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USA: AHN 568 > Unit 2: DDX and CXR > Flashcards

Unit 2: DDX and CXR Flashcards

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1
Q

Know what air, fat, soft-tissue/water, bone, metal looks like on a CXR

A 
Air: Block (least dense = radiolucent)
Fat: Intermediate dare (grey)
Soft-Tissue/water: Intermediate (grey)
Bone: Whitish (more dense = radiopaque)
Metal: Solid white
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2
Q

Where the diaphragm should be in comparison with the ribs

A

Anterior Ribs: 6-7, with the 7th rib piercing the diaphragm
Posterior Ribs: 8-10
Hyperventilation: 10 or more ribs with other correlating signs

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3
Q

Positioning of the patient to Dx a pneumothorax

A

Erect positioning on expiration is most ideal

Lateral decubitus position in a bed-bound patient with the suspected lung up

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4
Q

Best test to assess for free floating air in a suspected bowel perforation

A

Abdominal Series: Consists of spine & upright abdominal & chest x-rays

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5
Q

How distance affects viewing

A

The further an object is away from the x-ray receptor, the greater the magnification. The greater the magnification, the larger the casting shadow is = the object appears larger and less sharp than in reality.

The closer an object is to the x-ray receptor, the less magnified and more sharp is object is.

The further away from the x-ray tube, the less magnified and more sharp an object is.

The closer to the x-ray tube, the more magnified and less sharp an object is.

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6
Q

Best way to assess a bed-ridden patient with right or left pneumothorax

A

Suspect Right: left lateral decubitus

Suspected Left: right lateral decubitus

Gravity causes air to accumulate superiorly

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7
Q

Best way to assess a bed-ridden patient with right or left free pleural fluid

A

Suspect Right: Right lateral decubitus

Suspected Left: Left lateral decubitus

Gravity causes fluid to accumulate posteriorly

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8
Q

Best way to assess for a bullet in the heart

A

Fluoroscopy: can see in real-time, turn the patient, and watch motion of heart/bullet

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9
Q

Best way to assess for air trapping

A

Expiratory PA or fluoroscopy:

On expiration: the effected lobe will remain radiolucent, while the other lobes will become more dense with the surround interstitium

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10
Q

Which side of the diaphragm appears higher on cxrs

A

The right hemidiaphragm d/t underlying structures (Liver). Usually 1-2 cm above the left hemidiaphragm

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11
Q

What film is more sensitive to assess for detection of small effusions?

A

Lateral Film: posterior costophrenic sulci lie below the dome of the anterior hemidiaphragm on the AP/PA, and therefore, are not visible in these positions. The lateral film is able to detect effusions from 75ml. The PA, AP aspects take 175-250ml of fluid to be able to detect fluid.

Lateral decubitus is also helpful: 5ml

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12
Q

What causes overly white x-ray films

A

Under penetration, Under/short exposure

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13
Q

Normal anatomical positioning of the clavicles, sternum, trachea

A

Trachea: Trachea is midline and overlies the spine. Is equidistant from the medial aspects of the clavicles

Sternum: midline. Generally obscured on PA view d/t underlying mediastinal objects. Easily seen on lateral view

Clavicles: Spinous process should dissect the medial ends of the clavicles. You should not be able to see the medial end of the clavicle more on one side. should appear the same

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14
Q

Evaluating Pulmonary Nodules

A

Nodules are considered anything <3cm.

Anything >3cm is considered a mass.

Solitary nodules should always be evaluated.

Most valuable method to assessing nodules is comparing new and old films.

Benign nodules tend to remain unchanged over times.

Calcified nodules are mostly benign: Central laminar, diffuse, or popcorn

Malignant nodules: may have eccentric or stippled calcification

Smokers who are 55-74 should be evaluated for lung cancer

Benign nodules are more often found in non-smokers < 35 y/o

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15
Q

Assessing pleural effusions

A

3 Patterns of pleural effusions:
1 - Blunted costophrenic angle
2 - Meniscus sign
3 - Subpulmonic effusion

2 Types:
1 - Free Flowing: makes a meniscus respective of gravity. Fluid will shift d/t gravity on lateral decubitus view
2 - Loculated: effusion in an unusual location that defies gravity. Fluid will not shift or may partially shift on lateral decubitus view

2 Sub Types:
1 - Subpulmonic Effusion: Fluid between lung base and diaphragm that does not track up the pleura.
a: doesn’t blunt costophrenic angle
b: diaphragm more horizontal than normal (apex shifts laterally)
c: Left side: Stomach bubble sign
d: Right side: abnormally high horizontal/minor fissure
2 - Pseudotumor: Fluid collection trapped within a fissure…gives the appearance of a lung mass
a: loculated at a fissure (usually minor)
b: smooth lenticular contour to “mass”

PA/AP: requires 175-250ml of fluid to blunt one of the sulci
Lateral: requires 75ml of fluid to detect
Decubitus: good for assessing if effusion is loculated of free-flowing
Supine: just don’t do it

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16
Q

CXR finding with COPD

A

Hyperinflation: Film will have diffuse lucency with small heart structures, horizontal hemidiaphragms and > 10 ribs

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17
Q

Definitions of acini, interstitium, bronchioles, pleura

A

Acini: Cluster of alveoli arranged around terminal airways that form a secondary pulmonary lobule

Interstitium: Collection of vessels, lymphatics, bronchi, and connective tissue that is the supporting framework of the alveoli

Bronchioles: Branches from which the bronchus divides

Pleura: Serous membranes lining the thorax and enveloping the lungs

 a: Parietal pleura: membrane which is attached to the inner surface of the thoracic cavity
b: Visceral pleura: membrane that layers the individual lobes of the lungs
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18
Q

Clostridium Botulinum (Botulism)

A

Nature of sxs: Neurological

Onset: 12-72 hours

Source: Home canned or poorly canned food contain low acid)

Associated sxs: blurred vision, diplopia, ptosis, slurred speech, muscles weakness

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19
Q

Giardiasis

A

Nature of sxs: Foul-smelling, explosive, watery diarrhea

Onset: 1-4 weeks

Source: Contaminated water (farm wells, streams, lakes)

Associated sxs: mucus in stool, increased flatulence**, greasy stools

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20
Q

Gastroenteritis (viral/bacterial)

A

MOST COMMON CAUSE OF DIARRHEA

Nature of sxs: abrupt onset of diarrhea that usually lasts < 1 weeks, with no other signs of organ involvement

Onset: insidious

Associated sxs: fever, NVD, cramping pain, hyperactive peristalsis

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21
Q

Drug-Induced

A

Laxatives and ABx

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22
Q

Laxative drug-induced diarrhea

A

Usually women.

May present with hysterical behavior

Sodium Hydroxide Test: phenolphthalein in the laxative causes stool to turn red with the sodium is introduced to it

Associated sxs: Muscles weakness, hypokalemia, lassitude

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23
Q

Abx induced diarrhea

A

Causes: ampicillin, tetracycline, lincomycin, clindamycin, chloramphenicol

Sxs: mild/watery diarrhea, nonspecific cramping abdominal pain, low-grade fever

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24
Q

Pseudomembranous Entercolitis

AKA antibiotic associated colitis

A

Nature of sxs: Severe colitis with pseudomembrane formation.

Onset: days or weeks after taking abx

Source: too much bacteria build up (abx, immunosuppressed, hospital, surgery)

Associated sxs: Severe diarrhea, pus in stool, fever, dehydration, hypotension

Life-threatening diarrhea of colonic dysenteric type, generally caused by clindamycin, c-diff superinfection can precipitate

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25
Staphylcococcus Toxin
Nature of sxs: Severe NVD Onset: 2-4 hours after eating contaminated food ( Source: usually meat or dairy
26
Dysentery Syndrome
Nature of sxs: Acute, watery diarrhea (prior history of good health) Onset: 1-3 days Source: Usually shigella bacteria or amoeba in contaminated food or water Associated sxs: Bloody diarrhea***, feeling of incomplete defecation, cramps, fever, malaise, NV
27
Tension HA
Most common Location: occipital/suboccipital and bilateral Pain: Constrictive band around the head or scalp tightness. May go down neck and back Duration: Persists all days for several days ***May awaken with HA but rarely have one at night
28
Cluster HA
More common in men Location: periorbital and unilateral Pain: severe pain in eye that might radiate to the front of the face/temporal regions Duration: 20-60 minutes (attacks short lasting, usually develop cluster/pattern of frequent attacks) * ***usually an early morning HA * ***usually occur pattern or cluster
29
Migraines
Classic Migraine and Common Migraine
30
Classic Migraine
Nature of sxs: Aura and prodrome prominent, pt will go to sleep and HA will be gone Location: Periorbital and Unilateral Pain: Severe throbbing Onset: Prodrome has abrupt onset and lasts about 15 prior to HA. Duration: 2-8 days.
31
Common Migraine
*******More common Nature of sxs: Aura and prodrome vague or absent (prodrome may manifest by personality change, malaise, NV) Location: Frontotemporal or supraorbital region and is unilateral/bilateral Pain: Throbbing Onset: Gradual Duration: 4-72 hours
32
HA induced by Glaucoma
Nature of sxs: localized to eye and patient sees halo(s) Location: localized to eye(s) Pain: increased with intraocular pressure
33
NV with Esophageal Obstruction/achalasia
Sxs: Vomiting regurgitated or undigested food, Odorless vomitus, Usually occurs in early morning or after large meals
34
NV with Increase ICP
Sxs: Projectile vomiting not preceded by nausea, Papilledema
35
NV associated with hepatic capsule distention/mesentertic congestion
Sxs: consistent with CHF (tachycardia, gallop rhythm, peripheral edema)
36
NV associated with hepatitis/cirrhosis
sxs: Jaundice or hepatomegaly
37
Presumptive DDx
diagnosis made solely on symptomology, prior to testing/confirmation from testing
38
DDX
diagnosis which examines all the possible causes for a set of sxs in order to arrive at a diagnosis
39
Appendicitis
Pain: colicky progressing to constant Location: early - epigastrium/periumbilical. late - RLQ Associated sxs: fever, vomiting after pain has started, constipation, involuntary guarding, rebound tenderness Precipitating: movement and coughing Ameliorating: lying still
40
Diverticulitis
Pain: intermittent, cramping Location: LLQ Associated sxs: Constipation/diarrhea, might have palpable mass in LLQ
41
Cholecystitis
Pain: colicky progressing to constant Location: RUQ radiating to inferior scapula Associated sxs: NV, dark urine, light stools, jaundice. Murphy's sign, tenderness to RUQ Precipitating: fatty foods, PO contraceptives, drugs
42
IBS
Pain: Recurrent Location: most coming in LLQ Associated sxs: Alternating periods of constipation/ diarrhea, mucus in stool, small marble-like stools Precipitating: stress Ameliorating: defecation
43
Carcinoma of the ampulla of vater
Hx of occasional silver-colored stools alternating with normal or light-colored stools (d/t a mixture of upper GI blood from the carcinoma with alcoholic stools)
44
Pancreatitis
Pain: steady and severe Location: LUQ, epigastric, radiates to back Associated sxs: NV, prostration (prone position), diaphoresis, diffuse rebound tenderness Precipitating: lying supine Ameliorating: leaning forward
45
Most common cause of LBP
Mechanical origin: acute lumbosacral strain, postural backache, degenerative lumbosacral arthritis
46
Sensitive diagnostic test for suspected herniated disk/tumor
MRI
47
Airway deviation toward affected lung
marked atelectasis/collapsed lung Lobectomy/pneumonectomy pleural fibrosis pulmonary fibrosis
48
airway deviation away from affected lung
Tension pneumothorax pleural effusion Large mass
49
SOB worse when upright and better when lying down (platypnea)
Intracardiac shunt and/or vascular lung shunt
50
SOB associated with hyperventilation/anxiety
dizziness, lightheadedness, paresthesia (especially in perioral region and extremities), palpitations, sighing respirations, Normal PFT, "can't get enough air
51
SOB d/t cardiac etiology
Paroxysmal nocturnal dyspnea, SOB intensified with recumbency, slow recovery period from dyspnea and tachycardia
52
SOB d/t pulmonary etiology
Intensified with exertion, dialy productive cough, postural changes have little or no effect, fast recovery priod from dyspnea and tachycardia **dont usually have dyspnea at rest
53
Chest pain with MI
Nature of pain can be different for each patient. | Pain might not be relieved from nitro
54
Angina Pectoris
Nature of pain: Substernal, paroxysmal, and in same spot every time for the patient. generally lasts 30s to a few minutes Precipitating: exertion, cold exposure, emotional stress, sexual activity Ameliorating: Nitro and rest ***pain generally not sticky or sharp
55
Variant Angina
Nature of pain: Substernal Precipitating: Vasospasm not exertion...commonly occurs at rest or sleep Ameliorating: nitro ****not usually sharp or sticky
56
Cervical Angina
"pseudoangina" Mimics angina symptomology but is not brought on my exertion Precipitating: cervical movement, cough/sneeze, lateral head movements
57
GERD
***Most common cause of noncardiac CP Nature of pain: Burning (may be indentical to angina) Precipitating: overeating, recumbency, may awaken during sleep Ameliorating: Antacids, PPI Physical findings: water brash, heartburn
58
Esophageal Spasm
***especially obese people Nature of pain: Burning (may be identical to angina) Precipitating: Induced by ingestion of alcohol or cold liquids Ameliorating: Occasionally relieved by nitro
59
Mitral Valve Prolapse
Nature of pain: Sticky quality, lasts several hours, usually occurs @ rest, pain is not substernal Precipitating: Ameliorating: Recumbency and BB Physical findings: Click/late systolic murmur, palpitations, arrhythmias, syncope
60
HCM
Nature of pain: Similar to angina Precipitating: Nitro Ameliorating: Squatting and BB Physical findings: Murmur intensified by nitro and valsalva maneuver. LVH and LAE
61
Cervicodorsal Arthritis
Nature of pain: Sharp or sticky...only lasts a few seconds Precipitating: Body movement, cough/sneeze, prolonged recumbency
62
PE
Nature of pain: Pleuritic Precipitating: PO contraceptives, CV risk factors, prolonged immobilization, DVT Ameliorating: Physical findings: DVT, tachypnea, SOB, hemoptysis, tachycardia, decreased oxygen saturation
63
Pneumonia
Physical findings: SIRS, cough, egophony on percussion
64
Pericarditis
Nature of pain: Precordial, sharp/dull, protracted duration Physical findings: Fever, recent viral infection, pericardial friction rub, diffuse ST segment elevation
65
Chest Wall Syndrome
Nature of pain: Sharp and stick, fleeting Precipitating: Recumbency, palpation Physical findings: Local tenderness on palpation, crowing rooster, reproducaple
66
Gas Entrapment Syndrome
Nature of pain: Dull, achy Precipitating: Bending and tight garments Ameliorating: Passage of flatus, nitro
67
Causes of acute cough
Viral URI, allergies, bacterial pneumonia
68
Causes of chronic cough
Upper airway cough syndrome (PND), asthma, CHF, GERD, Psychogenic
69
Viral URI associated cough
***Most common cause for acute cough Nature of sxs: acute onset of noisey cough over hours or days, lasts 7-10 days, cough is worse at night, Sputum thick and yellow BUT minimally produced Associated sxs: fever, sore throat, general aches/pains ****if > 14 days assess for secondary bacteral infection
70
Allergy associated cough
Nature of sxs: reccurrent cough without dyspnea, minimally productive, may be seasonal Associated sxs: sneezing, itching of eyes, conjunctivitis, tearing, boggy/edematous nasal mucosa
71
Bacterial pneumonia associated cough
Nature of sxs: Acute onset of noisy cough, cough worse at night, incidence highest in winter Associated sxs: SIRS criteria, fever/chills
72
Upper Airway Cough Syndrome (PND)
***may not be aware of condition Nature of sxs: frequent throat clearing and hawking, cough worse in morning Precipitating: recumbency, various sinusitis/rhinitis Physical findings: Mucoid secretions in posterior pharynx, Mucosa of nose and oropharynx presents with a cobble stone appearance
73
Asthma associated cough
Nature of sxs: recurrent cough, minimally/not productive, worse in later afternoon/night Associated sxs: SOB, wheezing Precipitating: exercise, allergens
74
CHF associated cough
Nature of sxs: Cough often nocturnal Associated sxs: Dyspnea on exertion Precipitating: Recumbency Physical findings: CHF
75
GERD associated cough
Nature of sxs: Irritative, nonproductive cough Associated sxs: Heartburn, eructation, sour tase Precipitating: recumbency, ingestion of chocolate, caffeine, alcohol Physical findings: none
76
Psychogenic (HABIT) cough
coughs only when awake (not during sleep), can stop coughing on demand
77
Chronic Bronchitis associated cough
***most common chronic cough in adults (especially smokers) Nature of sxs: minimally productive, may be worse in morning

USA: AHN 568 (10 decks)

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