Pictures Flashcards
What type of disease does this patient have?
Obstructive Pulmonary Disease
note the scooped out pattern of the flow volume loop
What is shown here?
Pic B–centriacinar emphysema…target resp bronchioles first w/ dilation
Pic C–panacinar emphysema…target alveolar ducts & alveoli w/ dilation first, but doesn’t really psare anything.
What is shown here?
centriacinar emphysema….targets resp bronchioles first
most common form, seen in smokers
What is shown here?
panacinar emphysema
target alveoli first
less common
What is shown here?
emphysema
see the airspace dilation
What is shown here?
a bleb. thin lung tissue that is like a balloon and easy to pop
seen in emphysema
if it pops–pneumothorax
Mrs. Jones is a 64 year white female comes in with vague complaints of “not feeling well,”
She is a little short of breath, but admits to being “out of shape.”
Her PMH is unremarkable, she is on no medications, and her exam is entirely normal.
Her EKG is shown below. You inform the patient:
A.She is having a heart attack
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B.She is having ischemia
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C.She is in Atrial Fibrillation
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D.She has a very normal EKG
Answer: D. Normal EKG.
After studying this EKG you inform the patient:
A.Not to worry. In Sinus Tachycardia and when drugs wear off she will be OK.
●
B.She is having an Acute Anterior MI and we need to hospitalize
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C.She is in Sinus, but with frequent PACs
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D.She is in Atrial Fibrillation with rapid ventricular response
D. A fib. The irregularly irregular beat tips off that it is 1/3 things, including maybe a fib.
also no p waves-not sinus.
See a PVC here.
ST upslope in septal leads.
V2-V3 Widened QRS complex.
When you see an irregularly irregular rhythm…there are 3 possibilities of what it is. What are the 3 options?
- atrial fibrillation.
- MAT: multifocal atrial tachycardia
- atrial flutter with varying degrees of AV block
What do you see here?
A. In Sinus Bradycardia with inverted T-waves in some precordial leads. Not to worry.
B.In Sinus Bradycardia with ischemic changes in Septal/Anterior leads. Hospitalize.
D.In Junctional rhythm with inverted T-waves V 1-3
E.In junctional rhythm with evidence of old Anterior MI
F. In junctional rhythm with evidence of old Inferior MI.
D. Junctional rhythm w/ inverted T waves in V1-3
p waves absent.
What is this wave indicative of?
this is a delta wave. This + a shortened PR interval is indicative of Wolf Parkinson White Syndrome
Describe Wolf Parkinson White Syndrome.
congential abnormality
most common cause of ventricular pre-excitation
via Bundle of Kent
usu asymptomatic
HOWEVER, if they go into afib or SVT & you give them certain meds–>can progress into ventricular fibrillation & die.
If a patient with WPW goes into afib or SVT…which meds should be given to them?
Procainamide
NOT a calcium channel blocker or something.
What is multifocal atrial tachycardia?
tachycardia, a subset of SVT often seen in patients with COPD
see 3 morphologically weird p waves + varying PR intervals
What do pathologic Q waves indicate?
an old infarct
What can a decubitus view be useful for? Lordotic?
Decubitus–determine if a fusion was a consolidation
Lordotic–see the apex of the lung
Opacification of what part of the lung will silhouette the left heart border?
- Left lower lobe
- Right upper lobe
- Left upper lobe
- Lingula
Answer: 4. Lingula
A 56 yr.-old woman with diabetes mellitus and hypertension presents to the emergency department with 6/10 chest pain and ST segment inversions in leads V2-V4. Given the appearance of this chest radiograph you suspect
1) ACS
2) Lobar pneumonia
3) Aortic Dissection
4) congestive heart failure
Answer: ACS
Lobar pneumonia: expect to find consolidation
Aortic Dissection: mediastinal widening, lose aortic notch.
Congestive Heart Failure: pleural effusion, blunting of costophrenic angles. Wispy infiltrates bilaterally.
A 72yr-old man s/p CVA developed respiratory distress after tube feeds were initiated. The most likely cause of his distress was:
1) ACS ,
2) pulmonary embolism,
3) an improperly placed naso-gastric tube or
4) acute congestive heart failure
Answer: #3, improperly placed nasogastric tube
see all the fluid splattered around in the poor guy’s lung
A 50 yr-old woman presents to her primary care physician with no complaints. She feels well. Her chest radiograpy most likely represents 1) a pleural effusion in the right lung, 2) a tension pneumothorax, 3) a lobar pneumonia or 4) she’s had a pneumonectomy
Answer: #4, surgical removal of the lung for cancer or something.
It is so white, way more than a lobe. No mediastinal shift. Pneumonectomy!!
Is this a PA view or AP view? How can you tell?
PA b/c you can’t really see the scapula & the heart appears to be a normal size.
This is the view you usu want. Appropriate estimate of heart size etc.
Which view is this?
AP
heart looks crazy large! Can see the medial border of the scapula.
do this when patient can’t move & you have to use a portable xray machine.
Which view is this?
Lateral
Is there anything wrong with this chest xray?
Nope. You can see 9+ ribs, suggesting proper inspiration.
What is wrong with this xray?
rotation
note that the spinous processes are not equidistant from the medial borders of the clavicles
Is there anything wrong with this imaging?
Yep, inadequate inspiration
not able to see 9+ ribs
this crowds the airspace & can be mistaken for an infiltrate
Is there anything wrong with this chest xray?
insufficient anatomy included
want to see 1st ribs, costophrenic angles, lateral parts of ribs
there also appears to be a solitary nodule in the L lung
Is there anything wrong with this chest xray?
Yep, underpenetrated–too white
✖Underpenetration- mistakenly diagnose pleural disease or infiltrate
Is there anything wrong with this chest xray?
normal penetration
nothing too abnormal
Is there anything wrong with this chest xray?
Overpenetration–too black
✖Overpenetration- under diagnose pleural disease or infiltrate
Can you name these structures?
- Spinous process
- clavicle
- Medial edge costoclavicular joint
- Scapula
- SVC
- Hilum
- Right axillary fold
- Breast-can cause misdiagnosis of pneumonia
- Costophrenic angle
- 1st rib
- Trachea
- Aortic arch
- Left hilum (usu higher than the right hilum) Left hilum has a box shape.
- LV
- bowel bubble
- Costophrenic angle
What is wrong here?
left heart border indistinct
could be a lingula infiltrate
What is wrong here?
globular appearance, indistinct heart borders
pericardial effusion
What is wrong here?
heart >50% of the chest
can still see the borders
maybe aortic stenosis & LV hypertrophy
What is this?
See huge space b/w pleura & chest cavity–Pneumothorax.
Tension pneumothorax b/c of the tracheal shift. If you percussed their lungs they would sound hyperresonant. Their vitals are probably unstable. If they had a simple pneumothorax, there would be no mediastinal shift & stable vitals.
What’s going on here?
right middle lobe consolidation
What is wrong here?
blunted costophrenic angles
bilateral pleural effusions in the lower lobes of the lungs
What is wrong here?
scoop on right lung–called a meniscus means fluid in the lung.
What is shown here?
alveolar infiltrate pattern, whispy, puffy
indicative of CHF
What’s this?
alveolar infiltrate
pneumocystis carnii pneumonia
