Chest

Question 1

What sign on a CXR would suggest the left upper lobe is clear

Answer 1

Visible left heart border

Question 2

What are the common locations of metastasis in lung cancer

Answer 2

liver, bones, brain and adrenal glands

Question 3

Which lymph node groups are most likely to see spread from a primary lung cancer

Answer 3

Bronchopulmonary, tracheobronchial and supraclavicular

Question 4

How does emphysema show up on a CT

Answer 4

Black holes in the lung tissue

This is seen in smokers

Question 5

What colour is air on a CXR

Answer 5

black

Question 6

How do you interpret a CXR

Answer 6

Patient name and CHI 
Check if there is a side marker 
Projection (PA or AP) 
Inspiration 
Rotation - is it centred 
Penetration

Question 7

Which CXR projection is best for measuring the cardiothoracic ratio

Answer 7

PA

AP makes the heart look enlarged just because its closer

Question 8

How can you tell if a CXR is adequately inspired

Answer 8

Need to be able to see the anterior ends of at least 6 ribs

Question 9

Which lung hilum sits higher

Answer 9

The left one is slightly higher

Question 10

How many lobes are inn each lung

Answer 10

Right lung has 3 lobes and the left has 2

Question 11

How does a lobar collapse occur

Answer 11

When there is obstruction of a bronchus

Question 12

How does left upper lobe collapse appear on CXR

Answer 12

loss of left heart borders (veil like opacity), volume loss on the left lung and higher left diaphragm

Question 13

How does left lower lobe collapse appear on CXR

Answer 13

loss of volume on left lung, white triangle behind the heart (sail sign), left hilum will sit lower and isn’t as visible and the left diaphragm border will disappear towards the centre

Question 14

How does right upper lobe collapse appear on CXR

Answer 14

horizontal fissure is pulled higher, increased density of upper area

Question 15

How does right middle lobe collapse appear on CXR

Answer 15

smallest lobe so not a massive volume change but loss of clarity of the right heart border and some density

Question 16

How does right lower lobe collapse appear on CXR

Answer 16

loss of the right hemidiaphragm but can still see the heart border

Question 17

Which lobe is it rare to see collapse in isolation

Answer 17

Rare to see middle collapse in isolation as there is a common bronchus with the lower lobe until they split (most blockages occur before this split)

Question 18

What happens to the heart borders in right middle lobe consolidation

Answer 18

Loss of the right border

Will also get haziness in the lower zone

Question 19

What happens to the heart borders in left upper lobe consolidation

Answer 19

Loss of the left border

Also get increased density

Question 20

How does fluid appear on an erect CXR

Answer 20

Fluid will collect at the bottom and gives a meniscus sign with blunting of the costophrenic angle

Question 21

How does pneumothorax present on a CXR

Answer 21

A dark crescent with no lung markings following the lung edge
In tension, the heart and trachea will be pushed over to opposite side

Question 22

What are the signs of heart failure on a CXR

Answer 22

Dilatation of upper lobe vessels and cardiomegaly
Interstitial opacity – increased markings (Kerley B lines and cuffing)
Airspace opacification (cotton wool appearance)
Pleural effusion

Question 23

Where should a endotracheal tube sit

Answer 23

Should sit around 5cm above carina (tracheal division)

Shouldn’t see the balloon expanding the trachea

Question 24

What is the most common issue with endotracheal tube placement

Answer 24

Placing it too far down and it ends up in the right bronchus
May also enter the oesophagus

Question 25

How do you assess the position of tubes and lines

Answer 25

Usually CXR

Question 26

Where should a NG tube sit

Answer 26

Should be subdiaphragmatic, in the stomach

Question 27

What are the common errors with NG tube placement

Answer 27

Tube enters the respiratory system – either in trachea or gone down into a bronchus
May remain in the oesophagus
May have been coiled at the back of the mouth

Question 28

Where is a central venous catheter inserted

Answer 28

Can be inserted via the internal jugular or subclavian veins

Question 29

Where should a central venous catheter sit

Answer 29

Tip should ALWAYS end up on the right side of the patient as it goes in the SVC
SVC found it the anterior part of the 2nd intercostal space

Question 30

What are the common sites of malposition of a central venous catheter

Answer 30

can be too high (proximal SVC) or low (in the heart) or can be displaced and found in another vein

Question 31

What size of lung mass is considered a nodule

Answer 31

Nodules are 7-30mm

Question 32

What size of lung mass is considered a mass

Answer 32

Masses are >30mm

Question 33

Which area of the lung is the most common site of mets from another cancer

Answer 33

Base of lungs are common as they have the greatest blood supply

Question 34

Where do most primary lung cancers sit

Answer 34

Primary lung cancers tend to be apical (as smoke from cigarettes rises in the lungs)

Question 35

What is a pneumoperitoneum

Answer 35

Gas in the peritoneum

Occurs if there is perforation of the GI tract

Question 36

How does pneumoperitoneum present in CXR

Answer 36

On an erect CXR the gas will rise and appear under the diaphragm - black area

Question 37

How does PE present clinically

Answer 37

Dyspnoea, pleuritic chest pain, cough and haemoptysis and may have DVT signs

Question 38

What test can rule out a PE

Answer 38

D-dimers

Question 39

What is a normal cardiothoracic ratio

Answer 39

Less than 0.5

Ratio of the max cardiac diameter vs the max thoracic diameter

Question 40

How can you tell if a CXR is properly rotated

Answer 40

The medial ends of the clavicles should be equidistant from the spinous processes of the upper thoracic vertebrae

Question 41

Where are Peripherally inserted central catheters (PICC) inserted

Answer 41

Via the brachial, cephalic or basilic veins