CardioResp Investigations

Question 1

hallmark feature of lung consolidation on a CXR?

Answer 1

air bronchogram- dark lines through areas of opacification due to sparing of large airways- will be of a lower density.

Question 2

differential diagnoses for lung consolidation?

Answer 2

pneumonia
lung cancer
pulmonary haemorrhage
pulmonary oedema

Question 3

Use and requirements of thoracoscopy?

Answer 3

Can be use to take biopsy in presence of pleural effusion

Need adequate amount of effusion fluid for biopsy sample.

Question 4

ABG expected in pt with LT history of COPD?

Answer 4

Type 2 Resp failure: reduced PaO2 to less than 8.0kPa, and raised pCO2 to more than 6.0kPa.
Compensated/partially compensated resp acidosis with low pH, raised pCO2 and raised HCO3-, as HCO3- can be increased LT to compensated for raised pCO2 in order to retain normal pH, although this means central chemoreceptors now unresponsive to raised PaCO2 and reset to higher level, so hypoxic drive to breathe , which can be problematic in O2 therapy.

Question 5

On EWS scoring, which is the 1st parameter to change to highlight that a Pt is becoming increasing unwell?

Answer 5

RR

Question 6

CIs to using spirometry?

Answer 6

recent surgery within 12 wks
recent MI within 12 wks
unstable angina
pneumothorax
haemoptysis
aortic aneurysm
PE
acute N and V disorders

Question 7

Give 4 points to note on a CXR following recog of pt, dob, date radiograph was performed, prior to commencing ABCDE?

Answer 7

Positioning- PA or AP radiograph, PA if doesn’t say (standard)- high gastric air bubble as air rises, scapulae not in the way of the lung fields. AP- can’t comment on if cardiomegaly present as can give false impression due to anterior posit of heart in mediastinum. Adequate exposure?
Penetration- good if IV discs just visible
Rotation- are the spinous processes in line, and the mediastinal rib edges should be same difference each side.
Inspiration

Question 8

how are lines produced on a CXR?

Answer 8

differing densities

Question 9

what is atelectasis and how might it appear of a CXR? Also give some causes.

Answer 9

partial lung collapse
appearance: well-defined horizontal line
diaphragm tenting
causes: 
compression e.g. from lung carcinoma
post-surgery complication

Question 10

causes of upper zone fibrotic shadowing on a CXR?

Answer 10

TB
extrinsic allergic alveolitis
ankylosing spondylitis
radiotherapy-radiation fibrosis?
sarcoidosis
histoplasmosis
cystic fibrosis

Question 11

causes of mid zone fibrotic shadowing on a CXR?

Answer 11

progressive massive fibrosis (PMF)

Question 12

causes of lower zone fibrotic shadowing on a CXR?

Answer 12

idiopathic pulmonary fibrosis

asbestosis

Question 13

important areas to check on a CXR when considering E-everything else?

Answer 13

lung apices
hila
behind the heart
under the diaphragm

Question 14

what to discuss if abnormality on a CXR?

Answer 14

L or R lung, and zone
density-opaque or lucent
size
shape-round, oval
borders- well defined? regular/irregular?

Question 15

what is meant by the silhouette sign on a CXR?

Answer 15

should be described as loss of this sign
as means inability to see normal contours that are normally present due to adjacent anatomical structures having different densities.

normal structures providing contours: soft tissue densities of the heart and bones
lung fields-air

Question 16

typical description of lung Ca on CXR?

Answer 16

cannon ball appearance

Question 17

what can cause lung white out on a CXR, other than a pleural effusion?

Answer 17

lung collapse

pneumonectomy

Question 18

what sign may be noted on a CXR when aspergillus invades TB cavity?

Answer 18

crescent sign

=aspergilloma

Question 19

TOE vs TTE?

Answer 19

Trans thoracic 1st as less invasive, may only need this but if unable to assess valve function fully due to poor quality images because of structures in the way e.g. Skin, muscle, liver etc. then do TOE- better images but more invasive.

Question 20

when might a transthoracic ECHO be inadequate?

Answer 20

obesity
chronic lung disease
ventilated patients

Question 21

how might previous herpes-zoster infection appear on a CXR?*

Answer 21

multiple calcified nodules

Question 22

CXR appearance in HF?

Answer 22

cardiomegaly- C to T ratio more than 50%
upper lobe diversion- distension of pulmonary veins as blood redirected to these to avoid oedema areas.
pleural effusion
bilateral perihilar shadowing-‘bats wing’
fluid in the fissures
kerley B lines- horizontal engorged lymphatics at periphery of lower lobes.

Question 23

TOE gives high resolution of which structures?

Answer 23

posterior mediastinal structures e.g. LA, tricuspid valve and descending aorta.

Question 24

imaging modality of choice for investigating cardiomyopathy?

Answer 24

MRI

Question 25

bilateral symmetrical hilar enlargement should raise the suspicion of what diagnosis from CXR?

Answer 25

sarcoidosis

may also be the result of pulmonary HTN

Question 26

differential diagnosis of lung cavities on CXR?

Answer 26

lung abscess-TB, klebsiella or stap aureus
lung Ca
septic embolus
fungal infection-if immunocomp
wegener’s granulomatosis (granulomatosis with polyangitis)- single or multiple cavitatory nodules at cortical and sub-pleural sites. May present as persistent cough, usually unproductive, hamoptysis, pyrexia, dyspnoea and post-obstructive infection.