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PRES 3 > Chest X-Rays > Flashcards

Chest X-Rays Flashcards

1
Q

When is AP better than PA?

A

Unstable patient (not able to stand) and in ICU

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2
Q

More than 10 posterior ribs…

A

COPD

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3
Q

Deviated trachea

A

Tension pneumothorax

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4
Q

“Punched-out” lesions

A

Multiple myeloma

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5
Q

Costophrenic/cardiophrenic angles blunted

A

Pleural Effusion

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6
Q

Pneumoperitoneum is seen as

A

free gas under right diaphragm

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7
Q

Flattened hemidiaphragm

A

hyperinflation - COPD

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8
Q

Edge of the heart not clearly defined is a sign of…

A

Consolidation

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9
Q

Consolidation in the middle of the Right heart border is in the…

A

Right Middle lobe

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10
Q

Consolidation in the top of Left heart border is in the…

A

Left Upper Lobe

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11
Q

Wide mediastinum (>8cm)…

A

Aortic dissection

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12
Q

Surgical emphysema suggests…

A

Pneumomediastinum (ruptured oesophagus)

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13
Q

Dark lung

A

Pneumothorax

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14
Q

White lung

A

Pneumonia, oedema, effusion

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15
Q

On what side is the gastric bubble?

A

Left (if associated with hiatus hernia, above the diaphragm)

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16
Q

NG tube position

A

below the diaphragm

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17
Q

Chest drain angle insertion

A

towards for effusion; up for pneumothorax

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18
Q

50y, smoker, SOB, dry cough, wheeze

A

COPD

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19
Q

COPD findings on CXR

A

DR.LC3: flattened Diaphragm, widely spaced Ribs, hyper-inflated Lungs, thinning of the Cardiac shadow, blunting of Costophrenic angles, barrel shaped Chest

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20
Q

Common cause of recurrent COPD exacerbation

A

H. Influenzae infection

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21
Q

Gold-standard evaluation for COPD

A

Post-bronchodilator spirometry (reversibility test: negative): FEV1/FVC ratio low (<70%)

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22
Q

20y, fever, chills, night sweats, haemoptysis, unintentional weight loss

A

Pulmonary TB

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23
Q

Cause of Pulmonary TB

A

Mycobacterium tuberculosis (mainly)

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24
Q

Pulmonary TB findings on CXR (given CXR)

A

bilateral hilar lymphadenopathy, rankl complex

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25
Q

Treatment of Pulmonary TB

A

RIPE (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for 2 months + RI for 4 months

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26
Q

TB medication that can cause reddish urine

A

Rifampicin

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27
Q

“Snow-storm” appearance

A

Milliary TB (bilateral micro-nodular interstitial pattern)

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28
Q

Milliary TB commonly occurs in…

A

Immunocompromised patients (HIV-AIDS, Leukaemia)

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29
Q

Milliary TB confirmation test

A

Bone marrow or CSF culture

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30
Q

Chronic and persistent productive cough + SOB + finger clubbing

A

Bronchiectasis

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31
Q

“Tram-track” appearance

A

Bronchiectasis

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32
Q

Bronchiectasis: 1st line investigation

A

CXR

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33
Q

Bronchiectasis: investigation of choice

A

HR-CT scan

34
Q

“signet ring sign” on CT scan

A

Bronchiectasis

35
Q

Chest drain inserted after a RTA, due to pneumothorax can lead to…

A

Subcutaneous surgical emphysema (conservative treatment)

36
Q

Immunocompromised patient + fungus ball

A

Pulmonary abscess due to Aspergillosis

37
Q

30y, autoimunne condition, persistent cough, SOB, tender red bumps on skin, granuloma development

A

Sarcoidosis (red bumps are erythema nodosum)

38
Q

Sarcoidosis finding on CXR

A

bilateral hilar lymphadenopathy

39
Q

Sarcoidosis treatment

A

conservative + regular CXR + long-term steroids

40
Q

50y, female, SOB within 24h of a surgery for which was under GA

A

Post-operative Atelectasis (“pyramid” on CXR given - right lower lobe atelectasis; absent air bronchogram)

41
Q

Atelectasis S/S

A

hypoxia, increased respiratory rate, low grade pyrexia

42
Q

Causes of Atelectasis

A

Blocked airway (foreign body, mucus plug, tumour), Surgery, Pleural effusion, Pneumothorax

43
Q

Atelectasis treatment

A

pain control + chest physiotherapy (deep breathing exercises) - if no improvement, bronchoscopy

44
Q

Atelectasis treatment if pneumothorax or pleural effusion associated

A

drainage/surgical

45
Q

15y, tall, thin, male, sudden onset of SOB

A

Spontaneous pneumothorax

46
Q

Spontaneous pneumothorax: risk factors

A

Male, young, Marfan’s Syndrome, smoking, scuba-diving, high altitudes, flying (if older than 40y should be the secondary type, with underlying disease such as COPD/Asthma)

47
Q

Sudden SOB +/- pleuritic chest pain, slightly elevated JVP, hyper resonance on percussion, diminished/absent breath sound on the affected side

A

Spontaneous pneumothorax

48
Q

Spontaneous pneumothorax: treatment

A

If large = surgical intervention (small = no treatment needed)

49
Q

Management of Tension pneumothorax

A

Life-threatening emergency = ABCDE (A: Immediate needle decompression)

50
Q

Explain the procedure of needle decompression for Tension pneumothorax

A

Use a large bore canulla (14/16G), identify 2nd ICS on the affected side, insert in the anterior midclavicular line

51
Q

Complication of needle decompression and how to proceed

A

Simple pneumothorax -> immediately thereafter, proceed with a tube thoracostomy

52
Q

CXR findings of Tension pneumothorax

A

ipsilateral increased ICS, flattened hemidiaphragm, tracheal deviation, displacement of mediastinal structures to contralateral side

53
Q

Possible causes of Tension pneumothorax

A

Mechanical ventilation and simple pneumothorax with lung injury that fails to seal following penetration, blunt chest trauma, failed central venous cannulation

54
Q

Horizontal fluid level + pneumothorax

A

Hydropneumothorax

55
Q

Management of Hydropneumothorax

A

Insert a chest drain

56
Q

Blunting of costophrenic angles with rising fluid levels along the chest wall (Meniscus sign)

A

Pleural Effusion

57
Q

Confirmative diagnosis of Pleural Effusion

A

USS guided Thoracocentesis (Transudate/Exudate)

58
Q

Transudate x Exudate

A

Several laboratory tests are helpful in distinguishing transudates from exudates including pH, total protein, lactate dehydrogenase (LD), amylase, glucose, white cell count and differential. Only one of these values has to fall into the exudate range for the effusion to be classified as an exudate. To distinguish exudates from transudates if the patient’s serum total protein is normal and the pleural fluid protein is less than 25g/L the fluid is a transudate. If the pleural fluid protein is greater than 35g/L the fluid is an exudate.

59
Q

Transudates: causes and characteristics

A

Transudates are usually bilateral and arise from either increased capillary hydrostatic pressure or decreased oncotic pressure secondary to congestive heart failure, fluid overload, cirrhosis or hypoalbuminemia.

60
Q

Exudates: causes and characteristics

A

Exudates are usually unilateral and result from increased capillary permeability or decreased lymphatic resorption associated with infection, connective tissue disease, pancreatitis or cancer.

61
Q

Air UNDER hemidiaphragm

A

Pneumoperitoneum = likely due to perforation of duodenal ulcer or abdominal viscus

62
Q

“Rigler´s sign”

A

Double wall sign = Pneumoperitoneum

63
Q

How to check the correct position of the NG tube?

A

CXR + measurement of NG aspirate pH using pH indicator paper (>5.5 is alkaline = RESPIRATORY = incorrect position)

64
Q

Describe the correct position of the NG tube

A

The chest X-ray viewing field should include the upper oesophagus and extend to below the diaphragm: the NG tube should remain in the midline down to the level of the diaphragm, bisect the carina and the tip of the NG tube should be clearly visible and below the left hemidiaphragm (approximately 10 cm beyond the gastro-oesophageal junction and therefore is likely to be within the stomach)

65
Q

Complete white out of one side, pulling the trachea to the abnormal side, contralateral hyperinflation

A

Pneumonectomy (usually due to primary lung cancer)

66
Q

Boot-shaped heart

A

Tetralogy of Fallot (VSD, pulmonary stenosis, displaced aorta, RVH)

67
Q

CXR findings of Tetralogy of Fallot

A

upturned cardiac apex (RVH), pulmonary artery segment concavity (pulmonary stenosis), over-riding aorta (pulmonary stenosis and VSD), oligemia (diminished lung markings)

68
Q

Tetralogy of Fallot: S/S

A

cyanosis; SOB and rapid breathing, especially during feeding or exercise; Loss of consciousness (fainting); Clubbing of fingers and toes; Poor weight gain; Tiring easily during play or exercise; Irritability; Prolonged crying; A heart murmur

69
Q

Productive cough, fever, SOB, white area in the middle of the right lung on CXR

A

Right middle lobe Pneumonia (right lower zone opacification, air bronchograms, indistinct right heart border, horizontal fissure, clearly demarcated hemidiaphragm)

70
Q

Gold standard investigation of Pneumonia

A

CXR

71
Q

Triage score for Pneumonia (severity and management)

A

CURB-65 (Confusion, Urea >20mg/dL, RR >30, BP <90/60, >65y) - 1 pt each: 0-1 outpatient, 2 inpatient, >=3 ICU

72
Q

Productive cough, fever, SOB, white area at the top of the left lung on CXR

A

Left upper lobe Pneumonia

73
Q

Ankle swelling + SOB + huge heart on CXR

A

Cardiomegaly

74
Q

Diffused enlarged heart (“money bag appearance”)

A

Cardiomegaly likely due to pericardial effusion (double contour in the R heart border, splaying of the carina)

75
Q

“Shmoo sign”

A

Left ventricular enlargement likely due to hypertension (L heart border is displaced leftward, inferiorly with rounding of the cardiac apex)

76
Q

Acute breathlessness + SOB on lying flat (orthopnea) + SOB that awakens during sleep relieved in upright position (paroxysmal nocturnal dyspnea)

A

Congestive heart failure

77
Q

Congestive heart failure findings on CXR

A

ABCDE: Alveolar oedema (“bat´s wings”) + B lines (Kerley - interstitial oedema) + Cardiomegaly + Dilated prominent upper lobe vessels + Effusion (pleural)

78
Q

Multiple large well-circumscribed round-shaped pulmonary lesions

A

Cannonball metastasis (CC = Cannonball - Carcinoma -> likely secondary to renal cell carcinoma or choriocarcinoma) // other causes: carcinoma (prostate, endometrial, adrenal), sarcoma (synovial)

79
Q

Incidental finding on CXR of a 8month-old with flaring/widening of the ribs at the costochondral junction, fraying and cupping of the proximal humeral metaphysis bilaterally

A

Rickets disease

80
Q

Intermitent inter-scapular pain, NO chest pain, underlying connective tissue disorder, “b-shaped image on the left hemithorax” on CXR

A

Thoracic Aortic Aneurism (TAA) - can be seen in patients with Marfan’s Syndrome

81
Q

Dextrocardia + gastric bubble on the right

A

Situs Inversus (check: location of the heart apex, aortic arch, stomach bubble and liver)

82
Q

Situs Inversus + chronic sinusitis (ear/nose/throat symptoms) + bronchiectasis (recurrent chest infections) + infertility

A

Kartagener Syndrome (rare, autosomal recessive genetic cilliary disorder)

PRES 3 (12 decks)

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