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SUMRAD > CHEST > Flashcards

CHEST Flashcards

1
Q

What is below aortic knob and splits after carina of trachea?

A

Bronchus in hilar region

Smaller bronchi are INVISIBLE bc filled with air, so all looks black on NORMAL film

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2
Q

Where are vessles seen commonly?

A

lung bases d/t gravity

taper as they move peripherally

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3
Q

What structures should be noted when viewing?

A

BE aware of scapula border, humerus, nipple shadow, breast tissue

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4
Q

How should the spine be viewed laterally?

A

lucent/dark-Moving superior to inferior should opaque to more dark
Retrosternal should ALWAYS BE Lucent/CLEAR

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5
Q

WHAT is systematic approach for viewing xray?

A 
Name date-M, F
Large abnormality- WHITE STUFF which lobe
Technique- PA, AP, Lateral, Upright, Lateral decubitus
RIPMA
Full view- costorphrenic, apices
Bones
Soft tissue- trachea, mediastina, vascu
Heart
Pleura and fissures
Lungs
Diaphragm
Lines
Stomach bubble
Free stuff- 7th cervicle spine rib, Air fluid level
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6
Q

What determines rotation adequacy?

A

SP equal btwn clavicle. Whatever clavicle is opened more that side is rotated away
Bad outcomes- heart size, vessels hila diaphragm distorted

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7
Q

What determines inspiration adequacy?

A

See at-least 8-9 post ribs, Count 1-3 closely

Bad outcomes- lungs compressed, may look like LL PNA

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8
Q

What determines penetration adequacy

A

Should see spine through heart. Lateral- R diaphragm behind heart, pulm vessels 1/3 of lung periphery

BAD- OVER-lungs look like emphysema (dark). UNDER (opaque) penetration creates false PNA inLL

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9
Q

What determines magnification adequacy

A

AP films enlarge heart. AP do apical lordoctic position

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10
Q

What determines angulation adequacy

A

Clavicle should be S shaped. Medial ends superimposed on 3-4ribs.
Sometimes can see UL better bc apex w/in mid 1/3 of clavicle

BAD- if clavicle highset, apical lordotic heart is large

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11
Q

What are reasons for LLD position?

A

Air fluid level
Pleural effusion layers out >75ml
Loculated effusion

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12
Q

*Expiratory films needed for…

A

Small pneumothorax

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13
Q

Can CXR diagnosis Cancer?

A

NO

Highly suspicious

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14
Q

What is fluid (pus, blood, gastric, water) filled space around bronchi, which makes bronchi more visible?

A

Air bronchograms
Finding in Air space DZ/Alveolar Dz
Air space

Peribronchial- same, but on end

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15
Q

What would opacities look like with alveolar dz?

A 
Confluent merged
Poor defined borders
Consolidation and Lobar stays in lung section
Hazy fluffy
Bat wing w/in lobes
\+Silhouette sign
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16
Q

The minor and major fissure are located where?

A

R lobe
Minor- upper horizontal R lobe
Major- lower lateral to medial diagonal R Lobe

L lobe
ONLY one Major lower, obliquely

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17
Q

Which condition can be segmental, interstitial, streaky, round and cavitary, overlap?

A

Pneumonia- Strep Pneumonia MC
Round- H.flu, strep, no SS
Segmental- multi lobar staph, pseudo, few bronchograms

TB
ARDS

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18
Q

List the DDX Airspace and key findings?

A

Pneumonia- lobar UPPER mostly
Aspiration- bronchi opaque, then bc lucent, lower lobes
Pulmonary edema-CHF late, drown, drugs
TB
Hemorrhage
ARDS- BIL infiltrate acute/adult resp. distress syndrome.
Chronic alveolar DZ- Emphysema

19
Q

What are the DDX cavity lesions/ REACTIVATION TB? *

A

Cavitary lesion have cleared center, discreet border

  1. TB
  2. Staph
  3. Strep
  4. Klebsiella
  5. Coccidiomycosis
20
Q

Is TB always in upper lobes?

A

NO
Primary- ANYWHERE (CT) ipsilateral hilar adenopathy
Reactivation TB- cavitation anywhere, MC UL w/ effusion
Miliary TB- starry night CT everywhere. Pillets on CXR

21
Q 
What disease has the following
white line, netlike
dots
mass, nodules, honeycomb
NO AIR BRONCHOGRAMS
NO LOBAR
focal and diffuse
A

Interstitial DZ

Systemic and Bilateral

22
Q

What are characteristic findings of CHF?

A

Interstital DZ- EARLY CHF

Alveolar - LATE CHF

23
Q

This DDX are common in what kind of locale DZ:

  1. Atypical PNA- viral, myoc, fungal, miliary TB, varicella, PCP
  2. Mass, nodules, tumor
  3. BiL hialar adenopathy-sacroid, restricts
  4. RA
  5. Pulmonary fibrosis
  6. Silicosis, asbestosis etc
  7. Early CHF, non cardiac
A

INTERSTIAL DZ

24
Q

XRAY show dark, white fluffy patches, denser white area. Describe each.

A

LUCENCY- darker, absent. Bulla, PNeumothorax, cycst
OPAGUE- white less dense, fluid mass
CONSOLIDATION- dense white

25
Q

Mr. Chain c/c of SOB, cough, and shoulder pain? What is DDX based on CXR?

A

Apical mass- apex
Shoulder pain
Smoker
Elderly

26
Q

What enlarges the mediastinum other then the heart?

A 
Torturous aorta
lymph nodes
Mediastinal masses
Aortic AA
Pericardial effusion- fluid around heart
Bony abnormalities
27
Q 
CXR it noted that this mass is what based off the findings below?what is plan?
<30yo
<3cm
Round, well defined edges
NO growth for 2y
Central calcification
A

BENIGN mass
Repeat CXR Q3MO FOR 1Y
2YR- REPEAT every 6MO

28
Q 
CXR it noted that this mass is what based off the findings below?what is plan?
>30yo
>3cm
Irregula, poor defined edges
Growth
Asym calcification
Cavitary
A

SUSPICIOUS OF MALIGNANCY
w/u CT
Biopsy-dx
PET- stage dx

29
Q

What causes pleural space to appear opacified on CXR?

A

Pleural effusion- blunt costophrenic angle
Concave meniscus
Loculated effusion- thick viscous
Fissures opacified, effusion

30
Q

If the ascending aorta is no longer seen, where is the consolidation?

A

Silhouette sign

Blurred ascending aorta means RUL consolidation

31
Q

If the R heart border is no longer seen, where is the consolidation?

A

Blurred R heart border means RML consolidation

32
Q

If the R hemidiaphragm is no longer seen, where is the consolidation?

A

Blurred R hemidiaphragm means RLL consolidation

33
Q

If the descending aorta is no longer seen, where is the consolidation?

A

Blurred decending aorta means LUL or LLL consolidation

34
Q

If the L heart border is no longer seen, where is the consolidation?

A

Blurred L heart border means LINGULA or LUL consolidation

35
Q

If the L hemidiaphragm is no longer seen, where is the consolidation?

A

Blurred L hemidiaphragm means LLL consolidation

36
Q

What do straight line indicate on CXR?

A 
Not normal
Lobar PNA
Atelectasis
Kerby B lines
Air Fluid
37
Q

What can be seen on Lateral view if the infiltate is on the spine?

A

SPINE usually superior white/opaque-lower spine dark/lucent
+ Spine sign- infiltrate is posterior to heart in spine
HIGH density in LLL

38
Q

How far should endotracheal tube go?

A

3-5cm ABOVE carina

Radiopaque tube- black btwn two opague tracks

39
Q

Where should central venous catheter?

A

Runs superior to SVC and R atrium

40
Q

What is difference in Child CXR vs Adult?

A

Child Thymus make wide mediastinum
Heart is 65% of width. TOF
Croup- viral infx=Narrow Trachea- “Steeple sign”

41
Q

The coin is en face on PA, where is it located?

A

Esophagus

42
Q

The coin is on edge on PA, where is it located?

A

Trachea

43
Q

For foreign bodies, what must be of concern?

A

Radioopague

Evaluate for Atelectasis

44
Q

When should a CT for chest be ordered?

A 
Details of size, extent, lesion
Systemic lung dz
Nodules and masses follow/up
Staging
Pleural effusion >75ml
Pulmonary embolus
Aorta and medstinal structures
Trauma

SUMRAD (13 decks)

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