Lau PowerPoint - Chest Radiography

Question 1

True or False: Chest xray in asthma patients in usually normal

Answer 1

True

Question 2

In more severe cases of asthma, what does the chest xray present with?

Answer 2

Hyperinflated lungs

Question 3

In exacerbations of asthma, what is there evidence of on the X-ray?

Answer 3

pneumothorax

Question 4

Lung shadowing usually indicated what in patients with bronchopulmonary aspergillosis?

Answer 4

pneumonia or eosinophilic infiltrates

Question 5

Per Lau, what is the real reason we get a chest x-ray on asthmatic patients?

Answer 5

to rule our pneumo - why? b/c of the presence of hyperinflated lungs which can easily cause a collapsed lung

Question 6

Obvious bullae, paucity of parenchymal markings, or hyper lucency suggests the present of what?

Answer 6

emphysema

Question 7

What happens to both the lung volume and also the diaphragm in COPD patients?

Answer 7

increased lung volume and flattened diaphragm

Question 8

What is the current definitive test for establishing the presence or absence of emphysema in people?

Answer 8

CT scan

Question 9

Due to the flattened diaphragm present in COPD, what organ will you now be able to palpate during exam? What does this NOT indicate and why?

Answer 9

liver; hepatomegaly, but really this is just liver DISPLACEMENT. The fact that the lung is hyperinflammed has caused the shift.

Question 10

What should you always do before you intubate a patient?

Answer 10

Ventilate them until their pulse ox is AT LEAST 98%.

Question 11

In general, what class of drug is being used for symptomatic benefit in patients with COPD?

Answer 11

bronchodilators

Question 12

The three most common symptoms of COPD include: cough, ____ and _____-

Answer 12

sputum production, exertional dyspnea

Question 13

The hallmark of COPD is what?

Answer 13

airflow obstruction

Question 14

PFT show airflow obstruction with reduced values of ___ and what ratio?

Answer 14

FEV1 and FEV1/FVC

Question 15

Bronchodilators along with what other drug is used for long-term treatment of COPD?

Answer 15

beta agonists

Question 16

When is it acceptable for patients to have air in their abdominal cavity?

Answer 16

before they go for Continuous ambulatory peritoneal dialysis (CAPD).

Question 17

In which part of the lung field should you be looking for a pneumothorax?

Answer 17

top

Question 18

A COPD and asthma patient both come in with SOB and fever - who do you treat with AB and who do you treat with bronchodilator? Why?

Answer 18

COPD gets treated with AB while the asthma patient gets treated with a bronchodilator. The COPD person most likely has walking pneumo and should be given a macrolide like erythromycin

Question 19

Which xray view is used to view the retrocardiac space?

Answer 19

Lateral

Question 20

Walking patients should get what xray type?

Answer 20

PA and lateral (better quality than AP and more reliable in terms of accuracy)

Question 21

Nonwalking patients should get what type of X-ray?

Answer 21

AP - these are typically portable

Question 22

When checking the xray - you should check from outside to inside - True or False?

Answer 22

True

Question 23

On which X-ray view does the aorta look wider?

Answer 23

AP

Question 24

Criteria used to distinguish between transudative and exudative pleural effusions.

Answer 24

Light’s Criteria

Question 25

___pleural effusions are defined as effusions that are caused by systemic factors that alter the pleural equilibrium.

Answer 25

Transudative

Question 26

__pleural effusions are caused by alterations in local factors that influence the formation and absorption of pleural fluid.

Answer 26

exudative

Question 27

What does SPN stand for?

Answer 27

Solitary pulmonary nodule

Question 28

True or False: all patients who present with a cough need a chest xray?

Answer 28

True, per Lau

Question 29

What is one reason Lau states is why we want to give a chest x-ray to all patients with a cough and/or cardiac problems?

Answer 29

b/c diabetics can often have a heart attack with NO PAIN.

Question 30

What is the major component of each hilar shadow on the chest xray?

Answer 30

pulmonary artery

Question 31

When you first get a chest xray what are the first two things you want to examine?

Answer 31

bone and soft tissue

Question 32

The heart should have ____ the diaphragm - if not, what does this indicate?

Answer 32

half; cardiomegaly

Question 33

The diaphragm should be found at what level rib posteriorly and what level rib anteriorly?

Answer 33

8th to 10th; 5th to 6th

Question 34

Why are you asked to take a deep breath and hold it for chest xray?

Answer 34

to allow for maximum lung volume and provide the most clear view of the chest

Question 35

A pneumothorax will be evident when there is a________of the edge of the collapsed lung, with no further lung markings beyond this line. This line may be confused with the scapula or ribs if the clinician does not look closely.

Answer 35

linear delineation

Question 36

Are chest xrays usually taken in the inspiratory or expiratory phase?

Answer 36

Chest X-rays are conventionally acquired in the inspiratory phase of the respiratory cycle. The radiographer asks the patient to, 'breathe in and hold your breath!'

Question 37

What are some of the false errors that can be found if the xray is taking during the expiratory phase of the respiratory cycle?

Answer 37

If the image is acquired in the expiratory phase, the lungs are relatively airless and their density is increased. Also, the raised position of the diaphragm leads to exaggeration of heart size, and obscuration of the lung bases.

Question 38

What is one main reason to take an expiratory chest xray?

Answer 38

Occasionally an erect x-ray is taken in expiration specifically to help identify a pneumothorax (which looks larger on an inspiratory film).

Question 39

NOTE: When a person inspires the diaphragm drops and the lungs expand. It is therefore important to take the x-ray when the maximum amount of lung is visible i.e. on inspiration. By counting the visible ribs you can determine when the film was taken. In the normal lung you should be able to count 10 Posterior and 6 Anterior ribs if the x-ray was taken on inspiration.

Answer 39

OK

Question 40

Pleural effusion in posterior recess of costophrenic angle is best seen in which chest view

Answer 40

lateral chest view

Question 41

Which view should be obtained to diagnose an infiltrate in a retrocardiac location?

Answer 41

lateral chest view

Question 42

Which chest view results in magnification of anatomic structures (for ex: the cardiac silhouette is increased by up to 15 to 20%)?

Answer 42

AP chest view

Question 43

What is the tell tale sign of a aortic (thoracic) aneurysm on the chest xray?

Answer 43

wide mediastinum;

Question 44

What can cause the appearance of a wide mediastinum? (falsely)

Answer 44

In the setting of trauma, patients are positioned supine while a chest x-ray is acquired, very often causing the mediastinum to appear wide spuriously.

Question 45

Which chest xray view tells us if there is a perforation in the abdominal cavity?

Answer 45

lateral decubitus

Question 46

Which chest xray view is used to diagnosis TB?

Answer 46

apical lordotic

Question 47

Where will you find infiltrates associated with TB?

Answer 47

At the top of the lung (especially for NEW TB)

Question 48

Infiltrates found in the middle of the lung are associated with which bacteria?

Answer 48

Klebsiella

Question 49

Infiltrates in the lower lobe are associated with which condition?

Answer 49

pneumonia

Question 50

Which xray view is best when it is necessary to demonstrate the presence of an air-fluid interface?

Answer 50

left lateral decubitus - you can also specifically be looking for pleural effusion

Question 51

What are the three organs that can irritate pleural effusion?

Answer 51

pancreas, heart, and spleen

Question 52

If the patient is diagnosed with bilateral pleural effusion, from where is the effusion really coming?

Answer 52

Right side

Question 53

What are the two xray signs that indicate pancreatitis?

Answer 53

sentinal loop and colon cutoff sign

Question 54

A patient that comes in with chronic pneumo should really be worked up for what possible diagnosis?

Answer 54

cancer

Question 55

What tests (2) should be given to confirm diagnosis of lung cancer?

Answer 55

bronchoscopy with biopsy and ct with contrast

Question 56

What is the tell tale sign of a tension pneumothorax?

Answer 56

deviated trachea - remember it turns to the opposite side of the pneumo

Question 57

What chest xray view results in false widening of the mediastinum?

Answer 57

AP

Question 58

If in the xray you note the aortic knob becoming something like a 3, what is the likely diagnosis?

Answer 58

coarctation of the aorta

Question 59

What are the two main findings that we specifically use xray to find?

Answer 59

infiltrates and effusion

Question 60

What are you specifically looking for in the retrosternal space?

Answer 60

TB

Question 61

What is one indication that the patient is a young person? (based on the lateral chest xray view)

Answer 61

look for spacing in between the vertebrae.

Question 62

What is the one very important thing that you DO NOT see in the PA view? THINK...

Answer 62

costophrenic angle

Question 63

NOTE: NEVER underestimate the power of checking multiple films from the patients history

Answer 63

OK

Question 64

What are the four types of lungs cancer?

Answer 64

small cell, large cell, squamous cell, and adenocell - large cell most rare but most curable; small cell most deadly;

Question 65

What type of lung cancer do smokers typically get? Non smokers?

Answer 65

small cell followed by squamous cell; adenocell

Question 66

When placing a chest tube, do you place the tube at the top or bottom of the rib?

Answer 66

Top - this way you avoid the vascular bundle (VAN)

Question 67

Term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue.

Answer 67

crepitus

Question 68

Crunching, rasping sound, synchronous with the heartbeat,[3] heard over the precordium in spontaneous mediastinal emphysema produced by the heart beating against air-filled tissues.

Answer 68

Hamman sign

Question 69

The presence of a cervical rib can cause what?

Answer 69

thoracic outlet syndrome

Question 70

What are some of the hallmark signs of thoracic outlet syndrome?

Answer 70

pain and paresthesia along with common neurologic symptoms (specifically of the upper limb).

Question 71

What is it called when you have a lumbar rib?

Answer 71

Gorilla rib

Question 72

A hilar mass may be indicative of what?

Answer 72

sarcoidosis

Question 73

what is the most common cause of bilateral pleural effusion?

Answer 73

infection in the lungs - either pneumonia or pneumonitis

Question 74

what test can be done to tell if the patient has pneumonia or simply pneumonitis?

Answer 74

CXR will tell you if its pneumonia

Question 75

Two diseases that attack the interstitial, fibrous tissue of the lungs and will give you an "interstitial pneumonia"

Answer 75

PCP and mycoplasma

Question 76

what is the most compliant way to treat mycoplasma?

Answer 76

azithromycin (1x/day)

Question 77

what is the treatment for mycoplasma that has patients exhibit the least amount of compliance?

Answer 77

erythromycin (4x/day) associated with GI sx

Question 78

what is the treatment for mycoplasma that only involves taking the med 2x/day?

Answer 78

biaxin/calrithromycin

Question 79

what is the class of drugs that is best to treat bronchitis and pneumonia?

Answer 79

macrolides

Question 80

REMEMBER YOUR MACROLIDES, name 4

Answer 80

Azithromycin Erythromycin Clarithromycin Telithromycin

Question 81

what are the two ways you can diagnosed with having bronchitis?

Answer 81

cough more than 6 months in an entire year or be a smoker!

Question 82

the loss of normal borders between thoracic structures in CXR is called what? what does this indicate?

Answer 82

silhouette sign; presence of fluid or mass in the lung

Question 83

____:outline of an airway made visible by increased density of the surrounding parenchyma due to consolidation or presence of fluid.

Answer 83

air bronchogram - please remember that this is a CXR finding and NOT a test!!!

Question 84

solitary pulmonary nodules are typically made of what?

Answer 84

calcium

Question 85

dark spots around a nodule indicate what?

Answer 85

that the nodule has been around for a long time, and is no longer growing in size

Question 86

what is an indication that the SPN is still growing?

Answer 86

the area surrounding the mass is between white and black (grey)

Question 87

almost always associated with a linear increased density on chest x-ray.

Answer 87

atelectasis

Question 88

TB is often found where in a CXR? why?

Answer 88

top of the lungs - b/c it is aerophillic

Question 89

what are the four drugs used to treat TB?

Answer 89

rifampin, ethanbutol, INH, and PZA (pyrazinamide)

Question 90

what is the testing procedural steps for TB?

Answer 90

ppd + or sx --> cxr; + cxr --> sputum

Question 91

Cold agglutination, Hemolytic anemia, and Bullous myringitis (vesicles on the tympanic membrane)is the triad for what?

Answer 91

mycoplasma

Question 92

What is the two main causes of bilateral pleural effusion?

Answer 92

Infection in lungs: two types: pneumonia or pneumonitis

Question 93

What is the cause of interstitial pneumonia?

Answer 93

PCP or mycoplasma