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CLASP - Radiology > Chest Masterclass > Flashcards

Chest Masterclass Flashcards

1
Q

how does X ray make an image?

A

compares densities
- more dense = whiter
less dense = darker

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2
Q

process of interpreting an X ray?

A 
check name and CHI
is there a side marker?
is it technically accurate
- projection
- inspiration
- rotation
- penetration
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3
Q

PA radiograph?

A

…

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4
Q

normal cardiothoracic ratio?

A

<0.5

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5
Q

how is cardiothoraciC ratio (CTR) measured?

A

PA x-ray

not AP as objects close to the x ray tube are enlarged so the heart would look bigger on AP

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6
Q

why is a large inspiration in CXR important?

A

to see at least 6 ribs

can look like pathology of not fully inspired

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7
Q

how can you tell if CXR is centred?

A

medial ends of clavicles are equal distance from spinous processes

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8
Q

mediastinal borders on CXR?

A 
aorta
pulmonary artery
left auricle
left ventricle
right atrium
trachea
hemidiaphragm
stomach bubble
horizontal fissure
- should all be seen on CXR
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9
Q

what are pulmonary hila?

A

junctions between the heart and lungs
where the pulmonary arteries and bronchi enter and the pulmonary veins exit the lungs
mainly arteries (veins small)

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10
Q

which hilum generally sits higher?

A

left

- come out above the bronchus which the right comes out below

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11
Q

normal difference in diaphragm height?

A

right side 1.5cm higher

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12
Q

zones of lungs?

A 
not same as lobes
lungs divided into
 - upper (to 2nd rib)
- middle (2-5)
- lower (below 5)
should be roughly same size
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13
Q

review areas/

A

ares where things are missed

  • lung apices (masses etc)
  • behind heart (consolidation etc)
  • below diaphragm (gas bubbles, gastic things etc)
  • bones and soft tissue
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14
Q

lingula is found in which lung?

A

left lower lobe

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15
Q

what causes lobar collapse?

A

blockage in bronchus (lobe supplied by obstructed bronchus isnt ventilated and its air gets reabsorbed so lobe looses volume and collapses)

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16
Q

signs of lobe collapse?

A

reduced volume in lung

  • sail sign
  • higher diaphragm
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17
Q

how does upper lobe collapse present?

A

collapses forward against anterior chest wall
heart becomes less visible
volume loss causing higher diaphragm etc
“veil like opacity” in upper lobe

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18
Q

how does middle lobe collapse present?

A

smallest lobe so not much volume loss seen
obscuration of righ atrium loss of clarity of right heart border
preservation of the diaphragm on that side

19
Q

what can cause collapse of middle and lower right lobes?

A

blockage in bronchus intermedius (common bronchus which splits to supply air to middle and lower lobes)

20
Q

how does consolidation present?

A

diaphragm preserved

may have clouding of other mediastinal features but no volume loss?

21
Q

air bronchograms?

A

tubular outline of an airway made visible by filling of the surrounding alveoli with fluid/exudate etc (e.g from infection)
specific for consolidation?

22
Q

should pleural cavity be visible if normal?

A

no

23
Q

when is pleural cavity seen?

A

pleural effusion
- fluid gathers at lung bases if upright and often forms curved meniscus sign (blunt costophrenic recess)
pneumothorax

24
Q

larger pleural effusion?

A

more homogenous

meniscus sign tracks against the lobes

25
Q

what is seen in pneumothorax?

A

clear black crescent overlying edge of lung markings
clear black area surrounding lung if larger
(lung edge should not be visible in normal lungs as stuck to pleura)

26
Q

how does large tension pneumothorax present?

A

large air filled space displaces mediastinum and trachea

heart can be pushed over to other side

27
Q

signs of pulmonary oedema (heart failure) in order?

A
  1. dilation of upper lobe vessels and right side of heart (then left side)
    - upper lobe veins should be pencil thin and hard to see)
  2. interstitial opacities (fluid overspills into interstitium which supports the lungs)
  3. airspace opacification (alveoli causing cotton wool appearence, perihilar/batwing effusion)
  4. pleural effusion
28
Q

ABCDE of heart failure signs?

A 
alveolar bat wings
kerly B lines
cardiomegaly
dilated upper lobe vessels
edema
29
Q

tubes which may be seen on CXR?

A

endotracheal tubes
-normal = 5cm abover carina, 2/3 width of trachea, balloon cuff should not expand trache
- abnormal = tip extends past carina inot right main bronchus, may enter oesophagus)
nasogastric tube
- normal = in subdiaphragmatic position in stomach (overlying gastric bubble on CXR), 10cm beyond gastro-oesophageal junction
- abnormal = tip in oesophagus, bronchus/lung, coiled un upper airway, intracranial in case of skull fracture
Central venous catheters
- inserted via right or left internal jugular or subclavian veins but has to enter right side SVC
- 2nd intercostal space is normal place of tip
- abnormal = too high in proximal SVC
- ……..

30
Q

what might malpositioned endotracheal tube cause?

A

lung collapse

if too far into right bronchus, only right lung will be inflated

31
Q

nodule classification based on size?

A

miliary nodule = <2mm
pulmonary micronodule = 2-7mm
pulmonary nodule = 7-30mm
pulmonary mass = >30mm

32
Q

distribution of pulmonary nodules?

A

perilymphatic
centrilobular
random

33
Q

morphology of pulmonary nodules?

A

solid
partly solid
ground glass

34
Q

primary lung cancer tend to be where?

A

apical (where the smoke does)

metastases = lower (where most blood vessels are)

35
Q

cancer staging?

A

TNM

  • tumour size
  • nodes
  • metastases
36
Q

investigations in suspected lung cancer?

A 
contract enhanced CT
- asses size, mets and biopsy guidacne
FDG-PET CT
- nodal metastases
- distant mets
- delineating tumour
37
Q

what is pneumoperitoneum?

A

perforation of hollow organ results in gas in peritoneal cavity
gas rises up above the diaphragm
seen as a thin black line between diaphragma nd sub-diaphragmatic structures

38
Q

PE presentation?

A 
dyspnoea
pleuritic chest pain
cough 
orthopnoea
haemoptysis
signs of DVT in leg
39
Q

PE investigation?

A 
D dimers (can rule out but not confirm)
CTPA = gold standard as visualises the clot
40
Q

PE x ray features?

A

usually normal or show non-specific findings

only really used to look for alternative causes of symptoms

41
Q

CTPA features of PE?

A

clot can be visualised

42
Q

V/Q scan features of PE?

A

looks for defects caused by the clot

mis-matched perfusion defect

43
Q

how might the heart be affected by PE?

A

enlarged right side as it cant pump blood out against blockage in pulmonary artery
contrast/blood can back up into IVC etc

CLASP - Radiology (8 decks)

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