Chest X-Rays Flashcards
1
Q
When is AP better than PA?
A
Unstable patient (not able to stand) and in ICU
2
Q
More than 10 posterior ribs…
A
COPD
3
Q
Deviated trachea
A
Tension pneumothorax
4
Q
“Punched-out” lesions
A
Multiple myeloma
5
Q
Costophrenic/cardiophrenic angles blunted
A
Pleural Effusion
6
Q
Pneumoperitoneum is seen as
A
free gas under right diaphragm
7
Q
Flattened hemidiaphragm
A
hyperinflation - COPD
8
Q
Edge of the heart not clearly defined is a sign of…
A
Consolidation
9
Q
Consolidation in the middle of the Right heart border is in the…
A
Right Middle lobe
10
Q
Consolidation in the top of Left heart border is in the…
A
Left Upper Lobe
11
Q
Wide mediastinum (>8cm)…
A
Aortic dissection
12
Q
Surgical emphysema suggests…
A
Pneumomediastinum (ruptured oesophagus)
13
Q
Dark lung
A
Pneumothorax
14
Q
White lung
A
Pneumonia, oedema, effusion
15
Q
On what side is the gastric bubble?
A
Left (if associated with hiatus hernia, above the diaphragm)
16
Q
NG tube position
A
below the diaphragm
17
Q
Chest drain angle insertion
A
towards for effusion; up for pneumothorax
18
Q
50y, smoker, SOB, dry cough, wheeze
A
COPD
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
20
Q
Common cause of recurrent COPD exacerbation
A
H. Influenzae infection
21
Q
Gold-standard evaluation for COPD
A
Post-bronchodilator spirometry (reversibility test: negative): FEV1/FVC ratio low (<70%)
22
Q
20y, fever, chills, night sweats, haemoptysis, unintentional weight loss
A
Pulmonary TB
23
Q
Cause of Pulmonary TB
A
Mycobacterium tuberculosis (mainly)
24
Q
Pulmonary TB findings on CXR (given CXR)
A
bilateral hilar lymphadenopathy, rankl complex
25
Treatment of Pulmonary TB
RIPE (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for 2 months + RI for 4 months
26
TB medication that can cause reddish urine
Rifampicin
27
"Snow-storm" appearance
Milliary TB (bilateral micro-nodular interstitial pattern)
28
Milliary TB commonly occurs in...
Immunocompromised patients (HIV-AIDS, Leukaemia)
29
Milliary TB confirmation test
Bone marrow or CSF culture
30
Chronic and persistent productive cough + SOB + finger clubbing
Bronchiectasis
31
"Tram-track" appearance
Bronchiectasis
32
Bronchiectasis: 1st line investigation
CXR
33
Bronchiectasis: investigation of choice
HR-CT scan
34
"signet ring sign" on CT scan
Bronchiectasis
35
Chest drain inserted after a RTA, due to pneumothorax can lead to...
Subcutaneous surgical emphysema (conservative treatment)
36
Immunocompromised patient + fungus ball
Pulmonary abscess due to Aspergillosis
37
30y, autoimunne condition, persistent cough, SOB, tender red bumps on skin, granuloma development
Sarcoidosis (red bumps are erythema nodosum)
38
Sarcoidosis finding on CXR
bilateral hilar lymphadenopathy
39
Sarcoidosis treatment
conservative + regular CXR + long-term steroids
40
50y, female, SOB within 24h of a surgery for which was under GA
Post-operative Atelectasis ("pyramid" on CXR given - right lower lobe atelectasis; absent air bronchogram)
41
Atelectasis S/S
hypoxia, increased respiratory rate, low grade pyrexia
42
Causes of Atelectasis
Blocked airway (foreign body, mucus plug, tumour), Surgery, Pleural effusion, Pneumothorax
43
Atelectasis treatment
pain control + chest physiotherapy (deep breathing exercises) - if no improvement, bronchoscopy
44
Atelectasis treatment if pneumothorax or pleural effusion associated
drainage/surgical
45
15y, tall, thin, male, sudden onset of SOB
Spontaneous pneumothorax
46
Spontaneous pneumothorax: risk factors
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
Sudden SOB +/- pleuritic chest pain, slightly elevated JVP, hyper resonance on percussion, diminished/absent breath sound on the affected side
Spontaneous pneumothorax
48
Spontaneous pneumothorax: treatment
If large = surgical intervention (small = no treatment needed)
49
Management of Tension pneumothorax
Life-threatening emergency = ABCDE (A: Immediate needle decompression)
50
Explain the procedure of needle decompression for Tension pneumothorax
Use a large bore canulla (14/16G), identify 2nd ICS on the affected side, insert in the anterior midclavicular line
51
Complication of needle decompression and how to proceed
Simple pneumothorax -> immediately thereafter, proceed with a tube thoracostomy
52
CXR findings of Tension pneumothorax
ipsilateral increased ICS, flattened hemidiaphragm, tracheal deviation, displacement of mediastinal structures to contralateral side
53
Possible causes of Tension pneumothorax
Mechanical ventilation and simple pneumothorax with lung injury that fails to seal following penetration, blunt chest trauma, failed central venous cannulation
54
Horizontal fluid level + pneumothorax
Hydropneumothorax
55
Management of Hydropneumothorax
Insert a chest drain
56
Blunting of costophrenic angles with rising fluid levels along the chest wall (Meniscus sign)
Pleural Effusion
57
Confirmative diagnosis of Pleural Effusion
USS guided Thoracocentesis (Transudate/Exudate)
58
Transudate x Exudate
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
Transudates: causes and characteristics
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
Exudates: causes and characteristics
Exudates are usually unilateral and result from increased capillary permeability or decreased lymphatic resorption associated with infection, connective tissue disease, pancreatitis or cancer.
61
Air UNDER hemidiaphragm
Pneumoperitoneum = likely due to perforation of duodenal ulcer or abdominal viscus
62
"Rigler´s sign"
Double wall sign = Pneumoperitoneum
63
How to check the correct position of the NG tube?
CXR + measurement of NG aspirate pH using pH indicator paper (>5.5 is alkaline = RESPIRATORY = incorrect position)
64
Describe the correct position of the NG tube
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
Complete white out of one side, pulling the trachea to the abnormal side, contralateral hyperinflation
Pneumonectomy (usually due to primary lung cancer)
66
Boot-shaped heart
Tetralogy of Fallot (VSD, pulmonary stenosis, displaced aorta, RVH)
67
CXR findings of Tetralogy of Fallot
upturned cardiac apex (RVH), pulmonary artery segment concavity (pulmonary stenosis), over-riding aorta (pulmonary stenosis and VSD), oligemia (diminished lung markings)
68
Tetralogy of Fallot: S/S
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
Productive cough, fever, SOB, white area in the middle of the right lung on CXR
Right middle lobe Pneumonia (right lower zone opacification, air bronchograms, indistinct right heart border, horizontal fissure, clearly demarcated hemidiaphragm)
70
Gold standard investigation of Pneumonia
CXR
71
Triage score for Pneumonia (severity and management)
CURB-65 (Confusion, Urea >20mg/dL, RR >30, BP <90/60, >65y) - 1 pt each: 0-1 outpatient, 2 inpatient, >=3 ICU
72
Productive cough, fever, SOB, white area at the top of the left lung on CXR
Left upper lobe Pneumonia
73
Ankle swelling + SOB + huge heart on CXR
Cardiomegaly
74
Diffused enlarged heart ("money bag appearance")
Cardiomegaly likely due to pericardial effusion (double contour in the R heart border, splaying of the carina)
75
"Shmoo sign"
Left ventricular enlargement likely due to hypertension (L heart border is displaced leftward, inferiorly with rounding of the cardiac apex)
76
Acute breathlessness + SOB on lying flat (orthopnea) + SOB that awakens during sleep relieved in upright position (paroxysmal nocturnal dyspnea)
Congestive heart failure
77
Congestive heart failure findings on CXR
ABCDE: Alveolar oedema ("bat´s wings") + B lines (Kerley - interstitial oedema) + Cardiomegaly + Dilated prominent upper lobe vessels + Effusion (pleural)
78
Multiple large well-circumscribed round-shaped pulmonary lesions
Cannonball metastasis (CC = Cannonball - Carcinoma -> likely secondary to renal cell carcinoma or choriocarcinoma) // other causes: carcinoma (prostate, endometrial, adrenal), sarcoma (synovial)
79
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
Rickets disease
80
Intermitent inter-scapular pain, NO chest pain, underlying connective tissue disorder, "b-shaped image on the left hemithorax" on CXR
Thoracic Aortic Aneurism (TAA) - can be seen in patients with Marfan's Syndrome
81
Dextrocardia + gastric bubble on the right
Situs Inversus (check: location of the heart apex, aortic arch, stomach bubble and liver)
82
Situs Inversus + chronic sinusitis (ear/nose/throat symptoms) + bronchiectasis (recurrent chest infections) + infertility
Kartagener Syndrome (rare, autosomal recessive genetic cilliary disorder)
