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Mar: Sem 4 - Principles II > Exam 1: xrays > Flashcards

Exam 1: xrays Flashcards

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1
Q

Would bones be more present with overexposure or underexposure?

A

overexposure

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2
Q

What type of body habitus results in underexposed x-rays?

A

Obesity

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3
Q

With overexposure, a chest x-ray will appear too ______.

A

dark
* the bones are very white but small nodules and fine structures in the lung aren’t seen

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4
Q

With underexposure, a chest x-ray will appear too ____.

A

bright
* this is hard to interpret
* small pulmonary blood vessles appear prominent and could lead you to think there are infultrations

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5
Q

Major difference b/w male and female cxr

A
  • caused by breast tissue: breast tissue absorbes some xr beam
  • this can cause underexposure of the tissues in the path
  • not a problem if the breasts are above the hemidiaphragms

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6
Q

Pt position with PA and AP xr views

A

PA: (usually ambulatory pts) the xr tube is behind the pt and the beam passes from the pts back and exits the front of the chest
AP: if laying down, xr tube passes antrior to posteior

AP makes the heart look a little larger because the beam spreads out a little more
*But PA (upwright) helps with lung expension and pulm. vessels - i.e. a hemothorax will become gravity dependent (run down)

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7
Q

What mnemonic should guide x-ray assessment?

A

Are There Many Lung Lesions?

Abdomen
Thorax
Mediastinum
Lung
Laterality

S7
Laterally= bilateral lung

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8
Q
  • In the thorax assessment, sharp ____ angles will have ____ fill in the gaps if there’s a ____
  • There is a ____ if the air goes ____ the angles instead of filling in the gaps.
A
  • In the thorax assessment, sharp costophrenic angles will have blood fill in the gaps if there’s a hemothorax
  • There is a pneumothorax if the air goes around the angles instead of filling in the gaps.

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9
Q

In the mediastinum assessment, what tells you there is cardiomegaly?

A

Cardiac silhouette > than 1/2 to 2/3 greater than normal

S17
From K: I believe this should say 1/2-2/3rds of the space in thorax

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10
Q

What is the systematic order of approach for chest x-ray assessment?

A
  1. Bony framework
  2. Soft tissues
  3. Lung fields and Hila
  4. Diaphragm and pleural spaces
  5. Mediastinum & heart
  6. Abdomen and neck

Beautiful Sky, Lets Hike Down Mountain Above

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11
Q

What structures make of the pulmonary Hila?

A

Pulmonary arteries & veins
* the hila is the shadow of the pulm artery and vein adjacent to the heart shadow

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12
Q

Abnormalities in lung fields are marked by excessive ____ and ____.

A

radiolucency and radiopacity (or opacified areas)

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13
Q

What do you look for with bony framework?

A

Ribs
Sternum - sometimes hard to see
Spine
Shoulder girdle
Clavicles
*Anterior view sometimes gets lost in mediasteinum

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14
Q

What do you look for with soft tissues?

A

Breast shadows be mindful of breasts obscuring the costophrenic angles
Supraclavicular areas
Axillae - more pneumothorax accumulation
Tissues along side of breasts

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15
Q

What do you look for with Lung fields?

A

Hilum (base/root of lung – close to heart)
Lungs: Linear and fine nodular shadows of pulmonary vessels
Blood vessels
40% obscured by other tissue

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16
Q

What do you look at with the diaphragm and pleral surfaces?

A

Diaphragm (liver sits higher on the R so that dome is higher)
Dome-shaped
Costophrenic angles
Normal pleura is not visible on the cxr unless two layers come together to form interlobar fissures

S25

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17
Q

What do you look at with the mediastinum and heart (Right side)?

A

Heart size on PA
Right side: Inferior vena cava, Right atrium, Ascending aorta, Superior vena cava

biggest takaways are to look for the aortic knob and the size of the cardiac silhouette

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18
Q

What do you look at with the mediastinum and heart (Left side)?

A

Left side: Left ventricle, Left atrium, Pulmonary artery, Aortic arch, Subclavian artery and vein

Order from bottom to top: LV, LA, pulm art, aortic arch and subclav artery and vein

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19
Q

What do you look at with the abd and neck?

A

Abdomen: Gastric bubble, Air under diaphragm
Neck: Soft tissue mass, Air bronchogram

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20
Q

What structure is indicated by 1 on the figure below?

A

Superior Vena Cava

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21
Q

What structure is indicated by 2 on the figure below?

A

Inferior Vena Cava

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22
Q

What structure is indicated by 3 on the figure below?

A

Right atrium

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23
Q

What structure is indicated by 4 on the figure below?

A

Right ventricle

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24
Q

What structure is indicated by 5 on the figure below?

A

Left ventricle

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25
Q

What structure is indicated by 6 on the figure below?

A

Ascending Aorta and Aortic Arch

S26

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26
Q

What structure is indicated by 7 on the figure below?

A

Pulmonary vasculature

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27
Q

What would the results be for a poor inspiration on a chest x-ray?

A
  • High diaphragm
  • Crowding of lung markings

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28
Q

What would be the result of over or under penetration?

A
  • Can obliterate or exaggerate important findings
  • A proper PA cxr, you can make out the thoracic vertabrae

S30

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29
Q

What would be the result of rotation of the pt?

A
  • Distortion of normal structures. Check proper orientation by looking if the clavicles are equally long or look at equal distance from vertebral spines to the end of the calvicle

S30

30
Q

What describes the anatomical position of the right upper lobe (RUL) ?

A
  • Upper ⅓ of right lung
  • Posteriorly, adjacent to first 3 - 5 ribs
  • Anteriorly, reaches as far down as 4th rib

S34

31
Q

What lobe of the right lung is located primarily posteriorly?

A

Right Lower Lobe (RLL)

32
Q

Which of the right lung lobes is typically smallest and triangular in shape and is narrowest near the hilum?

A

Right Middle Lobe (RML)

S35

33
Q

How high up posteriorly will the RLL extend?
How low will the RLL extend?

A

T6 down to as low as L2 with full inspiration

S36

34
Q

What structures do the major and minor fissues seperate?

A
  • Major fissure: more expansive and seperates RUL and RML from the RLL
  • Minor fissure: seperates RUL from RML (this representates the visceral pleural surfaces of both these lobes) at the level of T4

S37

35
Q

Which right lung fissure is oriented obliquely?

A

Major Fissure

S37

36
Q

The portion of the left lung that coresponds anatomically to the RML is incorperated where?
what fissure devides the two left lobes?

A
  • LUL
  • major fissure (identical to the R lung)

S40

37
Q

What is the silhouette sign?

A

Lung lesion that obscurs normal anatomy (in this case the aortic arch).

S43

38
Q

What is the Air Bronchogram Sign?

A
  • In the lungs, bronchi should not be visible because there is air density surrounded by alveoli (soft tissue has different density)
  • Air bronchogram = visulization of intrpulmonary bronchi which indicates abnormal lung i.e. consolidation

with lung consolidation, pulmonary vessels are no longer visulalized because they are surrounded by other soft tissue density

AKA: bad news bears

S44

39
Q

What is consolidation?

A

Inflammatory exudate of WBC, plasma, bacteria, and debris. i.e. a density corresponding to a segment or lobe

RML consolidation pictured.

S49

40
Q

What is the most common reason for consolidation?

A

Pneumonococca (pneumonia)

S49

41
Q

Is there loss of lung volume noted with consolidations?

A

No

S49

42
Q

What are examples of localized lung liquid densities?

A
  • Infiltrate
  • Consolidation
  • Cavitation
  • Mass
  • Congestion
  • Atelectasis

ICC MAC

S48

43
Q

What are examples of generalized lung liquid densities?

A
  • Diffuse alveolar
  • Diffuse interstitial
  • Mixed
  • Vascular

David Always Inturrupts Many Vamipres

S48

44
Q

What are some disease states consistent with increased air density?

A
  • Emphysema
  • Bulla
  • Localized airway obstruction
  • Diffuse airway obstruction

D- LOBE

S48

45
Q

What signs are seen in an atelectatic lung space? (3)

A
  • Density corresponding to segment or lobe
  • Loss of volume
  • compensatory hyperinflation

there is no ventilation to the lobe beyond the obstruction

S50

46
Q

4 Steps of cxr evaluation

A
  1. identify abnormal shadows
  2. anatomically localize the leasion
  3. identify the pathology
  4. identify the etiology
  5. after that confirm you clinical suspition with MRI, CT, contrast etc

Shady Leonard Paces Easily

S51

47
Q

What disorder is likely from the radiograph below?

A

Gohn’s Complex. Lesion of calcified infection with associated lymph node involvement. Usually results from tuberculosis.

We done GROWN some calcium

S66

48
Q

What disorder is likely from the radiograph below?

A

Anterior Medistinal Mass

we can’t see the aortic knob here - aortic rupture or mass or esophageal rupture?
Corndog mostly wants us to see something is wrong

S67

49
Q

What is the likely pathology based on the x-ray below?

A

RUL Pneumonia

S61

50
Q

What is the likely pathology based on the x-ray below?

A

Right Pleural Effusion
no costophrenic angle

S59

51
Q

What lung lobe is affected by the effusion noted in the image below?

A

Trick Question. Costophrenic angle still visible. This is likely a RLL pneumonia, not an effusion.

S62

52
Q

What is the likely pathology based on the x-ray below?

A

Free air under the diaphragm

S64

53
Q

What is the likely pathology based on the x-ray below?

A

LUL mass

S68

54
Q

What is the likely pathology based on the x-ray below?

A

Metastatic Cancer
also a porticath on the L side and a neck fusion

S69

55
Q

What is the likely pathology based on the x-ray below?

A

Pulmonary Metastasis Hematogenous

S70

56
Q

What is the likely pathology based on the x-ray below?

A

Pneumomediastinum
- shadow on the L side of the heart

S72

57
Q

What is the likely pathology based on the x-ray below?

A

Pneumothorax

S75

58
Q

What is the likely pathology based on the x-ray below?

A

Subcutaneous Air
- diaphragm also looks weird - depressed maybe?

S76

59
Q

What is the likely pathology based on the x-ray below?

A

Deep Sulcus Sign indicative of pneumothorax
- *we also have a gastric silhouette on the left (the diaphragm is way at the bottom)

S77

60
Q

How can one differentiate if a swallowed coin is in the trachea or the esophagus?

A

If the coin sits flat then its likely to be in the esophagus.

*FB’s always go to the path of least resistance - usually if its in the trachea, this coin will sit a little higher (i.e. the carina)

S81-82

61
Q

What is the likely pathology based on the x-ray below?

A

Post-operative pneumonectomy
* but we also have some tracheal shift, so follow up with clincial correlation - haha sounds like a rad…

S88

62
Q

What is the likely pathology based on the x-ray below?

A

Pulmonary Edema
Large cardiac silhouette and its hard to make out other scructures

S86

63
Q

What is the likely pathology based on the x-ray below?

A

Transverse Aortic Arch aneurysm or a large tumor

S90

64
Q

What is the likely pathology based on the x-ray below?

A

Cardiomegaly

well over the 50% normal cardiac silhouette

S91

65
Q

What is the likely pathology based on the x-ray below?

A

Aortic Dissection

distended and widened mediasteinum

S93

66
Q

What is the likely pathology based on the x-ray below?

A

Chiladiti Sign indicative of interposition of bowel in between liver and the diaphragm. Not good. Especially after bowel surgery.

*per Corndog: usually this causes no symptomes!

You’re CHILLY when your bowel is torsed

S94

67
Q

Chilaiditi syndrome refers to what? and is only in the presence of what?

A
  • Chilaiditi syndrome refers only to complications in the presence of Chilaiditi’s sign.
  • These include: abdominal pain, torsion of the bowel or shortness of breath

S94

From K:Chilaiditi syndrome is a generally benign condition in which a segment of the intestine is interposed between the liver and diaphragm

68
Q

What is the likely pathology based on the x-ray below?

A

Mediastinal air secondary to esophageal rupture
* AKA: Boerhaave’s syndrome

BORING, you HAVE air in your mediastinum

S95

69
Q

What is the likely pathology based on the x-ray below?

A

Bilateral Hilar Adenopathy - lots of fluid retention

S96

70
Q

What is the likely pathology based on the x-ray below?

A

LUL Atelectasis

S103

71
Q

What is the likely pathology based on the x-ray below?

A

Bilateral “cotton-ball” appearance is likely for TB

S112

Mar: Sem 4 - Principles II (23 decks)

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