Introduction and Normal Variants

Question 1

The standard chest examination consists of ___ xray views

Answer 1

PA and lateral chest views

Question 2

Perform a __ view of the chest to reduce magnification of the heart

Answer 2

left lateral view

Question 3

what is the right border of the heart

Answer 3

right atrium

Question 4

what is the left border of the heart

Answer 4

left ventricle

Question 5

what do you COUNT to evaluate a chest film

how many should be seen

what would cause a decrease or increase number seen

Answer 5

ribs (dont miss the 2nd rib - commonly missed)

9-10.5

decrease in ribs - not full inspiration when taking film or phrenic nerve issues

increase in ribs - COPD - air trapping

Question 6

when you see see a left or right on the lateral chest film, what does this mean

Answer 6

if it was a left lateral chest view, the left side of the patient is closest to the FILM (not the tube)

Question 7

when examining a patients chest films you should set them up after imaging and look at them how

Answer 7

PA on left

lateral on right

Question 8

which bronchus is more vertical

Answer 8

right bronchus - more likely for something inhaled to land here

Question 9

PA film is obtained when patient is facing the cassette (away from tube) and the tube is how far away from the patients back

Answer 9

6 ft

Question 10

AP supine chest view the xray tube is how far away

Answer 10

40 inches

Question 11

what are the differences between AP and PA views

what is preferred

Answer 11

AP - magnifies the heart and widens mediastinum

PA with inspiration is preferred

Question 12

what is lateral decubitus position or cross table lateral position used for

Answer 12

assess volume of pleural effusion

determine if mobile or loculated based on if effusion travels to the side of the lung which the patient is laying on

Question 13

what are the indications of inspiration an expiration views

Answer 13

pneumothorax accentuated on expiration

diaphramatic paradoxical motion

obstruction

Question 14

what are the indications of lordotic views

Answer 14

apical lung disease

right middle lobe disease

lingular lobe disease

Question 15

what are the indications of oblique chest views

Answer 15

small peripheral lesions

rib fractures

Question 16

on PA chest view, the diaphragm should be seen at the level of the right __

Answer 16

right 10th posterior rib

Question 17

how can you determine if the patient is rotated on a PA film

Answer 17

trachea may be shifted

clavicular heads should be equal distance from the spinous processes

Question 18

how many secondary bronchi to left and right lung

Answer 18

left - 2

right - 3

Question 19

how many alveoli in a pair of human lungs

Answer 19

300 million alveoli

Question 20

what is inflammation of these membranes that causes them to secrete fluid that collects in the thoracic cavity

how do you treat

Answer 20

pleurisy

steroids

Question 21

what divides the right middle and right upper lobe

Answer 21

minor horizontal fissure

Question 22

right and left major oblique fissures are seen on what view

Answer 22

best seen on lateral view

also seen on PA but not as well

Question 23

what does the fissure appear as if there is fluid in the fissure

Answer 23

increase in density

Question 24

what is the slice thickness of a HRCT scan

Answer 24

.625 mm to 1.5 mm

Question 25

left minor fissure is present in what percent of people

Answer 25

8-18%

Question 26

what does the left minor fissure separate

Answer 26

left upper lobe from the lingula

Question 27

the azygos fissure consists of what

Answer 27

2 layers of parietal pleura and 2 layers of visceral pleura

Question 28

where is the azygos fissure located

Answer 28

upper medial region of the right upper lobe

Question 29

where is the inferior accessory fissure located

Answer 29

lower medial region of the right lower lobe

Question 30

where is the superior accessory fissure located

Answer 30

divides right lower lobe into superior segment and 4 basal segments

Question 31

where is the rhomboid ligament located

Answer 31

aka costoclavicular ligament between 1st rib and clavicle normal variant that looks like lytic lesions under the medial surface of the clavicles

Question 32

how do you know if a breast implant is leaking

Answer 32

rim of calcification

Question 33

what are companion shadows

Answer 33

shadows of clavicle seen above clavicle

Question 34

what are findings of pectus excavatum on xray what is treatment

Answer 34

obliteration of lower right heart border sternum protruding inwards flattening of the heart verticality of the anterior ribs tx - pectus bar

Question 35

what are clinical findings of pectus carinatum and excavatum

Answer 35

mitral valve prolapse

Question 36

what are the xray findings of straight back syndrome

Answer 36

xray ratio < 1/3 distance between T8 and posterior sternum on lateral view / distance of trasnverse diameter of thorax at the level of diaphraphm on PA view loss of normal kyphosis on xray leftward shift of the heart prominent pulmonary artery

Question 37

what are symptoms of straight back syndrome

Answer 37

most are asymptomatic systolic ejection murmur - made louder with chest compression 1/2 the cases involve mitral valve prolapse palpitations chest pain

Question 38

in straight back syndrome, the AP diamete of the chest is what

Answer 38

10-11 cm or less

Question 39

what do you do when you suspect a mitral valve prolapse

Answer 39

echocardiogram

Question 40

children with pectus carinatum have what

Answer 40

scoliosis

Question 41

pectus carinatum treatment

Answer 41

external bracing technique

Question 42

what are the xray findings of pectus carinatum

Answer 42

marked protrusion of the upper third of sternum chicken or pigeon breast deformity

Question 43

the L pulmonary artery arches over what the R pulmonary artery passes posterior to what

Answer 43

L - left upper lobe bronchus R - ascending aorta

Question 44

what is normal thorax:heart width

Answer 44

2:1

Question 45

how do you evaluate for rib fractures

Answer 45

examine posterior ribs first and then anterior ribs and then lateral aspects of ribs

Question 46

fracture of the upper 3 ribs is associated with what

Answer 46

aortic injury

Question 47

fracture of the lower 3 ribs is associated wtih what

Answer 47

liver or spleen injury

Question 48

multiple bilateral rib fractures in various stages of healing suggest what

Answer 48

child abuse in children or alcohol abuse

Question 49

what is a term for multiple rib fractures that can cause paradoxical movement of the thoracic cage

Answer 49

flail chest

Question 50

majority of CT scans of the chest are what type

Answer 50

intravenous contrast spiral CT studies best assess the pulmonary, pleural, and mediastinal structures

Question 51

what are the applications of spiral CT

Answer 51

pulmonary nodules hilar and mediastinal masses lung cancer pulmonary emboli aortic diseaes - aneurysm and dissection pleural diseases

Question 52

what are the applications of HRCT

Answer 52

bronchiectasis interstitial disease alveolar diseases emphysema