Chest X-rays Flashcards

1
Q

where is the left lingula?

A
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2
Q

which ribs do the lungs & pleura go down to

  • on the mid clavicular line?
  • on the mid axillary line?
A
  • *lungs:**
  • mid clavicular line: 6th rib
  • mid axillary line: 8th rib
  • *pleura:**
  • mid clavicular line: 8th rib
  • mid axillary line: 10th rib
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3
Q

where are the costophrenic and cardio-phrenic angles?

A
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4
Q

what is the neuronal control of breathing from?

A

central respiratory control: brainstem - pons & medulla

communicated to the thorax via the phrenic nerve (visceral c3-5) & intercostal nerves

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5
Q

what do dense substances appear as on the x-ray?

A

white :)

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6
Q

what is this?

A

costophrenic angle

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7
Q

what is this ?

A

cardio-phrenic angle

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8
Q

label this bestie xox

A
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9
Q

how you approach a chest x-ray? (explain 1 & 2)

A
  • *1. Patient details: (normally in top corners)**
  • name
  • age / dob
  • image type
  • date
  • previous imaging (for comparison)
  • *RIPE**
  • Rotation: the medial aspect of each clavicle should be equidistant from spinous process
  • Inspiration: (patient should take deep breath in, you see:) 5-6 anterior ribs (or 8-10 posterior ribs), costo-phrenic angles and lateral rib edges should be present
  • *- Projection:** AP or PA (standard)
  • Exposure: (of the film). left hemi-diaphragm should be visible to the spine and verterbrae behind the heart

then,

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10
Q

how do u approach an x-ray? (overview)

A
  • *1. Patient details: (normally in top corners)**
  • name
  • age / dob
  • image type
  • date
  • previous imaging (for comparison)
  • *RIPE**
  • Rotation
  • Inspiration
  • Projection
  • Exposure
  • *ABCDE:
    i) AIRWAY**
  • Trachea
  • Carina
  • Bronchi
  • Hilar Structures
  • *ii) BREATHING**
  • Lung fields
  • Pleural Space
  • *iii) Circulation**
  • Heart Size
  • Heart Borders
  • Mediastinum
  • *iv) Diaphragm**
  • Curvature
  • Elevation
  • Beneath diaphragm
  • *v) Everythng else**
  • Bones
  • Soft tissue
  • Other objects
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11
Q

what are the main things that could cause airways to not be correct? (4)

A
  • non-central trachea
  • airway obstructions
  • foreign bodies
  • englargement of hilar regions
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12
Q

how do you tell if an x-ray is PA or AP?

who is more likely to have an PA or AP x-ray?

A
  • *PA**
  • The standard / default
  • Patient must be able to stand
  • Can comment on cardiac size
  • *AP**
  • The ill / recumbent patient
  • Scapulae in lung field
  • anterior ribs more prominant
  • Can’t comment on cardiac size
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13
Q

whats wrong here?

A
  • tracheal deviation (to right)
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14
Q

whats up here?

A

hilum enlarged

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15
Q

what would you look for ABCDE BREATHING?
what look for that could go wrong? (3)

A

ii) BREATHING
- Lung fields
- Pleural Space

  • *look for:
  • opacification / whitening of lungs: infection :(
  • collapse of lung
  • air of fluid in pleural space**
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16
Q

whats wrong here?

A

whitening of the lung - in the right middle zone of the lung

17
Q

whats wrong here?

how can you tell?

A

pneumothorax

  • A pneumothorax is, when looked for, usually easily appreciated on erect chest radiographs. Typically they demonstrate:*
    • visible visceral pleural edge is seen as a very thin, sharp white line*
    • no lung markings are seen peripheral to this line*
    • peripheral space is radiolucent compared to the adjacent lung*
    • lung may completely collapse*
    • mediastinum should not shift away from the pneumothorax unless a tension pneumothorax is present (discussed separately)*
18
Q
  • which areas do you look for with ABCDE CIRCULATION? (3)
  • what things do you loo
A

ABCDE CIRCULATION:

  • Heart size (width of the heart should be less than half the size of width of thorax)
  • *- Heart borders
  • Mediastinum**

Look for:

  • Englarged heart - PA view only
  • Loss of heart borders
19
Q

what is a cardiomegaly?

A
  • *normal**: width of the heart should be less than half the size of width of thorax
  • *cardiomegaly:** width of the heart is more than half the size of width of thorax on PA film
20
Q

whats wrong here?

A

loss of heart border !

21
Q

what do you look for in ABCDE Diaphragm? (5)

things that might be wrong? (3)

A
  • *Look for:**
  • Curvature
  • Elevation
  • Beneath diaphragm
  • Costophrenic and cardiophrenic angles
  • *Wrong:**
  • Blunted costophrenic and cardiophrenic angles
  • Flattened diaphragm
  • Sub-diaphragmatic air / gas (dont want !! )
22
Q

whats wrong here?

A

blunted cardiophrenic and costophrenic angles

23
Q

what do u look for ABCDE Everything else? (3)

what can go wrong?

A

v) Everythng else
- Bones
- Soft tissue
​- Other objects

  • *Wrong:**
  • fractures
  • discolations
  • pacemakers
  • inserted lines
24
Q

whats this?

A

cardiopacemaker

24
Q

whats wrong here?

A

air under the right diaphragm

25
Q

what is dextrocardia?

A

condition in which the heart is pointed toward the right side of the chest.

26
Q

whats up here? (2)

A
  • trachea is non-central
  • left lung is completely white (due to fluid build up)
27
Q

whats up here xo

A

inhaled foreign bodies (dentures)