Chest Comp Flashcards
1
Q
PA chests are good for visualizing?
A
- pneumothorax
- pleural effusions
- atelectasis
- signs of infection
2
Q
Why is erect chest better than supine?
A
- diaphragm allowed to move farther down (gravity)
- air fluid levels visualized
- engorgement and hyperemia of pulmonary vessels (distended and swollen with fluid) may be prevented
3
Q
What is a lateral chest good for visualizing?
A
-pathologies situated posterior to the heart ,great vessels, and sternum
4
Q
How much rotation is acceptable on a lateral chest?
A
1/4 to 1/2”
5
Q
How do you identify the left hemidiaphragm from the right?
A
The gastric air bubble and inferior border of the heart shadow
6
Q
What is better about a right lateral compared to a left?
A
Increased radiographic detail in the right lung because is it placed closer to the IR
7
Q
What is best seen on a supine chest?
A
-pathologies including the lungs, diaphragm, and mediastinum
8
Q
Why do we do a PA expiration chest?
A
- foreign bodies
- pneumothorax
9
Q
How many ribs are seen on a PA expiration chest?
A
8 or fewer
10
Q
What do we do to our technique for an PA expiration chest?
A
Increase mAs, lungs more dense without air
11
Q
Why do we do a lateral decubitus?
A
-better detects small amounts of fluid in the pleural space
12
Q
How do we position for fluid vs. air on a lateral decubitus?
A
Fluid: affected side down
Air: affected side up
13
Q
3 parts of the chest
A
- bony thorax
- respiratory system proper
- mediastinum
14
Q
What is the bony thorax?
A
Provides protective framework for the parts of the chest involved with breathing and blood circulation (thoracic visera)
15
Q
Parts of the sternum (breast bone)
A
- manubrium
- body
- xiphoid process
16
Q
Parts of the bony thorax?
A
- sternum
- clavicles
- scapulae
- ribs
- thoracic vertebrae
17
Q
Positioning landmarks and their vertebral levels?
A
- Vertebral prominens C7
- Jugular notch T3
- xiphoid process T9/T10, T11/T12 on inspiration (approx level of anterior diaphragm which separates the chest and abdominal cavity
18
Q
4 divisions of the respiratory system?
A
- larynx
- trachea
- bronchi
- lungs
19
Q
What is the diaphragm for?
A
Primary muscle of inspiration
20
Q
How does the diaphragm affect chest volume and thoracic pressure?
A
Diaphragm down (inspiration) = decreased thoracic pressure = increased chest volume = sucking action
21
Q
What does the esophagus connect?
A
The pharynx to the stomach (laryngeopharynx down)
22
Q
Where is the larynx (voice box) located?
A
C3/C6, suspended from hyoid bone
23
Q
What does the larynx consist of?
A
- thyroid cartilage (laryngeal prominence and cricoid cartilage)
- vocal cords
- epiglottis
24
Q
What vertebral level is the trachea at?
A
C6-T4/5
25
Where is the thyroid gland located?
Anterior and inferior to larynx,
| Stored and releases hormones
26
Where are the parathyroid glands located?
Posterior/lateral lobes of the thyroid gland
| Store and release hormones for maintenance of blood calcium levels
27
Where is the thymus gland located?
Inferior to thyroid gland
28
Right bronchi?
- wider and shorter, more vertical than left
- 25 deg angle
- things more likely to go down here***
- divides into 3 secondary bronchi
29
Left bronchi?
- smaller, longer than right
| - divides into 2 secondary bronchi
30
What is the carina?
Where the right and left mainstem bronchi split off from the trachea, left of the midline
31
Branches off of the mainstem bronchi?
Mainstem bronchi-secondary bronchi-bronchioles-alveoli
32
How many lobes/fissures does the right lung have?
- 3 lobes (superior, middle, inferior)
- 2 fissures (horizontal (s and m) , oblique (m and i)
- 1" shorter than left lung because of the liver
33
How many lobes/fissures does the left lung have?
- 2 lobes (superior and inferior)
| - 1 fissure (oblique)
34
What are the lungs composed of?
Parenchyma that allows for the breathing mechanism of expansion and contraction
35
What are the lungs contained in?
Pleura
- parietal
- visceral (close to lung) (aka pulmonary pleura)
36
Where is the apex located?
Above the clavicles (T1)
37
What are the costophrenic angles?
Extreme outermost lower corners of lungs
38
What is the hilum?
Central area of lungs where bronchi, blood vessel, lymph vessels, and nerves enter and exit the lungs
39
What projection are the hemidiaphragms seen?
Lateral
40
Parts of the mediastinum?
- thymus gland
- heart
- great vessels
- trachea
- esophagus
41
What does the thymus gland do?
Prominent in infancy, reaches max size at puberty, shrinks into adulthood
-aids with immune system and helps body resist disease, helps body produce antobodies
42
The heart and great vessels are enclosed in?
The pericardial sac
43
Where are the heart and great vessels located?
Posterior to body of sternum, anterior to T5-T8
| 2/3rds of heart to the left of the median plane
44
Esophagus sits between?
Anterior to descending aorta and posterior to trachea
45
Body habitus and thorax/lung size
Hypersthenic: broad and deep thorax, shallow vertically
Asthenic: narrow and long thorax, long vertically
46
Breathing movements, inspiration changes?
- vertical diameter (downward movement of diaphragm)
- transverse diameter (ribs outward and upward)
- anteroposterior diameter (raising of ribs especially 2-6)
47
Technique for chests?
Long scale contrast, more greys
| -110-125 kVp
48
Special considerations for older patients??
-have less inhalation capability which results in more shallow lung fields and high CR location
49
What is aspiration?
- foreign object swallowed
| - soft tissue technique
50
What is atelectasis?
- collapse of portion of lung, region appears more radiodense
- increase technique
51
What is bronchiectasis?
Irreversable dilation or widening of the bronchi or bronchioles, walls destroyed, chronically inflammed, increase mucous, chronic cough
-common in lower lobes, regional radiodensity
52
What is bronchitis?
Acute/chronic excessive mucous secreted into bronchi
- common in lower lobes
- hyperinflation and more dominant lung markings
53
What is COPD-chronic obstructive pulmonary disease
-persistent obstruction of airways
-emphysema or chronic bronchitis
-asthma
(Blunted bases)
54
What is cystic fibrosis?
- inherited
- heavy mucous causes clogging of bronchi and bronchioles
- hyperinflation and increased radiodensities
- increase technique with sever condition
55
What is dyspnea?
- shortness of breath, difficulty breathing
| - most common in older people
56
What is emphysema?
Irreversible chronic lung disease
- alveolar wall destruction, loss of elasticity, air not expelled during expiration (increased lung dimensions)
- flat diaphragm (blunted bases), radiolucent lungs
- decrease technique
57
90% of cancers start where?
Bronchi
58
What is epiglottitis?
- inflammation of the epiglottis
- life threatening, rapid
- most common in children aged 2-5
- soft tissue lateral technique
59
What is hamartoma?
- most common benign pulmonary mass, peripheral regions of lung
- small, radiodense, sharp outlines
60
What is a pleural effusion? (Hydrothorax)
- accumulation of fluid is the pleural cavity
- increase technique
- lateral decubitus affected side down or erect
61
What is empyema?
Pus in the pleural space, can develop from pneumonia
62
What is a hemothorax?
Blood in the pleural space
63
What is pleurisy?
Inflammation of the pleura
| Causes rubbing of pleura
64
What is pneumonia?
- inflammation of lungs resulting in accumulation of fluid in certain sections of the lungs
- increased lung markings
65
Types of pneumonia?
- aspiration
- bronchopneumonia
- lobar
- viral (interstitial)
66
What is aspiration pneumonia?
Aspiration resulting in edema
67
What is bronchopneumonia?
Bronchitis of both lungs
68
What is lobar pneumonia?
Pneumonia confined to 1 or 2 lobes of the lungs
69
What is viral (interstitial pneumonia)?
Pneumonia in the alveoli and connecting structures
70
What is a pneumothorax?
- air in the pleural space
- no lung markings
- best seen in the apex on expiration
- erect or lateral decub, affected side up
71
What is pulmonary edema?
- excess fluid within the lung "bat sign"
- most commonly caused by CHF or coronary artery disease
- increased radiodensity in hilar region
- increase technique in severe cases
72
What is RDS/hyaline membrane disease/ARDS?
- HMD: infants: decreased surfactant, alveoli stick together
- ARDS: adults
- air bronchogram sign
- increase technique
73
Types of TB?
Primary
| Secondary
74
What is primary TB?
- never had disease before
| - small lesions found in lungs and unilateral pleural effusion
75
What is secondary TB?
- adults, upper lobes
- upward retraction of the hila
- calcifications
- increase technique
76
When is TB best seen?
On AP lordotic so clavicles are above the apices
| -if supine, angle 15-20 deg cephalad
77
Types of occupational lung disease?
- Anthracosis
- Asebestosis
- Silicosis
78
What is anthracosis?
-deposits of coal dust, small opaque spots
| Black lung pnuemoconosis
79
What is asbestosis?
-inhalation of asbestosis that results in pulmonary fibrosis
80
What is silicosis?
- permanent condition
- inhalation of silica (quartz dust)
- nodules and scarring
- 3x more likely to develop TB
81
What is subcutaneous emphysema?
Cracking skin
| -air in subcutaneous
82
Anterior oblique chests best demonstrate?
- pathology involving the lung fields, trachea, and mediastinal structures
- determine the size and contours of the heart
83
Oblique lungs: degree of rotation to see the heart?
60 LAO
84
Do lung fields appear shorter on anterior or posterior obliques? Why
They appear shorter on posterior obliques because of increased magnification of the anterior diaphragm
85
Do the heart and great vessels appear larger on anterior or posterior obliques?
Posterior obliques, farther from the IR
86
Which side is best demonstrated on an anterior oblique?
PA away (side away from the IR)
87
Costochondral joint calssification?
-synarthrodial, no movement
88
Sternoclavicular joint classification?
- diarthrodial, synovial
| - double plane/gliding
89
Sternocostal- rib 1 joint classification?
- synarthrodial
| - cartilagenous, synchondrosis type
90
Sternoconstal rib 2-7 joint classification?
- diarthrodial, synovial
| - plane/gliding
91
Interchondral joints?
- diarthrodial, synovial
| - plane/gliding
92
Costovertebral joint classification?
- diarthrodial, synovial
| - plane/gliding
93
Costotransverse ribs 1-10 joint classification?
- diarthrodial, synovial
| - plane/gliding
94
Tracheostomy
- opening into the trachea to provide an airway
| - distal end at 1-2" above carina
95
Endotracheal tube?
- nose/mouth to trachea, for ventilation and sucking
- distal end 1/2" above carina
- infants between thoracic inlet and carina (T4)
96
Pleural drainage tube?
- remove fluid/air from pleural space
- fluid: laterally in pleural space at 5-6th intercostal space
- air: anterior in pleural space at midclavicle
97
Central venous catheter?
- infusion of toxic substances
| - subclavian or jugular veins, extends to SVC, 2.5cm above right atrial junction
98
Umbilical artery catheter?
- measures oxygen saturation
| - T6-T9 or below levels of renal arteries L1/L2
99
Pulmonary arterial catheter (swan-ganz)
- measures atrial pressures, pulmonary artery pressures, cardiac output
- subclavian, internal/external jugular, or femoral vein
- advances through right atrium into pulmonary artery
100
Umbilical vein catheter?
- deliver fluids/meds
- junction of right atrium and IVC
- anterior and superior to heart
101
Pacemaker?
- regulates heart rate by supplying electrical stimulation
- in subcutaneous fat in anterior chest wall
- catheter tips directed to right atrium or right ventricle
102
Automatic implantable cardioverter defibrillator (ICD)
- anterior chest wall
- catheter tips directed to the right atrium or right ventricle
- detects heart arrythmias and then delivers and electrical shock
- seen laterally on PA chest
103
What is the sail boat sign?
Thymus gland
104
Inspiration/expiration views done for?
- pneumothorax
- foreign body
- moving diaphragm
- ? Opacity on lung vs rib
105
Where does the mediastinum shift for atelectasis?
To affected side
106
RDS
Alveoli are injured causing fluid to leak in/around them
| Increase technique
107
How is TB transmitted?
Airbourne
108
Image taken for croup?
Ap soft tissue
109
Croup?
Narrowing of subglottic portion
| Gothic arch sign
110
What is congenital goiter?
Enlarged thyroid
111
Dextracardia?
Heart is on right side
| Congential
112
Situs inversus?
Major vessels or organs are on the opposite sides from where they would normally be
113
Open cones to see?
Croup
| Diaphragmatic hernia
114
How do you see a foreign body if it is radiolucent
Forced expiration
115
Cretinism?
Hypothyroid in children
Jaundice and decreased growth
Long bones and skull
116
Airborne precautions?
- Sars
- Small pox
- TB
- Varicella (chicken pox)
- Rubeola (red measles)
117
Droplet size for airborne precautions?
5 micrometers or smaller
118
Droplet precautions?
- Influenza
- Rubella (german measles)
- Mumps
- Pertussis (Whooping cough)
- Most pneumonias
- Diphtheria
- Pharyngitis
- Scarlet fever
- Meningococcal meningitis
119
Contact precautions?
- Hepatitis
- Herpes simplex and zoster
- Impetigo
- Scabies
- MRSA
- VRE
- Ebola
- Varicella
- Norwalk
- Lice
120
Droplet size for droplet precautions?
Greater than 5 micrometers
121
Contract drug resistant?
- C.Difficile
- E.Coli
- Rotavirus
- Shigella
122
Airborne and Contact?
- Varicella
- SARS
- Herpes zoster
123
Droplet and Contact
-Diphtheria
124
3 main functions of NG tubes?
1. Feeding
2. Decompression
3. Radiographic examination
125
Types of NG tubes?
1. Dobbhoff (most common for feeding)
2. Levin (one lumen with holes)
3. Salem-sump (one lumen)
126
3 main functions of NE tubes?
1. Feeding
2. Decompression
3. Radiographic examination
127
Types of NE tubes?
1. Miller-abbott (2 lumen, drainage, balloon)
2. Harris (1 lumen)
3. Cantor (1 lumen)
128
Another name for NE tubes?
NI (nasointestinal)
129
Why NE instead of NG tube?
- decrease or absence of peristalsis in the stomach, but not intestines
- delayed gastric emptying
- patient has had a gastric resection
130
CVCs are for?
- administration of chemo/long term drugs
- total parenteral nutrition
- dialysis
- blood transfusions
- blood drawing
- allows venous pressure monitoring
131
Types of CVCs
- Hickman (long term, meds, venous pressure, withdraw blood)
- Groshong (1 or 2 lumen, meds, fluid, withdraw blood)
- Raaf (2 lumen, dialysis)
- Port-a-cath (infusion, venous access)
- PICC (short/long term)
132
What is a swan ganz catheter also known as?
A pulmonary artery catheter
133
Purpose of a swan ganz?
- cardiac output
- heart pressures
- right and left ventricular failure
- monitor meds
- measure core temps
- oxygen in blood
134
Grid ratio formula?
h/D (interspace width)
135
Contrast improvement factors?
No grid: 1
5: 1 : 2
8: 1 : 4
12: 1 : 5
16: 1 : 6
136
Types of grids?
- Parallel
- Crossed
- Focused
- Moving
137
Grid problems?
- Off-level
- Off-center
- Off-focus
- Upside down
138
Is high kVp and high ratio grid better than low kVp and low ratio grid?
Yes
139
Which grid problem occurs with parallel, crossed, and focused grids?
Off level
