Exam 1 - Chest Flashcards
What is the function/purpose of the thymus gland?
immune response
Which cavity defines potential space between lung and chest wall?
pleural cavity
What is the muscular partition between thoracic and Abdomen?
diaphragm
What is path condition that shows a collapsed lung?
atelectasis
Anatomical angle by junction of lung and pericardium?
cardio phrenic angle
How many inches is trachea?
4.5 inches
Correct breathing instructions for PA lateral chest?
take image on inspiration of 2nd breath
How can you tell if a PA projection symmetrical?
clavicles
Preferred chest SID?
72 in
Where should the arms be positioned for a lateral chest x-ray?
over head
Which pt position demonstrates mediastinal structures in cardio?
oblique
What term is used if pt left shoulder breast thorax is touching IR?
LAO
What view demonstrates apices of lung best?
lordotic
What are methods used for radiation protection?
lead shield & collimation
Pt comes in with emphysema, what technique adjustments?
decrease
How many lobes in R lung?
3
How many lobes in L lung?
2
Which term describes abnormal breathing with absent and rapid?
cheyne stokes
Term refers to crackle in chest?
rales
Invasive procedure to remove fluid?
thoracentesis
Air in pleural cavity term?
pneumothorax
Exchange of gasses in alveoli?
diffusion
Which pleural is closer to lungs?
visceral
Disease with chronic dilation of bronchi?
bronchiectasis
Path condition that requires increased technique?
cystic fibrosis (fluid in lungs)
What is name of tube that serves passage way for food & air?
pharynx
Which projection best demonstrates asteriated foreign body in bronchial tree?
PA on inspiration & expiration
How many ribs above diaphragm in x-ray?
10
Is the esophagus posterior or anterior to the trachea?
posterior
Coronal plane perpendicular to IR?
lateral
Ingest foreign body where do they aspirate it?
to the right, into the bronchus
When pt can’t stand erect for fluid and air chest x-ray?
decubitus
Which structure doesn’t course through diaphragm?
trachea
Why is R lung higher?
liver
Why is PA preferred of chest?
reduce heart magnification
What causes blunt costophrenic angles?
pleural effusion
Which pt position for left pneumothorax?
right lateral decubitus
Which pathology represents lung over inflation?
chronic obstructive pulmonary disease (COPD)
Which pt positions provide near equivalent images?
RPO = LAO
RAO = LPO
All of the following are normal lateral chest x-ray except what?
closed intervertebral spaces
In which position is R lung best demonstrated?
RPO
If AP projection which oblique demonstrates max area of L lung?
LPO
Supine chest appears different from a upright chest how?
engorged great vessels
What part of lung extends above clavicle?
apices
Which of following is included with mediastinum?
thymus
What is most optimal position to see heart & lungs?
upright
Chronic dilation of one or more bronchi
Honeycomb pattern
bronchieactasis
Increased air spaces in tissue, associated with chronic bronchitis
emphysema/COPD
Most common fatal cancer in US, accounting for 28% of all cancer deaths
Occurs in bronchi
Smoking is main factor responsible for 85% of cases
Bronchogenic Carcinoma
Fluid in pleural cavity
Congestive heart failure, infection, trauma, neoplasm
If lung is full of fluid mediastinal shift to the right
Pleural Effusion (hydrothorax)
blood clot, 95% arise from deep venous thrombi
Potentially fatal
Hampton’s hump
Pulmonary embolism
Infectious disease of the lungs (really bad cough)
Demonstrates cavitation and calcification
Pleural effusion
tuberculosis (TB)
Long-continued irritation of certain dusts encountered in industrial occupations that cause a chronic interstitial
Pneumoconiosis
Associated with pulmonary fibrosis
Lower part of lung
inhalation of asbestos
Asbestosis
Decrease or increase technique when there is a pathological condition with air?
decrease
Decrease or increase technique when there is a pathological condition with fluid?
increase
What covers the lungs?
pleura
Inner layer of pleura
visceral
Outer layer of pleura
parietal
Which bronchus is shorter, wider, and more vertical?
right
What is the space between the 2 pleural cavities?
mediastinum
What happens within the alveoli?
diffusion
What are the requirements for a chest x-ray?
Apices to costophrenic angles (where the ribs meet the diaphragm)
Cardiophrenic angles
10 ribs
symmetrical clavicles
Body habitus of a larger person, stomach is higher, adipose tissue pushes organs up, 5% of pt
hypersthenic
Body habitus of a average sized pt, normal organ places, 50% of pt
sthenic
Body habitus of a slim person, organs slightly lower, 35% of pt
hyposthenic
Body habitus of a very skinny pt, organs are close to pelvic region, 5% of pt
asthenic
Exposure time should be no more than?
0.5 seconds
Average kVp for chest x-ray
110
higher kVp =
more gray tones
average kVp for abdomen x-ray
80
If kVp is too low then…
image will be under exposed
If kVp is too high then…
image will of burnout (loss of detail)
Where should you center for a PA chest x-ray?
midsagittal plane of body, CR enters at T7
Where should the CR be for a AP chest x-ray?
3 inches below juglar notch
Where should the CR be for a lateral chest x-ray?
T7, hilum in approx center of x-ray
Where should the CR be for an oblique chest x-ray?
T7
What angle should the pt be at for an oblique projection?
45 deg
What angle should the pt be at for an oblique projection examining the cardiac area?
50-60 deg
What angle should the pt be at for an oblique projection examining pulmonary disease?
10-20 deg
Where should the side of interest be in PA oblique projections?
farthest away from the IR
SID 72 in, Pt stands 1 ft in front of vertical grid and rests shoulders on grid
Or angle tube 15-20 degree cephalic angle (towards head)
To see apices and interlobular infusions
AP Axial “Lindblom Method” Lordotic Position
CR 10-15 degree cephalad, T3; apices above clavicles
to see pulmonary apices
PA Axial
What position do you use when a pt has fluid or air in their lungs?
lateral decubitus
Where should the affected side be when there is fluid in the lungs?
down
Where should the affected side be when there is air in the lungs?
up
Lower border of IR at level of manubrium, top border at nose
Pt inhale slowly during exposure
Take image right at end of inhalation
Demonstrate foreign bodies, swelling, masses in airway, fractures in larynx or hyoid bone
Ap trachea
Upper border of IR at level of laryngeal prominence
CR midway between jugular notch
Lateral trachea
shortness of breath
dyspnea
breathing stops
apnea
energetic respiration, deep breathing (after physical exhertion)
hyperpnea
determines ability of lungs to exchange oxygen and carbon dioxide
uses spirometers to measure different lung volume
pulmonary function tests
determines hydrogen ion concentration, partial pressure of carbon dioxide and oxygen concentration, and oxyhemoglobin saturation
performed with pulmonary function tests; use arterial blood obtained from radial artery
arterial blood gas tests
determines number of reduced white blood cells per volume of blood and measures hemoglobin
issues venipuncture technique to obtain blood sample
complete blood count
continuously monitors blood oxygen saturation; is useful in assessing exercise tolerance, transient changes in blood oxygenation, and sleep disorders
uses application of noninvasive oxygen sensor to client’s finger
oximetry
observes lung fields for fluid, masses, fractures, and other abnormal processes
chest radiograph
visually examines trachea and bronchial tree, obtains biopsy and fluid or sputum samples, or removed airway obstructions
uses tubular metal bronchoscope or flexible fiberoptic bronchoscope to visualize airway
bronchoscopy
identifies abnormal masses by size and location
combines radiography and computer tech to calculate tissue absorption and show density variations
lung scan
determines presence of pathogenic microorganisms and antibiotics to which they are most sensitive
obtained with swab
throat culture
identifies specific microorganisms and it’s drug sensitivities or presence of tubercle bacillus or abnormal cells
collected by trap with suctioning or by client after cough
sputum specimens
aspirates fluid for diagnostic and therapeutic purposes or removes biopsy specimen
uses needles to perforate chest walls and pleural space
thoracentesis
location: in bronchi
casual factors: newborn inherited
manifestations: repeated pneumonia, pancreatic insufficiency
radio appearance: hyperinflation, irregular thickening, increased radiodensities
treatment: prophylactic, antibiotics, chest physiotherapy, bronchodilators
cystic fibrosis
location: alveoli
casual factors: newborn, premi, lack of surfactant
manifestations: difficulty breathing
radio appearance: minutes granular densities in parenchyma, air bronchogram sign
treatment: artificial surfactant, positive pressure ventilation
hyaline membrane disease
location: subglottic, trachea, larynx
casual factors: primarily viral infections
manifestations: inspiratory stridor (barking cough)
radio appearance: smooth, tapered narrowing
treatment: steam, mist tent oxygen
croup
location: supraglottic
casual factors: acute infections, primarily, influenza
manifestations: sudden complete airway obstruction
radio appearance: fat epiglottic shadow
treatment: ER-intubation, antibiotics for infections
epiglottis
location: lobar/segment
casual factors: pneumococcus bacteria
manifestations: inflammatory exudates replaces air in the alveoli, upper respiratory tract infection, shills, fever
radio appearance: lobe/segment opacification, solid
treatment: antibiotic
pneumoccocal pneumonia
location: bronchial airway/alveoli
casual factors: streptococcus or staphylococcus bacteria
manifestations: abscesses
radio appearance: patchy opacification with air bronchogram
treatment: antibiotic
staphylococcal pneumonia
location: alveolar/interstitial
casual factors: virus
manifestations: inflammatory exudates replaces air in the alveoli, upper respiratory tract infection, shills, fever
radio appearance: linear or reticular pattern perihilar infiltrate
treatment: antibiotic
viral or mycoplamic pneumonia
location: alveolar (lobe/segment)
casual factors: foreign object
manifestations: edema
radio appearance: patchy opacification air bronchogram sign
treatment: corticosteroid and antibiotic
aspiration pneumonia
location: most common in right lung
casual factors: embolus, pneumonia, foreign bodies
manifestations: coughing, infected sputum
radio appearance: encapsulated opaque mass with air fluid level
treatment: antibiotic, aid in expectoration of purulent material
lung abscess
location: anywhere in lung
casual factors: myobacterium, childhood
manifestations: fever, weight loss, weakness
radio appearance: small focal lesions anywhere in the lungs with hilar enlargement
treatment: 2 drug regimen for 2 months or longer
primary TB
location: upper lobes and posterior segments
casual factors: mycobacterium adulthood
manifestations: fever, weight loss, weakness
radio appearance: gi lateral infiltrates in upper lobes, cavities, and calcifications
treatment: 2 drug regimen for 2 months or longer
secondary TB
location: bronchi/bronchioles
casual factors: bacteria, dust, cigarette smoke
manifestations: cough, shortness of breath, wheezing
radio appearance: no image change in 50%, increased bronchovascular markings, hyperinflation and depressed diaphragm
treatment: prophylactic antibiotics, bronchial dilators, expectorants, no cure
chronic bronchitis
location: destroyed alveolar septa
casual factors: compensating (older adults, lung removal), centrilobar COPD (smoking, dust, inhalation)
manifestations: barrel chest, hypoxia, difficulty breathing
radio appearance: pulmonary hyperinflation, bulla formation, flattened diaphragm, radiolucent retrosternal space
treatment: treat symptoms, no cure
emphysema
location: bronchi
casual factors: childhood, allergies, exercise, stress, anxiety
manifestations: wheezing, coughing, tight chest
radio appearance: no evidence unless during acute attack, bronchial narrowing/hyperlucent lungs
treatment: preventative and rescue bronchial dilators
asthma
location: basal segments of lower lobes
casual factors: repeated pulmonary infection and obstruction
manifestations: chronic productive cough
radio appearance: coarseness and decreased interstitial markings; radiodense lower lungs
treatment: antimicrobial or antibiotic drugs
bronchieactasis
location: most often upper lobes lung parenchyma
casual factors: inhalation of silica
manifestations: fibrous nodules
radio appearance: “egg shell” multiple, well defined, scattered nodules of uniform density
treatment: prevent further exposure, breath clean air, treat complications
silicosis
location: pleural lining
casual factors: inhalation of asbestos
manifestations: pulmonary fibrosis
radio appearance: pleural thickening with calcified plaques
treatment: prevent further exposure, breath clean air, treat complications
asbestosis
location: lung parenchyma
casual factors: 55-60 years, males, smoking
manifestations: cough, weight loss, dyspnea
radio appearance: “coin” lesion solitary, ill defined atelectasis with obstruction, hilar enlargement, cavitation in upper lung
treatment: surgical resection, radiation therapy, chemotherapy
bronchogenic carcinoma
location: throughout lungs
casual factors: female reproductive
manifestations: cough, weight loss, dyspnea
radio appearance: “cotton ball” sign multiple nodules, sharp margins, miliary/snowstorm nodules, solitary nodule, coursened, interstitial markings
treatment: all treatments palliative, surgical resection, radiation therapy, chemotherapy
pulmonary metastases
location: most often lower lobes
casual factors: inactivity
manifestations: none
radio appearance: serial films demonstrating progressive enlargement of affected vessel - “hampton’s hump” in pulmonary infarct
treatment: anticoagulants, throbolytics, vena cava filter
pulmonary embolism
location: obstruction of segment/lobe or lung collapse
casual factors: obstruction of a bronchus, pneumothorax, or pleural effusion
manifestations: due to causative pathology
radio appearance: local increase in density, plate-like streaks; mediastinal shift with severe cases
treatment: positioning of patient incentive spirometry
atelectasis
location: lung structure breakdown
casual factors: newborn, prematurity, lack of surfactant
manifestations: difficult breathing
radio appearance: patchy, ill-defined areas of consolidation
treatment: diuretics to decrease fluid build up oxygen therapy and ventilation
acute respiratory distress syndrome
location: air in pleural cavity
casual factors: rupture of subpleural bulla, trauma, iatrogenic causes
manifestations: sudden, severe chest pain and dyspnea
radio appearance: peripheral radiolucency without pulmonary markings
treatment: small-none, large-chest tube with suction
pneumothorax
location: fluid in the pleural cavity
casual factors: congestive heart failure, pulmonary embolism, infection, pleurisy, neoplastic dz, and connective tissue disorders
manifestations: weight gain, difficulty breathing
radio appearance: fluid best seen on lateral decubitus
treatment: thoracentesis to remove fluid
pleural effusion
location: infected fluid in pleural cavity
casual factors: chest wounds, ruptured abscess, obstruction
manifestations: difficulty breathing
radio appearance: lesion-lobulated fluid; possible air/fluid level
treatment: needle aspiration with possible drain placement
empyema
