Chest

Question 1

different X-ray densities, colour of air, fat, soft tissue/muscle, bone and metal?

Answer 1

air = black 
fat = grey 
soft tissue/muscle = grey/white
bone = white 
metal = bright white

Question 2

how do you consider if an x-ray is technically adequate?

Answer 2

-tions 
projection 
inspiration 
rotation 
penetration

Question 3

how is projection measured on a PA chest X-ray?

Answer 3

CTR
ratio of maximal horizontal cardiac diameter to maximal horizontal thoracic diameter
should be <0.5 (50%)

Question 4

why is CTR not measured on AP X-rays?

Answer 4

objects nearer appear artificially enlarged

Question 5

how do you tell if a CXR is adequately inspired?

Answer 5

anterior ends of at least 6 ribs should be visible

Question 6

how do you tell if a CXR is correctly centred? (rotation)

Answer 6

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

Question 7

which borders should all be clearly visible?

Answer 7

mediastinal borders

Question 8

what are the pulmonary hila?

Answer 8

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

Question 9

which hilum is normally higher?

Answer 9

left

Question 10

which diaphragm is normally higher?

Answer 10

right by 1.5cm

Question 11

how are the lungs divided?

Answer 11

upper, middle and lower zones

Question 12

what are the review areas?

Answer 12

lung apices
behind the heart
below the diaphragm
bones and soft tissues

Question 13

lung apices

Answer 13

masses (e.g. Pancoast tumour)

pneumothorax

Question 14

behind the heart

Answer 14

consolidation
masses
hiatus hernia

Question 15

below the diaphragm

Answer 15

free gas
lines and tubes
gastric distension
bowel obstruction

Question 16

bones and soft tissues

Answer 16

fractures
masses
mastectomy
subcutaneous emphysema
evidence of previous surgery

Question 17

why does lobar collapse occur

Answer 17

obstruction of a lobar bronchus

Question 18

causes of bronchial obstruction

Answer 18

aspirated foodstuff
tumours
mucus impaction

Question 19

what is ‘veil like opacity’

Answer 19

describes diffuse opacification caused by lobe collapse

Question 20

what infection would cause the left heart border to be obscured?

Answer 20

lingula

Question 21

what would cause loss of clarity of the right heart border but preservation of the right hemidiaphragm?

Answer 21

right middle lobe consolidation

Question 22

what would cause loss of clarity of the left upper mediastinum?

Answer 22

left upper lobe consolidation

Question 23

key criteria in air bronchogram

Answer 23

1. The bronchus must contain air

2. The surrounding lung must not

Question 24

pleural effusion erect CXR

Answer 24

dense pleural fluid is seen to collect at the lung bases and often forms the curved appearance of a ‘meniscus’ at the lung edges, blunting the costophrenic angles

Question 25

small pneumothorax

Answer 25

a dark crescent without lung markings bounded medially by the lung edge

Question 26

where is a pneumothorax often?

Answer 26

lung apex

Question 27

large pneumothorax

Answer 27

the lung edge and the black air filled pleural space with no lung markings

Question 28

tension pneumothorax

Answer 28

large air filled pleural space displaces the mediastinum depresses the diaphragm collapsed lung can be squashed against the heart

Question 29

heart failure mnemonic

Answer 29

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

Question 30

normal ET tube placement

Answer 30

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

Question 31

malposition of an ET tube

Answer 31

tip extends past carina | may have entered the oesophagus

Question 32

what are central lines inserted via?

Answer 32

right and left jugular or subclavian veins

Question 33

what are peripherally inserted catheters inserted via?

Answer 33

cephalic, basilic or brachial veins

Question 34

where should the tip of a central venous catheter be?

Answer 34

cavoatrial junction

Question 35

where should the tip of a peripherally inserted catheter be?

Answer 35

cavoatrial junction or in a central vein

Question 36

miliary nodule

Answer 36

<2mm

Question 37

pulmonary micronodule

Answer 37

2-7mm

Question 38

pulmonary nodule

Answer 38

7-30 mm

Question 39

pulmonary mass

Answer 39

>30mm

Question 40

TNM lung cancer staging

Answer 40

T Tumour size N Intrathoracic Lymph Node Staging M Metastases

Question 41

contrast CT for lung cancer

Answer 41

tumour size metastases guiding biopsy

Question 42

PET CT for lung cancer

Answer 42

nodal metastases | distant metastases

Question 43

pneumoperitoneum description

Answer 43

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

Question 44

pneumoperitoneum xray

Answer 44

thin black line between the diaphragm and subdiaphragmatic structures

Question 45

PE xray

Answer 45

look for alternative cause of symptoms

Question 46

PE CTPA

Answer 46

look for clot

Question 47

PE V/Q scan

Answer 47

look for defects caused by clot