Chest Pathology

Question 1

how do you work out the cardiothoracic ratio and what should it be

Answer 1

width of the heart/width of the thoracic cavity

< 50%

Question 2

Name the lobes of the right lung and the fissures

Answer 2

RUL
RML 
RLL 
minor fissure between RML & RUL
major fissure separating from other lobes

Question 3

Name the lobes of the left lung and the fissures

Answer 3

LUL
LLL
major fissure separating the two

Question 4

Aetiology (causes) of Cardiomegaly

Answer 4

Valve Disease - MVD/AVD/TVD
Hypertension
cardiomyopathy 
CAD
myocarditis
trauma/surgery

Question 5

what are the 2 types of heart valve disease

Answer 5

aortic or mitral

Question 6

what can valves be?

Answer 6

stenosed (narrowed) or incompetent (regurgitation)

Question 7

what happens in heart valve disease?

Answer 7

increase in pulmonary and right heart pressures leading to a pulmonary oedema

Question 8

what are the radiographic appearances for mitral’s valve disease? - 4 points

Answer 8

‘moghuls’
aortic knuckle
left pulmonary artery
left atrium

Question 9

what is the equation to identify hypertension

Answer 9

BP = HR + SVR

Blood Pressure = Heart Rate + Systemic Vascular Resistance

Question 10

what are the contributing factors for hypertension? - 8 points

Answer 10

Family History 
Smoking
Obesity
Diabetes
Kidney Diseases
High alcohol intake
Lack of exercise
Certain medicines (steriods)

Question 11

what can hypertension lead to ?

Answer 11

heart failure

Question 12

what would happen if the right half of the heart failed (right ventricular failure)?

Answer 12

general body vein pressure would increase and fluid would accumulate in the body, especially in tissues of the legs and abdominal organs (liver most likely to be affected)

Question 13

what would happen if the left half of the heart failed?

Answer 13

it would cause failure of the right ventricle causing biventricular failure

Question 14

name and describe the 3 types of cardiomyopathy?

Answer 14

dilated - enlarged heart with dilation of all 4 chambers
hypertrophic - assymetrical hypertrophy (enlargement) of the ventricular septum (HOCM)
restrictive - loss of ventricular compliance. Can have normal heart size, but ventricular cavities markedly obliterated by extensive endocardial thickening

Question 15

what are 4 common things resulting from hypertension cardiomyopathy

Answer 15

angina pectoris (chest pain)
syncope (fainting)
cardiac failure
sudden death

Question 16

what is Coronary Heart Disease and what can it result in

Answer 16

atherosclerosis

can lead to a Myocardial Infarction and injury and irreversible damage to the myocardium

Question 17

what is myocarditis?

what may causes the inflammation?

Answer 17

inflammation of the heart muscle

a viral or bacterial infection, rheumatic fever, or a toxic reaction to a drug

Question 18

what can myocarditis do? - 3 points

Answer 18

cause damage to the heart muscle
affect the heart’s pumping action
a degree of heart failure

Question 19

what is cardiac tamponade?

Answer 19

compression of the heart by an accumulation of fluid in the pericardial sac

Question 20

what is left ventricular failure called?

what is right ventricular failure called?

what is biventricular failure called?

Answer 20

pulmonary oedema - fluid will build up in the lungs due to congestion of the veins of the lungs
limb and abdominal oedema - general body vein pressure will increase and fluid will accumulate in the body, especially the tissues of the legs and abdominal organs (of these, the liver is the organ most likely to be affected).
congestive cardiac failure (CCF)

Question 21

what are the signs and symptoms of LVF?

Answer 21

Orthopnea
Dyspnea/Tachypnea
Restlessness/insomnia
Cynosis
Cough
Tachycardia
Fatigue
Weakness
Anorexia
Diaphoresis

Question 22

what are the signs and symptoms of RVF?

Answer 22

Weight gain
Ascites
Abdominal Distention
Oedema
Dilated peripheral veins
G.I. distress – nausea, vomiting, jaundice
Hepato/splenomegaly
Fatigue
Weakness
Anorexia
Diaphoresis
Smelly, Profund Sweat

Question 23

what is the treatment for heart failure?

what is the treatment for acute heart failure?

After patients are administered diuretics what must be done?

Answer 23

bed rest
diuretics such as Frusemide
medications such as Digoxin - increases the heart’s effectiveness at pumping blood

treatment is commenced with diuretics and drugs called nitrates that reduce the strain of the heart.

Patients’ fluid input and output is monitored regularly to make sure that the patient is not becoming dehydrated

Question 24

What is Acute Respiratory Distress Syndrome (ARDS)? - 2 points
who is usually affected?

Answer 24

‘shock lung’
sudden damage to alveoli - oedematous changes
Usually acutely ill patients – trauma, post surgery, infection

Question 25

what are the 4 types of lung cancer

Answer 25

small cell
non-small cell (NSCLC)
Mesothelioma
Metasases

Question 26

what are the 4 types of NSCLC

Answer 26

squamous cell
adenocarcinoma
large cell
bronchoalveolar cell carcinoma

Question 27

give 4 components of SCLC

Answer 27

strongly associated with smoking
v aggressive
metastises v early
central tumour = main bronchus

Question 28

NSCLC - prognosis and treatment

when is surgery best chance of cure?
what do patients who don’t have surgery undergo?

Answer 28

varies depending on stage

stages 1 or 2 - 20-25% of patients
radiotherapy / chemotherapy

Question 29

what are the survival rates for NSCLC at stage 1a and stage 4

Answer 29

stage 1a - 82% 5 yr survival

stage 4 - 10% 1 yr survival

Question 30

what is mesothelioma

Answer 30

a rare form of cancer, is a disease in which malignant cells are found in the pleura, or peritoneum

Question 31

what is reported in 70-80% of all cases of mesothelioma

Answer 31

a history of asbestos exposure

Question 32

where are areas frequented by metastases

how does it present

Answer 32

Breast
Testicular 
Colon
Sarcoma
Bladder
Prostate

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