Chest xray

Question 1

Give a systematic approach to interpreting a CXR

Answer 1

1. Name, DOB, CHI, date of CXR
2. Technically adequate? projection, inspiration, rotation, penetration
3. Cardiothoracic ratio
4. Contours
5. Lung zones and lobes
6. Bones
7. Diaphragm
8. Lines and tubes
9. Pleura

Question 2

How does the heart appear in an AP projection

Answer 2

Larger than it actually is

Question 3

Which projection is better, AP or PA?

Answer 3

PA

Question 4

What is a normal cardiothoracic ratio?

Answer 4

1:2

Question 5

What contours should you look for

Answer 5

trachea, aortic knuckle, LV, RA, hemidiaphragms, stomach bubble

Question 6

Which is higher, the left or right pulmonary hilum

Answer 6

Left is higher

Question 7

What causes lobar collapse/atelectasis

Answer 7

bronchial obstruction e.g. tumour

poor ventilation of the lung causes it to collapse and deflate like a balloon

Question 8

What is a typical feature of lobar collapse

Answer 8

Loss of lung volume on affected side
hyperdensity
fissure has been pulled out of place

Question 9

What is consolidation and how does it differ from atelectasis

Answer 9

When the alveoli are filled with dense material such as inflammatory fluid, blood, pus
it not a ventilatory problem like atelectasis

Question 10

What is a characteristic sign of consolidation

Answer 10

Air bronchogram - black lines indicating larger airways are spared of consolidation

Question 11

What features are characteristic of pleural effusion

Answer 11

costophrenic blunting
meniscus sign
fluid goes to the area of most dependence ie bottom of thorax

Question 12

What are findings of a pneumothorax

Answer 12

black spaces with ABSENT lung markings

air moves to areas of least dependence ie apices

Question 13

Signs of heart failure

ABCDE

Answer 13

Alveolar oedema - batwings sign 
B - Kerley B lines (septal lines)
Cardiomegaly 
Dilatation of upper lobe vessels 
E - pleural effusion

Question 14

At what level is the carina found

Answer 14

T5-7

Question 15

Where should an ET tube be found

Answer 15

5cm above the carina

Question 16

What is the correct placement of NG tube

Answer 16

passes the carina and descends in the midline
should be subdiaphragmatic
the tip should be visualised and be seen at least 10cm, away from the GOJ

Question 17

What are the consequences of a misplaced NG tube

Answer 17

aspiration pneumonia if misplaced in the lung tissue

Question 18

What are CVC and where should they be placed

Answer 18

Central venous catheters detect central venous pressure

should be found on right 2nd intercostal space

Question 19

What does PICC stand for

Answer 19

Peripherally inserted central catheter

Question 20

What size is a miliary nodule

Answer 20

<2mm

Question 21

Size of pulmonary micronodule

Answer 21

2-7mm

Question 22

Size of pulmonary nodule

Answer 22

7-30mm

Question 23

Size of pulmonary mass

Answer 23

> 3cm/30mm

Question 24

common locations for lung tumour to metastasise to

Answer 24

more lung, brain, liver, adrenal glands, bone

Question 25

What is different about liver metastases on contrast enhanced scans

Answer 25

They appear hypoattenuated because they generate their own blood supply

Question 26

What imaging is needed for suspected pneumoperitoneum

Answer 26

Erect CXR

Supine AXR

Question 27

on a CXR, what is the difference between pulmonary collapse and consolidation

Answer 27

collapse - loss of volume, hyperdense, fissure out of place

consolidation - hyperdense, preserved lung volume, air bronchograms

Question 28

why do you see air bronchograms in lung consolidation

Answer 28

bronchi are filled with air

lung tissue is filled with consolidation and inflammation