Exam #3 Flashcards
what three sections is the chest divided into?
Bony thorax, respiratory system, mediastinum
What is the bony thorax?
Part of the skeletal system that provides a protective framework for the parts of the chest involved with breathing and blood circulation, aka thoracic viscera
Sternum (divided into manubrium, body, xiphoid process)
2 clavicles, 2 scapulae, 12 ribs, 12 thoracic vertebrae
What are the two topographic landmarks for the chest?
Vertebra prominens (seventh cervical vertebrae): CR placement for PA chest
Jugular notch: CR placement on AP chest
What four general divisions make up the respiratory system?
Pharynx, trachea, bronchi, lungs
What is the diaphragm?
Dome shaped muscle, primary for inspiration
- dome moves downward , it increases volume of thoracic cavity while decreasing the intrathoracic pressure
What is the pharynx?
Passageway for food and fluids as well as air, making it common to the digestive and respiratory systems
Divided into the nasaopharnxy, oropharnxy, laryngopharnxy
What makes up the roof of the oral cavity?
Hard and soft palate
What marks the boundary between the nasopharynx and oropharynx?
Uvula
How does the epiglottis keep food from going down the larynx?
During the act of swallowing, it flips down and covers the laryngeal opening
What is the larynx?
Cagelike, cartilaginous structure, anterior portion of the neck suspended from hyoid
voice box
C3-C6
What is the topographic landmark in thyroid cartilage?
Laryngeal prominence, adams apple, C4-C5
What is the trachea?
Connects larynx to the main bronchi
C6-T5
What is the thyroid gland?
Below thyroid cartilage, store and releases hormones, needs to be protected in radiation imaging
What is the parathyroid gland?
Small, round glands embedded to the posterior surface of each lobe of the thyroid gland, store and secrete hormones, maintain calcium levels in blood
Everyone who’s hypersthenic has organs that are _______
Short, wide, and high, take cassette in landscape
Everyone who is hyposthenic has organs that are __________.
Longer, lower, midline
Everyone who is asthenic has organs that ___________.
Very long, narrow, more in the center, put cassette in portrait.
Describe the right primary bronchus.
Wider, shorter, more vertical, food particles or other foreign objects that happen to enter the respiratory system more likely to enter and lodge
What is the carina?
Specific prominence or ridge of the lowest tracheal cartilage and marks the division of the trachea
_______ bronchus divides into three secondary bronchi and the _______ divides into two.
Right, left
The ____ lung contains three lobes and the _____ lung contains two lobes.
Right, left
What does secondary bronchi subdivide into?
Bronchioles
What three lobes is the right lung divided into?
Superior (divided by horizontal fissure) middle (divided by oblique fissure) inferior
What two lobes is the left lung divided into?
Superior (divided by single deep oblique fissure) inferior
What is parenchyma?
The light, spongy, highly elastic substance that the lungs are composed of
Allows for breathing mechanism responsible for expansion and contraction of the lungs, brings oxygen into and removes carbon dioxide from the blood through the thing walls of alveoli
What is the pleura?
Delicate double walled sac that each lung is contained in
What is the parietal pleura?
The outer layer that lines the inner surface of the chest and diaphragm
What is the visceral (pulmonary) pleura?
Inner layer that covers the surface of the lungs
What is the pleural cavity?
Potential space between the double-walled pleura that contains lubricating fluid that allows movement during breathing
What is a pneumothorax?
Air or gas present in this pleural cavity that may cause the lung to collapse
What is a hemothorax?
Accumulation of blood in the pleural cavity
What is a pleural effusion?
Fluid within the cavity
What are the four important structures of the mediastinum?
Thymus gland, heart and great vessels, trachea, esophagus
Describe the thymus gland
Behind the upper sternum, temporary organ, almost disappears in adulthood, large role in development of the immune system that helps with disease resistance, essential to the growth and development of T cells
Describe the heart and great vessels
Enclosed in Double wall sac called pericardial sac
Great vessels
- IVC(returns blood from lower body), CVC(returns oxygenated blood from lungs), Aorta, large, pulmonary arteries and veins
To increase the volume of the chest during inspiration, the thoracic cavity increases in diameter in three dimensions, what are those dimensions?
Vertical: contraction in downward movement of diaphragm, increases thoracic volume
Transverse: rib, swing, outward, and upward increasing diameter
Anteroposterior: raising of ribs
Expiration causes diameters to return normal
What makes a good CXR?
Minimum of 10 pairs of ribs showing
kVp in CXR
Low contrast (long scale) with more gray shades which means HIGHER kVp
- requires grids
Time and mAs for CXR
High mA and short time
Situs Inversus
Visceral inversion
Major organs of body are on opposite side
What position do we do for CXR Peds
Infants who require head support: AP supine
Erect PA and laterals perferred
Technical factors for CXR Peds
Low kVp (70-85)
Less mAs
Low time
Geriatric applications for CXR
Higher CR location, pathological conditions can effect exposure adjustments
What are the reasons for CXR in erect position?
- Diaphragm able to move down farther.
- Air and fluid levels may be visualized.
- Engorgement (swollen with fluid) and hyperemia (excess of blood), a pulmonary vessels may be prevented.
Why do we do PA CXR?
To reduce magnification of the heart on the image
Ateclasis
Collapse of all or portion of lung as the results of obstruction of the Bronchioles, or puncture of an air passage
Bronchiectasis
Irreversible, dilation/widening of bronchi or bronchioles that may result from repeated pulmonary infection
Bronchitis
acute or chronic condition in which excessive mucus is secreted into the bronchi, causing cough, shortness of breath
Chronic obstructive pulmonary disease
Form of persistent obstruction of airways that usually causes difficulty in emptying the lungs of air, asthma
Cystic fibrosis
Inherited disease , secretion of having mucus causing progressive clogging up bronchi and bronchioles
Dyspnea
Shortness of breath, which creates a sensation of difficulty in breathing, mostly in elderly people, caused by pulmonary edema related to cardiac conditions
Emphysema
Irreversible and chronic lung disease in which air spaces in the alveoli become greatly enlarge as a result of alveolar wall destruction and loss of a elasticity
- Caused by smoking or long-term does inhalation
Epiglottitis
Life-threatening condition which can develop very rapidly ages 2 to 5
Lung neoplasm
New growth or tumor
- benign: hamarotma found in peripheral regions of the lungs
- malignant: lung cancers
What are the occupational lung diseases
-anthracosis: black lung pneumoconiosis, caused deposits of coal dust
-silicosis: permanent, inhalation of silica dust
-asbestosis: inhalation of asbestos dust fibers
Type of pleural effusion
-empyema: occurs when the fluid is pus, caused by chest wounds, obstruction of bronchi, ruptured lung abscess
-hemothorax: occurs when fluid is blood, congestive heart failure or trauma
Pleurisy
Characterized by inflammation of the pleura surrounding the lungs, causes visceral and parietal pleura rubbing during respiration, which could result in severe pain
Pneumonia
Inflammation of the lungs that result in accumulation of fluid within certain sections of lungs, creating increased radiodensities in these regions
Different types of pneumonia
Aspiration pneumonia: aspiration of a foreign object or food into the lungs
Bronchopneumonia: bronchitis in both lungs most commonly caused by streptococcus
Lobar pneumonia: confined to one or two lobes of the lungs
Viral pneumonia: inflammation of alveoli and connecting lung structures, most commonly is evident as increased radiodensities
Pulmonary edema
Excess fluid within the lung that most frequently is caused by back up in the pulmonary circulation associated with congestive heart failure
Respiratory distress syndrome
Emergent condition, in which the alveoli and capillaries of the lung are injured or affected the results in leakage of fluid and blood into spaces between alveoli, or into them with formation of hyaline membranes
Tuberculosis and different types
- Contagious disease that is caused by Airbourne bacteria
- Primary tuberculosis: occurs in person who’s never had the disease before, Hilar enlargement with enlarged lymph nodes
- Reactivation tuberculosis: develops in adults, and generally is first evident on radiograph bilaterally and upper lobes as irregular calcifications or molted
- AP lordotic projections
Organs of the digestive
- Oral cavity.
- Pharynx.
- Esophagus.
- Stomach.
- Small intestine.
- Large intestine.
Three parts in small intestine
Duodenum: short, but widest
jejunum
Ileum (ileocecal valve)
Accessory digestive organs
- Pancreas: posterior to stomach, produces hormones and digestive juices
- Liver
- Gallbladder: pear shaped sac, contracts and releases stored bile when stimulated
(Cholelithiasis: presence of one or more gallstones)
Urinary system organs
Two kidneys
Two ureters
One urinary bladder
One urethra
Intravenous Urogram
Examination of urinary system performed with intravenous contrast, medium
Peritoneum
Large serous, double wall, sac like membrane
- surface area approximately equal to the skin
- parietal covers abdominal wall, visceral covers organ
- Space between crown on visceral portions is the peritoneal cavity
- If close to posterior abdominal wall, then only partially covered by visceral peritoneum
Ascites
Abnormal accumulation of serous fluids
Mesentery
The fold that holds the small intestine in place, double for the peritoneum that extends anteriorly from the posterior abdominal wall to completely envelope a loop of small bowel, loosely, connect, small intestine to posterior wall
Omentum
Specific type of double fold peritoneum that extends from stomach to another organ
Lesser : extend superiorly from the lesser curvature of the stomach to portions of the liver
Greater : connects the transverse colon to the greater curvature of the stomach inferiorly, drips over small bowel, then folds back on its self to form an apron along anterior abdominal wall
Mesocolon
Peritoneum that attaches the colon to the posterior abdominal wall
- Transverse mesocolon is the visceral peritoneum that loosely connects the transverse colon to posterior abdominal wall
Greater and lesser sac
Major portion of peritoneal cavity is the greater sac, commonly known as peritoneal cavity
Smaller portion of upper posterior peritoneal cavity located posterior to stomach is the lesser sac, commonly known as omentum bursa
Retroperitoneal organs
Less mobile
Located behind peritoneal cavity
Infraperitoneal organs
Located under peritoneum
Lower rectum, urinary bladder and reproductive organs
Intraperitoneal organs
Organs with an abdominal cavity that are partially or completely covered by some type of visceral peritoneum but are not retro or infra peritoneal
Seven landmarks of Abdomen
- Xiphoid process: superior margin of abdomen
- Inferior coastal rib margin: locate upper abdominal organs
- Iliac crest: abdomen CR
- Anterior superior iliac spine: pelvic/vertebral structures
- Greater trochanter: secondary landmark
- Symphysis pubis: inferior margin in Abdomen
- Ischial tuberosity: PA Abdomen in prone position
Pneumoperitoneum
Free air or gas in peritoneal cavity caused by preforation of gas containing viscous
Mechanical bowel obstructions
Complete or nearly complete blockage of the flow of intestinal contents
- Fibrous adhesions: most common
- Crohn’s disease: chronic inflammation of intestinal wall that results in bowel destruction and at least half of affected patients
- Intussusception: telescoping of section of vowel into another loop
- Volvulus: twisting of a loop of intestine
Ileus
Nonmechanical bowel obstruction
Paralytic ileus
Ulcerative colitis
Chronic disease involving inflammation of the colon that occurs primarily in young adults
Why do you need to do an acute abdominal series?
When the patient has Ileus, Ascites, perforated hollow viscous, intra-abdominal mass, postop abdominal surgery
What are the 3 views in the acute abdominal series?
AP supine
Erect (lateral decubitus)
PA chest
How much time should the patient be upright for an erect abdomen?
5 min. Minimum
10-20 desirable
