CardioResp Investigations Flashcards
hallmark feature of lung consolidation on a CXR?
air bronchogram- dark lines through areas of opacification due to sparing of large airways- will be of a lower density.
differential diagnoses for lung consolidation?
pneumonia
lung cancer
pulmonary haemorrhage
pulmonary oedema
Use and requirements of thoracoscopy?
Can be use to take biopsy in presence of pleural effusion
Need adequate amount of effusion fluid for biopsy sample.
ABG expected in pt with LT history of COPD?
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.
On EWS scoring, which is the 1st parameter to change to highlight that a Pt is becoming increasing unwell?
RR
CIs to using spirometry?
recent surgery within 12 wks recent MI within 12 wks unstable angina pneumothorax haemoptysis aortic aneurysm PE acute N and V disorders
Give 4 points to note on a CXR following recog of pt, dob, date radiograph was performed, prior to commencing ABCDE?
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
how are lines produced on a CXR?
differing densities
what is atelectasis and how might it appear of a CXR? Also give some causes.
partial lung collapse appearance: well-defined horizontal line diaphragm tenting causes: compression e.g. from lung carcinoma post-surgery complication
causes of upper zone fibrotic shadowing on a CXR?
TB extrinsic allergic alveolitis ankylosing spondylitis radiotherapy-radiation fibrosis? sarcoidosis histoplasmosis cystic fibrosis
causes of mid zone fibrotic shadowing on a CXR?
progressive massive fibrosis (PMF)
causes of lower zone fibrotic shadowing on a CXR?
idiopathic pulmonary fibrosis
asbestosis
important areas to check on a CXR when considering E-everything else?
lung apices
hila
behind the heart
under the diaphragm
what to discuss if abnormality on a CXR?
L or R lung, and zone density-opaque or lucent size shape-round, oval borders- well defined? regular/irregular?
what is meant by the silhouette sign on a CXR?
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
typical description of lung Ca on CXR?
cannon ball appearance
what can cause lung white out on a CXR, other than a pleural effusion?
lung collapse
pneumonectomy
what sign may be noted on a CXR when aspergillus invades TB cavity?
crescent sign
=aspergilloma
TOE vs TTE?
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.
when might a transthoracic ECHO be inadequate?
obesity
chronic lung disease
ventilated patients
how might previous herpes-zoster infection appear on a CXR?*
multiple calcified nodules
CXR appearance in HF?
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.
TOE gives high resolution of which structures?
posterior mediastinal structures e.g. LA, tricuspid valve and descending aorta.
imaging modality of choice for investigating cardiomyopathy?
MRI
bilateral symmetrical hilar enlargement should raise the suspicion of what diagnosis from CXR?
sarcoidosis
may also be the result of pulmonary HTN
differential diagnosis of lung cavities on CXR?
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.
