Chest

Question 1

x-ray air

Answer 1

black

Question 2

X-ray fat

Answer 2

grey

Question 3

x-ray soft tissue/muscle

Answer 3

grey/white

Question 4

x-ray bone

Answer 4

white

Question 5

x-ray metal

Answer 5

bright white

Question 6

how does x-ray make an image

Answer 6

compares densities - more dense = darker, less dense = lighter

Question 7

what to look at to tell if x-ray is technically accurate

Answer 7

projection
inspiration (anterior ends of at least 6 ribs should be visible eg. diaphragm should be low)
rotation
penetration (is there enough radiation)

Question 8

how is the cardiothoracic radio measures

Answer 8

PA x-ray

not AP as objects close to the X-ray tube are enlarged so heart looks bigger

Question 9

what is the air underneath the diaphragm on the left

Answer 9

stomach bubble (gastric bubble)

Question 10

what are the lung hila

Answer 10

junctions between heart and lungs where pulmonary arteries and bronchi enter and the pulmonary veins exit the lungs

Question 11

which hilum sits higher than the other

Answer 11

left bc left pulmonary artery comes out over the top of the bronchus and right goes underneath

Question 12

which side of the diaphragm sits higher and why

Answer 12

right because it sits above the liver

Question 13

what is the upper zone of lungs

Answer 13

up to second ribs anteriorly

curvy ribs are anterior and straight ribs are posterior

Question 14

what areas need reviewed

Answer 14

Apices (pan coast tumour, pneumothorax)
Behind the heart
Below the diaphragm
Bones and soft tissues

Question 15

what is lobar collapse

Answer 15

when there is obstruction of a lobar bronchus so that lobe os no longer ventilated

looses volume, collapses like balloon

become collapse down and is more dense so is no longer black, is now more white

Question 16

which lung has 3 lobes

Answer 16

right

Question 17

which lung has a lingula

Answer 17

left lower lobe - separates from upper lobe

Question 18

sign of a lower lobe

Answer 18

sale sign

triangle sale shape coming down from centre

Question 19

sign of a left lower lobe collapse

Answer 19

sail sign

triangle sale shape coming down from centre

Question 20

what does a left upper lobe collapse look like

Answer 20

can no longer see the border of the left side of the heart

volume loss - left lung smaller

diaphragm gone up

veil like capacity??

Question 21

what happens when the right upper lobe collapses

Answer 21

right horizontal fissure is pulled up the way

clarity losses in the superior aspect of the right side of the mediastinum

Question 22

what happens when the middle lobe collapses

Answer 22

loss of clarity of the right heart border but preservation of the hemidiaphragm

Question 23

why do right middle and lower lobe often collapse together

Answer 23

because they are supplied by the same part of the bronchus

loss of right heart border clarity PLUS loss of clarity of hemidiaphragm

Question 24

what is pulmonary consolidation

Answer 24

follows same pattern as collapse without the volume loss

obstructs the same parts and the lobe collapses do making them cloudy

Question 25

what are some pleural space abnormalities

Answer 25

pleural effusion

Question 26

when is the pleural cavity visible

Answer 26

only if there's something wrong - pathological

Question 27

what is pleural effusion

Answer 27

fluid in the pleural space often collects at the bottom of the chest meniscus sign visible - fluid is collecting the the costophrenic angle tend to be all the same colour of white

Question 28

what is a pneumothorax

Answer 28

air in the pleural space air tends to rise up towards the apexes black crescent overlying edge of the lung that has no lung markings can see the lung edge - the pleural space is black and the lung has the lung markings in normal cxr lung marking should go right to the edge

Question 29

what is a tension pneumothorax

Answer 29

when the pneumothorax is so big is squashes the lungs so that the patient cannot ventilate pushes everything over to other side on a CXR

Question 30

what does heart failure look like on CXR

Answer 30

Pleural Effusion dilation of the upper lobe vessels/cardiomegaly ``` interstitial opacities airspace opacification -fluid overspilling into interdiction -lots of lines in lungs -looks like cotton wool once it gets into the alvioli ``` pleural effusion

Question 31

signs of heart failure ABCDE

Answer 31

``` A -alveolar oedema B- Kelley b lines C- cardiomegaly D- dilated upper lobe vessels E - pleural effusion ```

Question 32

normal endotracheal tubes

Answer 32

5 cm above the carina width - 2/3 of tracheal diameter cuff should not expand the trachea

Question 33

malposition of endotracheal tubes

Answer 33

Tip may pass the carina (were main bronchus splits) tip may be in the right main bronchus (will ventilate right lung but occlude left causing complete collapse) may have entered....

Question 34

where should nasogastric tubes be placed

Answer 34

sit beneath the diaphragm overlying the gastric bubble should be 10cm below gastro-oesophageal junction u know its in the oesophagus if it is passed the carina

Question 35

where should central venous catheters be

Answer 35

can be inserted via right and left internal jugular or subclavian veins tip MUST ALWAYS BE ON RIGHT SIDE OF PATIENT (SVC is always on right side) tip should be around the 2nd intercostal space anteriorly should be at the cavoatrial junction

Question 36

what are miliary nodules

Answer 36

tiny ones, heavily calcified, stable? | <2mm

Question 37

what size is a pulmonary mass

Answer 37

``` >30 mm solitary soft tissue density new haemoptysis ```

Question 38

what is a pulmonary nodule

Answer 38

7-30mm soft tissue density more towards the base of the lungs

Question 39

most common place for a primary lung cancer

Answer 39

apical - in smokers as smoke rises up

Question 40

how is lung cancer staged

Answer 40

TNM tumour size nodes metastasis

Question 41

what imaging is used to show tumour size and metastasis

Answer 41

contrast enhanced CT

Question 42

what is used to look at smaller metastasis

Answer 42

FDG-PET CT shows distant nodal metastasis

Question 43

what is pneumoperitoneum

Answer 43

perforation of a hollow viscus (stomach, duodenum, small or large bowel) resulting in gas in the peritoneal cavity

Question 44

what does pneumoperitoneum look like on CXR

Answer 44

gas interposed between the diaphragm and the liver thin black line of air

Question 45

what imaging is done for PE

Answer 45

CXR CTPA V/Q scan

Question 46

what does PE look like on CTPA

Answer 46

dilated right heart heart septum moves towards left large clot stops blood flowing through the pulmonary veins

Question 47

what does PE look like on V/Q

Answer 47

mismatch of ventilation and perfusion