ch. 3: respiratory Flashcards
1
Q
correct placement of endotracheal tube
A
tip of tube 5-7 cm above the carina
2
Q
complications from misplaced endotracheal tube (too low, too high)
A
low placement = atelectasis
high placement = air entering the stomach
3
Q
correct placement of a central venous pressure catheter
A
tip of catheter should be in superior vena cava
4
Q
complications from misplace central venous pressure catheter
A
internal jugular vein placement, right atrium = possible arrythmias/perforation, pneumothorax, infusion of fluid into mediastinum space
5
Q
correct placement of Swan-Ganz catheter
A
right or left main pulmonary artery seen radiographically within the borders of the mediastinum
6
Q
complications of misplaced Swan-Ganz catheter
A
pulmonary infarction
7
Q
correct placement of transvenous cardiac pacemaker
A
overexposure to demonstrate the tip of the electrode at the apex of the right ventricle
8
Q
complications of a misplaced cardiac pacemaker
A
coronary sinus placement needs a lateral chest image to distinguish, perforation at initial insertion
9
Q
cystic fibrosis is an ___________________ hereditary disease
A
autosomal recessive
10
Q
median age of survival in the US for cystic fibrosis patients
A
37 years
11
Q
___% of the morbidity and mortality related to CF is attributable to respiratory involvement
A
90%
12
Q
cystic fibrosis is characterized by the secretion of excessively viscous _________ by all ________________
A
mucus, exocrine glands
13
Q
radiographic appearance of cystic fibrosis
A
generalized irregular thickening of linear markings, hyperinflation
14
Q
hyaline membrane disease is caused by a lack of _________ in _______ lungs
A
surfactant, immature
15
Q
hyaline membrane disease is also called
A
idiopathic respiratory distress syndrome (IRDS), respiratory distress syndrome (RDS)
16
Q
hyaline membrane disease is a common cause of respiratory distress in what age group?
A
newborns/preemies
17
Q
radiographic appearance of hyaline membrane disease
A
granular appear of lung parenchyma (ground glass), underaeration, atelectasis, peripheral air bronchograms
18
Q
is croup (laryngotrachebronchitis) an upper or lower respiratory disorder?
A
upper
19
Q
is influenza an upper or lower respiratory disorder?
A
upper
20
Q
is epiglottitis an upper or lower respiratory disorder?
A
upper
21
Q
is pneumonia an upper or lower respiratory disorder?
A
lower
22
Q
is anthrax an upper or lower respiratory disorder?
A
lower
23
Q
is TB an upper or lower respiratory disorder?
A
lower
24
Q
is RSV an upper or lower respiratory disorder?
A
lower
25
are SARS viruses an upper or lower respiratory disorder?
lower
26
is pulmonary mycosis an upper or lower respiratory disorder?
lower
27
3 radiographic manifestations of pneumonia
alveolar, bronchopneumonia, interstitial pneumonia
28
radiographic manifestations of alveolar (air space) pneumonia
consolidation of lung parenchyma with little to no involvement of airways, inflammatory exudate replaces air in alveoli, presence of air bronchogram
29
radiographic manifestations of bronchopneumonia
originates in the bronchi, small patches of consolidation seen, absence of air bronchogram
30
radiographic manifestations of interstitial pneumonia
inflammation from virus/mycoplasma; involves walls and interstitial tissues of alveoli, produces linear or reticular pattern
31
pneumococcal pneumonia location and imaging appearance
location = lobar/segment
appearance = lobe/segment opacification
32
staphylococcal pneumonia location and imaging appearance
location = bronchial airway/alveoli
appearance = patchy opacification with air bronchogram
33
viral or mycoplasmic pneumonia location and imaging appearance
location = alveoli/interstitium
appearance = linear or reticular pattern
34
aspiration pneumonia location and imaging appearance
location = alveoli (lobe/segment)
appearance = patchy opacification
35
anthrax pneumonia location and imaging appearance
location = throughout both lungs
appearance = mediastinal widening with associated pleural effusions without infiltrates
36
lung abscesses are most common in the (left/right) lung
right
37
lung abscess imaging appearance
encapsulated opaque mass with air fluid level
38
radiographic appearance of croup
lower neck shows characteristic smooth, fusiform, tapered narrowing of the subglottic airway caused by edema
39
radiographic appearance of epiglottitis
rounded thickening epiglottic shadow on lateral
40
treatment for hyaline membrane disease
artificial surfactant, positive pressure ventilation
41
treatment for croup
steam, mist tent, O2
42
treatment for epiglottitis
ER- intubation, antibiotic for treatment
43
where is aspiration pneumonia most commonly located in the lungs?
posterior segments of the upper and lower lobes are most commonly affected
44
why are posterior segments of the upper and lower lobes are most commonly affected in aspiration pneumonia?
gravity
45
what organism causes anthrax?
Bacillus anthracis (bacteria)
46
how is the right bronchus different from the left?
more vertical, larger in diameter
47
how can a lung abscess spread?
infected material by the blood to the heart and brain
48
what organism causes tuberculosis?
Mycobacterium tuberculosis (bacteria)
49
4 radiographic patterns of primary TB
1. lobar/segmental consolidation is homogeneous, dense, and well defined
2. hilar and mediastinal lymph node enlargement
3. Ghon lesions
4. pleural effusion (usually unilateral)
50
what does military TB refer to?
dissemination of the disease by way of the bloodstream
51
radiographic manifestation of military TB
innumerable fine discrete nodules (granulomas) distributed uniformly throughout both lungs
52
secondary TB most commonly affects the (lower/upper) lobes in the ______ segments
upper, posterior
53
radiographic appearance of secondary TB
extensive fibrotic changes with possible calcification
54
radiographic appearance of tuberculomas
single or multiple nodules, 1-3 cm
55
tuberculomas can occur in ________ in the lung, commonly in the _____________
any part, periphery and upper lobes
56
location of RSV
bronchial epithelium
57
radiographic appearance of RSV
hyperinflation with diffuse increase of interstitial markings, severe cases demonstrate focal areas of atelectasis,
58
common complication of RSV when necrotic material and edema from infection cause bronchial obstruction
bronchial spasm, interstitial pneumonia
59
how is RSV spread?
droplets
60
how is TB spread?
droplets in the air
61
location of chronic bronchitis
bronchi/bronchioles, mucous gland secretion
62
imaging appearance of chronic bronchitis
no change in imaging in 50%
increased bronchovascular markings, hyperinflation and depressed diaphragm
63
location of emphysema
destroyed alveolar septa
64
imaging appearance of emphysema
pulmonary hyperinflation, bulla formation, flattened diaphragm
65
should there be any technique change for patients with bronchitis? with emphysema?
no for bronchitis, decrease for emphysema
66
location of asthma
bronchi
67
radiographic manifestation of asthma
no evidence unless during acute attack, bronchial narrowing/hyperlucent lungs
68
location of bronchiectasis
basal segments of lower lobes
69
radiographic appearance of bronchiectasis (regular and advanced)
regular = coarseness and decreased interstitial markings
advanced = oval/circular cystic spaces
70
location of sarcoidosis
nonspecific or unknown cause of multisystem granulomatous disease
71
radiographic appearance of sarcoidosis
bilateral hilar lymph node enlargement with or without diffuse parenchymal disease
72
COPD encompasses several diseases that involve damaged lung tissue that causes _______________
poor air exchange
73
Group of respiratory diseases caused by inhalation of foreign dust
pneumoconiosis
74
3 disease covered in pneumoconiosis section of ch. 3
silicosis, asbestosis, anthracosis
75
silicosis is a disease in response to __________
exposure to silica
76
asbestosis is a disease in response to _____________
inhalation of asbestos dust
77
anthracosis is a disease in response to ________________
long term exposure to dusts from coal mining
78
in relation to pneumoconiosis, XR will demonstrate _________ but High Resolution CT (HRCT) will better demonstrate _______________
fibrosis, the true extent of disease
79
in relation to pneumoconiosis, disease causes lung ______________, resulting in __________ of the lung tissue
inflammation, fibrosis
80
location of silicosis
most often upper lobes, lung parenchyma
81
location of asbestosis
pleural lining
82
location of anthracosis
throughout lungs
83
radiographic appearance of silicosis
multiple, well defined scattered nodules of uniform density
84
radiographic appearance of asbestosis
pleural thickening with calcified plaques
85
radiographic appearance of anthracosis
multiple, less well-defined nodules of granular density
86
_________________ are common, asymptomatic findings on chest imaging
solitary pulmonary nodules
87
risk of malignancy increases with ______ and ___________________________________
age, high-risk factors like smoking/occupational exposures/TB exposure
88
benign lung neoplasms are (common/rare), and the two most common are _____________
rare (2-5%), Hamartomas (1), bronchial adenomas (2)
89
Hamartoma characteristics
peripheral portion of lung, mixed tissue types
90
bronchial adenoma characteristics
beneath epithelial lining of bronchial tree
91
malignant lung neoplasms are classified as _____________ or _____________. what is most common?
small cell, non small cell
non small cell are most common
92
small cell lung cancer is _____________ and ________________
very aggressive, metastasize early
93
non small cell lung cancer includes
bronchogenic carcinoma (adenocarcinomas, squamous cell carcinoma, large cell carcinoma)
94
approximately ___ of cancers metastasize to the lungs
1/3
95
common primary cancers that spread to the lungs include
colon
breast
prostate
thyroid
renal
MSK sarcomas
96
radiographic appearance of pulmonary metastases
multiple widespread round or oval nodules
97
location of solitary pulmonary nodules
throughout lungs
98
location of bronchial adenoma
glandular structure of major/segmental bronchi
99
location of bronchogenic carcinoma
lung parenchyma
100
location of pulmonary metastases
throughout lungs
101
pulmonary embolism characteristics
very common, potentially fatal
95% arise from DVT in lower extremities
80% of cases are asymptomatic
102
location of pulmonary embolism
most often lower lobes
103
radiographic appearance of pulmonary embolism
serial images demonstrating progressive enlargement of the affected vessel
104
location of septic embolism
lung periphery
105
radiographic appearance of septic embolism
peripheral opacities
106
location of pulmonary arteriovenous fistula
most often lower lobes
107
radiographic appearance of pulmonary arteriovenous fistula
defined soft tissue mass
108
Incomplete expansion of the lung or part of a lung
“collapsed lung”
atelectasis
109
subcutaneous emphysema
-Presence of air in the ________________
-______________________ chest trauma
-Air will outline ___________ on radiograph
tissues of the chest wall, penetrating or blunt, chest muscles
110
ARDS stands for
adult respiratory distress syndrome
111
squamous carcinomas, adenocarcinomas, and bronchiolar (alveolar cell) carcinomas are what type of bronchogenic carcinomas?
non-small cell lung cancers (as opposed to small cell)
111
bronchogenic carcinoma breakdown
non small cell lung cancers = ___%
small cell lung cancers = ___%
NSCLC = 80%, SCLC = 20%
111
what is bronchiectasis?
refers to the permanent abnormal dilation of one or more large bronchi as a result of destruction of the elastic and muscular components of the bronchial wall
111
location of atelectasis
obstruction of segment/lob or lung collapse
112
radiographic appearance of atelectasis
local increased density, platelike streaks
113
location of ARDS
lung structure breakdown
114
radiographic appearance of ARDS
patchy, ill-defined areas of consolidation
115
location of subcutaneous emphysema
air in surrounding muscle bundles
116
radiographic appearance of subcutaneous emphysema
air steaks in muscle bundles
117
intrabronchial foreign bodies usually involve the (upper/lower) lobes and usually the (right/left) more often than the opposite side
lower, right more often than left
118
what is crepitation
a crackling sound or sensation
119
what is a pneumothorax vs pleural effusion?
pneumothorax = air in the pleural cavity
pleural effusion = accumulation of fluid in the pleural space
120
radiographic appearance of pneumothorax
(peripheral) hyperlucent area in which all pulmonary markings are absent with visceral pleural line
121
what respiration modification is necessary to see a pneumothorax?
expiration instead of inspiration
122
radiographic appearance of pleural effusion
blunting of the normally sharp costophrenic angle
123
radiographic (fluoroscopic) appearance diaphragmatic paralysis
paradoxical motion (depress on expiration, elevate on inspiration)
