Lau PowerPoint - Chest Radiography Part 2

Question 1

anterior mediastinal mass carries what major differentials?

Answer 1

4 T’s!!!! terribly lymphadenopathy, thymic tumors, teratoma, and thyroid mass.

Question 2

aortic aneurysm and pericardial cyst are part of the differential for what mass location within the mediastinum?

Answer 2

anterior

Question 3

what is the one indication that the mass is definitely NOT a hilar mass?

Answer 3

if you can see the mass hilum THROUGH the mass

Question 4

thyroid masses can be hot or cold - what is the big difference?

Answer 4

hot masses are the cells that are making too much thyroid hormone and may simply be inflamed - cold masses are more indicative of cancer/malignancy

Question 5

what is the most and least common differential for a mass in the anterior mediastinum?

Answer 5

lymphadenopathy and thyroid mass.

Question 6

what is a consistently enlarged thymus indicate?

Answer 6

myasthenia gravis

Question 7

what is the most common cause of middle mediastinal mass?

Answer 7

lymphadenopathy due to metastases or primary tumor

Question 8

the following are differentials for which location within the mediastinum? hiatial hernia, aortic aneurysm, thyroid mass, duplication cyst, and bronchogenic cyst?

Answer 8

middle mediastinal mass

Question 9

what is the one characteristic on an CXR that will definitely tell you the person has a hitial hernia?

Answer 9

gastric bubble above the diaphragm

Question 10

What is the most common complaint from patients suffering from a hiatial hernia?

Answer 10

GERD (and gas)

Question 11

middle mediastinal mass is most typically what until proven otherwise?

Answer 11

lung cancer (primary or metastasized)

Question 12

which type of lung cancer is known to produce neuroendocrine hormones?

Answer 12

small cell (gotten by mostly smokers)

Question 13

the differential for a ____ mediastinal mass includes neoplasm, lymphadenopathy, aortic aneurysm (as a single isolated mass).

Answer 13

posterior

Question 14

if the mass is projecting above the clavicles where is it’s location?

Answer 14

posterior mediastinal

Question 15

what is typically the cause of the left diaphragm being higher than right?

Answer 15

phrenic nerve injury (3,4,5)

Question 16

differentials include tb, cancer and pneumonia - cardiomegaly is also present - what is not most likely of the three?

Answer 16

cancer

Question 17

the patter of the “bat wing” on CXR is indicative of what?

Answer 17

pulmonary edema

Question 18

These are short parallel lines at the lung periphery. Typically indicative of CHF

Answer 18

kerley B lines

Question 19

what is the one major sign that almost always indicated pulmonary edema?

Answer 19

kerley B lines

Question 20

current jelly sputum - what should be your no. 1 ddx?

Answer 20

aspiration pneumonia

Question 21

what is the best CXR view to detect presence of LLL pneumonia?

Answer 21

lateral view

Question 22

what are the three things we are always looking for (as PA’s) when viewing the CXR?

Answer 22

pleural effusion, infiltrates, and pneumothorax

Question 23

concave menisci with blunting of both posterior costophrenic angles - what should be your no. 1 ddx?

Answer 23

pleural effusion

Question 24

what is the radiographic sign that is indicative of pericardial effusion?

Answer 24

water bottle heart

Question 25

a set of findings on physical examination in people with large collections of fluid around their heart.

Answer 25

Ewart's sign; + typically indicated pericardial effusion

Question 26

what will pericardial effusion do to the image of the heart on the cxr?

Answer 26

cause an enlarged heart shadow which appears as cardiomegaly

Question 27

the workup for pleural effusion includes a determination of what?

Answer 27

of whether the effusion is transudative or exudative - Light's criteria

Question 28

Protein (pleural to serum ratio) >.5 transudate or exudate?

Answer 28

exudate - these also have greater absolute protein!! (Hint: when you got out - you want to go out with a bang in full effect (heavy) and clear of conscience)

Question 29

LDH (pleural to serum ratio) >.6 transudate or exudate?

Answer 29

exudate - these also have higher absolute LDH

Question 30

Clear yellow appearance - transudate or exudate?

Answer 30

transudate - exudate would be clear or turbid in appearance

Question 31

Specific gravity > 1.016 transudate or exudate?

Answer 31

exudate

Question 32

Glucose (serum to pleural ratio) <1 transudate or exudate?

Answer 32

transudate - exudate is >1

Question 33

suggests nephrosis, CHF, cirrhosis - transudate or exudate? MCC?

Answer 33

transudate; CHF

Question 34

infection (pneumonia, TB), malignancy, | empyema, peritoneal dialysis, pancreatitis, or chylothorax - transudate or exudate? MCC?

Answer 34

exudate; bacterial/pneumonia

Question 35

what condition with give you both transduative and exudative effusions?

Answer 35

pulmonary embolism

Question 36

PE in small vessel with give you what type of effusions?

Answer 36

transudate

Question 37

PE in large vessels will give you what type of effusions?

Answer 37

exudate - Hint: remember, you want to exit in a big way

Question 38

what are the two MCC of pleural effusion?

Answer 38

CHF and pneumonia

Question 39

what is the MCC of obstruction of the SVC?

Answer 39

cancer of the apices of the lung

Question 40

what is the typical presenting sign for cancer of the apices of the lung?

Answer 40

atraumatic shoulder pain

Question 41

a tumor of the pulmonary apex is called?

Answer 41

pancoast tumor aka sulcus tumor

Question 42

what is the best way to treat a pancoast tumor? 1. surgery 2. chemo/radiation 3. surgery then radiation 4. no treatment

Answer 42

radiation - surgery would only spread the tumor

Question 43

combination of drooping of the eyelid (ptosis) and constriction of the pupil (miosis), sometimes accompanied by decreased sweating (anhidrosis) of the face on the same side - what is this called?

Answer 43

Horner's syndrome

Question 44

what type of lung cancer would also present with Horner's Syndrome? On which side of the face would the anhidrosis present?

Answer 44

Pancoast tumor/sulcus tumor/cancer of the apex of the lung. RIGHT SIDE

Question 45

A sulcus line is indicative of what?

Answer 45

pneumothorax

Question 46

pts with a chronic pneumothorax should be given what for treatment?

Answer 46

doxycycline

Question 47

what are the four types of pneumo?

Answer 47

spontaneous, traumatic, iatrogenic, tension

Question 48

pneumo typically occurring as a result of underlying lung disease?

Answer 48

spontaneous (secondary) - primary would be without disease

Question 49

pneumo assoc with mechanical ventilation w/ barotrauma.

Answer 49

tension pneumo

Question 50

systolic crunch heard over the cardiac apex

Answer 50

hamman's sign

Question 51

syndrome comprised of subcutaneous emphysema (air subcut tissue) and pneumo-mediastinum (air in center of chest cavity)

Answer 51

Hamman's syndrome - must do needle decompression.

Question 52

what is the relation between hamman's syndrome and hamman's sign?

Answer 52

the syndrome can cause the appearance of the sign

Question 53

tension pneumo is an example of what kind of shock?

Answer 53

obstructive shock - IOW caused by mechanical impediment to ventricular filling

Question 54

streaky lucencies over the mediastinum is indicative of what two things?

Answer 54

pneumo-mediastinum and subcutaneous emphysema (and if together you have Hamman's syndrome)

Question 55

which conditions include the following differentials: asthma, surgery (post op complication), traumatic tracheo-bronchial rupture, barotrauma, and smocking crack?

Answer 55

pneumomediastinum

Question 56

pnuemomediastinum should first be distinguished from what other two conditions?

Answer 56

pneumothorax; pneumopericardium

Question 57

what the one way you can differentiate pneumopericardium from pneumomediastinum? Hint: air pattern

Answer 57

air can be present underneath heart but should not be in neck if pneumopericardium

Question 58

what heart valve is typically replaced and why?

Answer 58

aortic - to prevent vegetation which leads to endocarditis and eventually the biggest danger is that this becomes a septic embolus

Question 59

term to describe fluid in the lungs

Answer 59

hydropneumothorax