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Diagnostic methods > Chest Radiography for the PA student > Flashcards

Chest Radiography for the PA student Flashcards

1
Q

what are the 6 CXR basics?

A

1 AP/PA
2 upright, erect, supine
3 rotation
4 inspiration/expiration
5 penetration
6 landmarks present

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2
Q

what are the RIPs of CXRs? (first three things to assess)

A

rotation
inspiration
penetration

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3
Q

how can you tell if a CXR is rotated?

A

clavicles should be equal distant from midline

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4
Q

what is full inspiration for a CXR?

A

can count 10 ribs or greater

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5
Q

How far away is a standard PA view?

A

6 ft away

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6
Q

what does correct penetration look like?

A

can barely see vertebral discs though heart

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7
Q

Over pentration causes you to?

A

under-interpret-too dark (and clear visibility of vertebrae)

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8
Q

Under penetration causes you to ?

A

over interpret -too light

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9
Q

what constitutes a diagnostic xray?

A
  • at least 2 views with one at least 90 degrees to the other
    • PA and lateral
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10
Q

what are the 8 steps of systematic approach to examining a CXR?

A
  • *1. RIP
    2. extra thoracic structures**
  • Ryan’s P D heart hangs low*
    3. ribs
    4. pleura
    5. diaphragms (Rt and Lt)
    6. heart
    7. hila
    8. lung parenchyma
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11
Q

which extra thoracic structures are important to note when examining a CXR?

A
  • sternum
  • ribs
  • spine→ foramina, vertebral bodies, intervertebral spaces
  • diaphragm
  • heart
  • supracardiac space
  • infracardiac space
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12
Q

what are 2 ways to determine orientation of a patient in a CXR?

A
  • gastric bubble → air rises in standing patient
  • beads→ bead at Bottom of bubble is patient is standing
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13
Q

where is the position of the heart in infants and younger children?

A

more central than older children and adults (more on the left side in older infants and above)

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14
Q

which view should be taken for a CXR intending to demonstrate the margins of the heart, ( what view shows how big the heart really is)?/why?

A

PA for least magnification from back to front where heart is

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15
Q

What is the normal cardiac diameter in males vs females?

A
  • Males
    • Less than 15.5cm
  • Females
    • Less than 14.5 cm
  • A change in diameter greater than 1.5cm is significant
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16
Q

Describe the cardio-thoracic ratio?

A

determines if the heart is enlarged

17
Q

Heart greater than x% of chest is considered an abnormal heart in adults?

This could be due to?

A

• Heart >50% of chest is
considered abnormal in an
adult.

• Possible causes of a ratio
greater than 50% include:
- cardiac failure
- pericardial effusion
- left or right ventricular
hypertrophy

18
Q

What soft tissue shadow do you most commonly see in a female chest x-ray?

A

breast tissue

19
Q

On an clavicle placement should be? if not it means it could be?

A

Clavicle placement should be at 2-3 intercostal space (if not, may be rotated)

20
Q

which 2 sharp diaphragmatic angles should you see?

A

costophrenic & costocardiac

21
Q

What should the diaphragm look like on a normal chest x-ray?

A
  • Rounded with sharp pointed costophrenic and costocardiac angles
    • menisus sign-blunted
  • right diaphragm is usually 1-2 cm higher because of liver
22
Q

The trachaea in a noral x-ray should be ?

A

trachea should be midline over the thoracic vertebrae and air filled

23
Q

The lung parenchyma in a normal xray should be ? If not then it may indicate?

A

Lung parenchyma becomes lighter as you go down the lung. If not, it may indicate a lower lobe ?or pleural effusion

24
Q

what is radiopacity and radiolucency?

A

radiopacity: whiteness (↑ density)
radiolucency: blackness (↓ density)

25
Q

what is infiltrate vs effusion?

A

collection of something (usually fluid in a space)

infiltrate: collection of something within tissue or space (usually lung parynchyma)
effusion: collection of fluid outside a tissue or within a potential space (outside lung tissue)

26
Q

What lung lobe is most posterior?

How many lobes does R & L lung have?

What lung has the lingula? Is it posterior or anterior?

A
  • Left lower lobe is most posterior
  • Right lung=3 lobes so left has 2
  • left lung has lingula (located anteriorly)
27
Q

what is mass vs lesion?

A

mass: well marginated solid that doesn’t belong there
lesion: poorly marginated, doesn’t belong

28
Q

what are the three patterns of radiopacity for infiltrates?

A
  • alveolar: fluffy, soft, poorly differentiated
  • interstitial: lacey branching lines toward periphery
  • vascular: pulmonary arteries ↓ or ↑ in size
29
Q

What are the possible causes of …

  1. Alveolar pattern?
  2. Interstitial pattern?
  3. Vascular pattern?
A
  1. Pulmonary edema
  2. Interstitial pneumonitis
    1. Pulmonary hypertension -if there is an increase in size of the pulmonary arteries as the extend out into lung
    2. Embolus-if there is a decrease in size, truncation, or obilteration of a pulmonary artery
    3. Pneumonthorax-Lack of vascular marking in periphery
30
Q

alveolar pattern chest xray

A

clouds (bilateral diffuse batwing alveolar infiltrates with air bronchograms)

31
Q

Vascular pattern

A

see vessels more at base rather then apex due to gravity

32
Q
  1. what is lobar consolidation?
  2. what would you look for in chest x-ray radiologically?
  3. What lung infection can cause lobar consolidation?
A
  1. alveolar space filled with inflammatory exudate
  2. -Lingular infiltrate that is obscuring heart border, density to corresponding to segment or lobe, air bronchogram, no significant loss of lung volume
  3. Pneumonia
33
Q

what is obstructive atelectasis?

A

no ventilation to the lobe beyond obstruction → causes corresponding lung segment to deflate

34
Q

what are the 3 signs of atelectasis on xray?

A
  1. ) density of one shrunken lobe
  2. ) loss of volume
  3. ) compensatory hyperinflation of unaffected lung
35
Q

what happens to the air distal to the blockage in atelectasis?

A

absorbed by pulmonary circulation

36
Q

what are 2 features of CHF in CXR?

A
  • *1.) ↑ heart size (cardiomegaly)**
    2. ) large hila with indistinct markings
    3. ) fluid in interlobar fissures
  • *4.) pleural effusions, alveolar (bat wings) & interstitial edema (Kerley B lines)**
    5. ) dilated prominent upper lobe vessels
37
Q

what does a tension pneumothoraxic look like?

A
  • one lung condensed with just air around it
  • tracheal deviation
  • air in the pleural cavity caused by a puncture of the lung or chest wall
38
Q

what does the polkadot sign in xray represent?

A

metastatic lung cancer

Diagnostic methods (11 decks)

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