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YEAR 3 OSCE > CHEST XRAYS > Flashcards

CHEST XRAYS Flashcards

1
Q

what is the approach to CXrays? (6)

A
  1. projection
  2. patient details
  3. technical quality - RIP
  4. obvious abnormalities
  5. Systemic review of the film - ABCDE approach
  6. summary
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2
Q

What is the standard projection?

A

PA

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3
Q

When is an AP projection film carried out?

A

sick patients

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4
Q

How do you know if a film is in PA? (2)

A
  1. arms are raised up

2. scapulae are pulled out almost fully out of lung fields

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5
Q

How can you tell if a film is in AP? (2)

A
  1. humerus is down

2. scapulae in lung fields

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6
Q

How do you check technical quality of the film? (3)

A
  1. look for lung apices
  2. look for lateral sides of the ribcage
  3. look for both costophrenic angles on the film
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7
Q

In assessing technical quality of the film what do you look for in Rotation?

A
  1. the heads/medial ends of the clavicles are equidistant from the spinous processes of the vertebral bodies
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8
Q

In assessing technical quality of the film what do you look for in Inspiration? (2)

A
  1. PA films are held on deep inspiration

2. Count ribs - 6 anterior ribs and 10 posterior ribs

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9
Q

In assessing technical quality of the film what do you look for in Penetration?

A
  1. you can the vertebral bodies behind the heart
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10
Q

What do you look for in obvious abnormalities and how do you describe them? (5)

A
  1. which lung
  2. which zone
  3. size
  4. shape
  5. density/texture
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11
Q

What do you look for in airways?

A
  1. tracheal deviation
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12
Q

What do you look for in breathing? (3)

A
  1. start at apices down to costophrenic angles
  2. inspect apices, hila, mediastinum and costophrenic angles
  3. edge of lung fields - pneumothoraces
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13
Q

In breathing - when you are looking at the hila which hila should be higher and when is this an exception, and what densities should they be in comparison to each other?

A
  1. left hilum should NOT be lower than the right
  2. exception - dextrocardia
  3. both same density
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14
Q

What do you loo for in circulation/cardio?

A
  1. cardiomegaly
  2. heart borders
  3. cardiophrenic angles
  4. behind the heart
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15
Q

How do you know if there is cardiomegaly?

A

the heart shadow is more than half the width of the chest cavity on PA film

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16
Q

What do you look for in regards to the heart borders? (3)

A
  1. if the left or right heart borders are not clearly visible
  2. consolidation
  3. collapse
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17
Q

What do you look for behind the heart?

A
  1. any lung masses
18
Q

What you do you look for in diaphragm? (4)

A
  1. both hemi-diaphragms are visible and NOT flattened
  2. costophrenic angles
  3. right hemi-diaphragms
  4. air under the diaphragm
    - left = gastric bubble
19
Q

What do you look for in the costrophrenic angles? (2)

A
  1. whether they are clearly demarcated

2. do they have fluid?

20
Q

Which hemi-diaphragm should be higher and why?

A
  1. right - due to liver
21
Q

What do you look for in exposure? (1 (3))

A
  1. bones
  • fractures
  • rib space narrowing = COLLAPSE
  • gas in soft tissues = black areas = SURGICAL EMPHYSEMA
22
Q

What do you say in a summary?

A
  1. summarise

2. provisional diagnosis and differentials

23
Q

What to look for in review? (8)

A
  1. apices
  2. hila
  3. behind the heart
  4. costophrenic angles

5, around pleura

  1. edge of lung fields - pnemothoraces
  2. pleural thickening
  3. under diaphraghm
24
Q

What is seen in a pneumonia? (4)

A
  1. dense or patchy consolidation - usually unilateral
  2. air bronchograms
  3. lower zones - may be difficult to distinguish from effusions
  4. need to know which lobes touch which heart and diaphragmatic borders - tells you which lobe is affected
25
Q

Which lung lobes touch the diaphragm?

A
  1. left and right lower lobes
26
Q

Which lung lobe touches the right heart border?

A
  1. right middle lobe
27
Q

Which lung lobe touches the left heart border?

A
  1. lingula
28
Q

what should you refer to the lobes as?

A

zones

29
Q

What is seen in a pleural effusion?

A
  1. loss of costophrenic angles
  2. homogenous opacification
  3. fluid level - meniscus
30
Q

Are transudate effusions bilateral or unilateral?

A
  1. more likely to be bilateral
31
Q

Are exudate effusions likely to bilateral or unilateral?

A
  1. unilateral
32
Q

What criteria is used to assess pleural effusion fluid?

A
  1. light’s criteria
33
Q

How do you assess heart failure? (5)

A
  1. A - alveolar (interstitial) shadowing
  2. B - Kerley B lines
  3. C - cardiomegaly
    - cardiothoracic ratio is greater than 50% on PA film
  4. D - prominent upper lobe vasculature
    - due to upper lobe blood diversion
  5. E - effusions and fluid in horizonatl fissures
34
Q

What are Kerley B lines?

A
  1. little white horizontal lines in the lateral lower edges
35
Q

What would be seen in pneumothorax? (3)

A
  1. loss of lung markings in the peripheral lung field
  2. a discrete lung edge
  3. tracheal deviation in tension pneumothorax
36
Q

how would you identify a lobar collapse?

A
  1. loss of volume
  2. narrowing of the space between ribs compared to the other side
  3. look for tracheal and mediastinal drift
37
Q

What is veil sign in lobar collapse? (2)

A
  • happens in the left upper lobe

- whole lung field looks like it is covered by a veil

38
Q

What is the sail sign in lobar collapse? (2)

A
  • happens in the left lower lobe

- sharp line like the edge of a sail at the same angle as the left heart border

39
Q

What can be seen in the RUL of the lung is lobar collapse? (3)

A
  • hazy
  • raised horizontal fissure
  • abnormality well demarcated by the fissure
40
Q

What happens to the right middle lobe in lobar collapse? (2)

A
  • loss of right heart border

- can be difficult to differentiate from consolidation

41
Q

What happens to the right lower lobe in lobar collapse? (2)

A
  • complete loss of diaphragmatic border

- hard to differentiate from effusion

42
Q

How do you describe demarcated lesions (single or multiple)?

A
  • round opacities

YEAR 3 OSCE (38 decks)

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