Answer 13

xray and film move synchronously around a focal point (slices)
ex: CT, PET
—
lungs, kidneys, and bony structures

Question 14

CT scan contraindications

Answer 14

expensive, often needs IV contrast, increased exposure to radiation

Question 15

contrast on a cerebral bleed? why?

Answer 15

no; bc contrast IS fluid* so it will blend with the bleed.

-order with NO contrast

Question 16

a 3D reconstruction image is taken by ___

Answer 16

Spiral (helical) CT

Question 17

what are the most common diagnostic xray

Answer 17

plain fils: ex. chest, abdomen, skeletal films

Question 18

variations of plain films includde

Answer 18

fluoroscopy, tomography

Question 19

barium contrast agent is mostly used for

Answer 19

from esophagus all the way to colon

Question 20

water soluble agents is used in…

Answer 20

urography

Question 21

biliary contrast agents

Answer 21

absorbed n the gut and excreted in the bile for biliary studies

Question 22

MRI enhancement agaents

Answer 22

gadolinium

Question 23

oil-soluble agents are used for

Answer 23

inhalation in bronchograms

Question 24

contraindication on Nuc med imaging

Answer 24

caution in pregnancy

Question 25

what radioisotope is used

Answer 25

technetium 99

Question 26

what is taken up in Bone scana

Answer 26

phosphate -technetium 99

Question 27

____ scan measures blood flow, O2, and glucose metabolism

Answer 27

PET

Question 28

what happens to the Tc99-pertchetate once it is inside the cell?

Answer 28

it is reduced and cannot diffuse back out

Question 29

what tissues take up iodine for this type of scan

Answer 29

thyroid tisse; thyroid scan

Question 30

a cold nodule is more likely to be _____ than hot nodules, meaning there will be no uptake in cold

Answer 30

cancerous | --

Question 31

what is thallium used to assess

Answer 31

regional blood flow of the coronary arteries blood supply to heart muscle

Question 32

how do you test for delayed gastric emptying

Answer 32

if >50% of foood (eggs) remains in stomach after 2 hours

Question 33

pros and cons of MRI

Answer 33

pros: no ionizing radiation, noninvasive, detailed images - - cons: artifact due to pt motion, no ferrous object near the magnet (pacemaker/defib, aneurysm clips), expensive, slower process than CT

Question 34

what is an MRI contrast risk

Answer 34

NSP- nephrotic systemic fibrosis also known as NFD -- due to the gadolinium

Question 35

pros and cons of US

Answer 35

pros- inexpensive noninvasive, no radiation - -- cons: quality of US images is tech dependent, pt body habitus

Question 36

the diaphragm should be between which ribs

Answer 36

the 7th and 10th ribs

Question 37

what type of cxr position make the heart appear enlarged and lungs hypoinflated?

Answer 37

AP and supine (portable)

Question 38

a lateral decubitus film aids in identifying what?

Answer 38

pleural effusion

Question 39

which type of films are used to view the apices of the lungs?

Answer 39

lordotic

Question 40

what type of view can be helpful for pneumothorax

Answer 40

expiratory

Question 41

with normal exposure: the vessels should be visualized to at least the peripheral _____ of the lung

Answer 41

2/3

Question 42

how many ribs indicates adequate inspiratory effort?

Answer 42

>7 ribs

Question 43

the width of the heart should be less than ____ the width of the thoracic cavity

Answer 43

1/2

Question 44

a greater than .5 ratio of the heart to thoracic indicate...

Answer 44

cardiomegaly (dilation or hypertrophy), pericardial effusion, small lung volumes, or pectus excavatum

Question 45

which hilum should be higher

Answer 45

left hilum should be higher than the right

Question 46

tracheal deviation is indicative of

Answer 46

tension pneumothorax ---- air pushes it to the other side

Question 47

how many lobe does the right lung have

Answer 47

3

Question 48

how many lobes does the left lung have

Answer 48

2

Question 49

lung infiltrates indicate

Answer 49

pneumonia

Question 50

____ usually arise/connected from the mediastinal

Answer 50

lung masses --- can indicate cancer

Question 51

____ are not as dense

Answer 51

lung nodules

Question 52

round edge of the bottom leg vs sharp edge on the opposite lung indicates

Answer 52

pleural effusion | "costophrenic angles"

Question 53

a tumor on the sternum makes it look like...

Answer 53

the sternum is being pushed out

Question 54

improper placing of the ET tube causes_____ and appearance shows ____

Answer 54

RL atelectasis (collapse) of the lung --- all white on cxr

Question 55

the NG tube should be seen where on cxr

Answer 55

curving to the left in the stomach past the gastroesophageal junction

Question 56

alveolar vs interstitial

Answer 56

alveolar spaces are filled with some material such as blood pus fluid or cells --- interstitial= tissue OUTSIDE of the alveoli are affected

Question 57

if pneumonia is bacterial this indicates alveolar or interstitial --- focal or diffused?

Answer 57

alveolar and focal (single lobe)

Question 58

if pneumonia is viral, this usually shows in a cxr as interstitial or alveolar? focal or diffused?

Answer 58

interstitial and diffuse (bilateral)

Question 59

if there is mycoplasma this is either alveolar or interstitial? diffuse or focal?

Answer 59

interstitial and diffuse

Question 60

air bronchogram sign

Answer 60

seen with alveolar processes

Question 61

what is the most likely cause of an interstitial pneumonia in a normal adult?

Answer 61

Mycoplasmal infection

Question 62

which type of acquired pneumonia shows on xrays that is more common in children than adults

Answer 62

Round

Question 63

what evolves from a normal cxr to an interstitial pattern to an alveolar pattern?

Answer 63

Pneumocystis jiroveci pneumonia (PJP) --- usually immunocompromised patients --> HIV

Question 64

a healing TB appears on a cxr as ____ | and is known as ____

Answer 64

Ghon Complex aka Ranke complex --- appears as a calcified nodule

Question 65

in a lung abscess, what must you rule out?

Answer 65

neoplasm by bronchoscopy or CT directed needle bx

Question 66

what do you expect to see in a cxr w lung abcscess

Answer 66

air fluid with thick wall; cavitation

Question 67

what are the most common type of lung CA and usually occur peripherally?

Answer 67

Adenocarcinomas

Question 68

SCC usually occur ____ and tend to cavitate

Answer 68

centrally

Question 69

what is the dilation of the bronchi called? is it diffuse or focal? what is it caused by?

Answer 69

Bronchiectasis; | could be both

Question 70

tramtracking or honeycomb infiltrates can be indicative of

Answer 70

Bronchiectasis

Question 71

when are cxr needed for COPD

Answer 71

they are usually not needed for eveluation UNLESS there's an exacerbation of sx needed to be ruled out

Question 72

deviation of mediastinum due to air in pleural cavity is due to?

Answer 72

tension pneumothorax

Question 73

how is hemopneumothorax represented on an xray

Answer 73

horizontal line along the base, pushes diaphragm down due to airfluid level

Question 74

what does the deep sulcus sign indicate

Answer 74

when the pt is supine it supports pneumothroax --- the affected is lower compared to the other one

Question 75

pneumomediastinum

Answer 75

where air presents in mediastinum due to injury/perforation of tracheobronchial

Question 76

fluid in pleural space indicates

Answer 76

pleural effusion

Question 77

what type of effusion shows in a pleural effusion due to chf

Answer 77

bilateral/cardiomegaly

Question 78

what type of effusion shows on a pleural effusion due to pneumonia

Answer 78

small

Question 79

what type of effusion shows on a cirrhosis pt with pleural effusion?

Answer 79

R side effusion

Question 80

what type of effusion shows up on xray on a pt with pancreatitis and pleural effusion

Answer 80

L side

Question 81

describe pleural effusions in upright, supine, and lateral positions

Answer 81

upright--> blunted angle of costophrenics supine--> increased density of affected hemithorax (may be misread as infiltrate) lateral--> fluid along lateral chest wall

Question 82

loops of bowel in the lower chest cavity indicate

Answer 82

diaphragmic rupture --- "there shouldnt be a connection b/w upper and lower lung/rupture

Question 83

if pt with hemoptysis is at risk for cancer what should be done next? what if pt is not at risk?

Answer 83

bronchoscopy --- not @ risk --> CT

Question 84

when would you get a cxr in chest pain or dyspnea?

Answer 84

``` you would not be wrong to get one --- but mostly if abnl exam - if >40yo or -at risk of cardiovascular dz ```

Question 85

what does the mediastinum consist of

Answer 85

heart, major vessels, and central lymph nodes situated between the lungs

Question 86

what are focal and diffuse lesions caused by in mediastinal lesions?

Answer 86

focal: masses diffuse: infxn, bleeding, infiltrating tumor * *bottom of slides*

Question 87

which mediastinal compartment are the lymph nodes in?

Answer 87

all three

Question 88

what is the most common anterior mediastinal mass

Answer 88

thymoma

Question 89

most frequent cause of middle mediastinal mass?

Answer 89

enlarged lymph nodes | seen on trachea border

Question 90

what are the most common posterior lesions?

Answer 90

neurogenic lesions