Exam I: Radiology Of The Airway

Question 1

Most common x-ray perioperatively (outside of OR)

Answer 1

PA (posterior to anterior)

Question 2

Most common X-ray taken in OR

Answer 2

AP (anterior to posterior, front to back)

Question 3

• real time, live images
• digital phenomenon
• helps with alignment of tools and implants

Answer 3

Fluoroscopy

Question 4

Common x-ray views of c-spine

Answer 4

• lateral
• AP
• open-mouth odontoid
• oblique
• pillar

Question 5

X-ray views

Answer 5

Question 6

Interruption C4 - C5

Answer 6

Question 7

Fluoroscopy C-Arm

Answer 7

Question 8

Unit of X-ray exposure

Answer 8

Roentgen (R)

Question 9

Unit of x-ray absorbed by tissue (must state where)

most practical term for our use because its purpose because it represents the actual dose

how much radiation is actually absorbed by the part being radiographed

Answer 9

Rad (r)

Radiation Absorbed Dose

Question 10

Unit for exposure equivalent relative to other forms of ionizing radiation

Answer 10

REM

Question 11

The amount of radiation that produces a specific amount of ionization of 1cc of air at STP

Answer 11

Roentgen

Used as measure of radiation exposure

Question 12

REM stands for

Answer 12

Roentgen Equivalent (in mammals)

Question 13

Bone (depicted as white on an x-ray) cause more/less radiation particles to get through?

Answer 13

Less

Question 14

Increased attenuation of x-ray particles will result in what type image?

Answer 14

Opaque (radio-opaque)

Question 15

A medium that allows greater passage of x-ray particles is said to be ____.

Answer 15

Radioluscent

Question 16

A radioluscent material will appear ____ on an x-ray.

Answer 16

Black (no visible component: air)

Question 17

Metal>Bone>Fluid/Fat/Soft Tissue>Air

High to low OR low to high attenuation?

Answer 17

High to low

Metal: Very white
Bone: White
Fluid: Lightly white or grayish/some blackening
Air: Black

Question 18

Bone and metal are radio-____.

Answer 18

Opaque

Question 19

ABCDEFG X-ray Assessment

Answer 19

Assessment/Airway
Bones
Cardiac Silhouette
Diaphragm
Equipment
Fields of Lung
Gastric Bubble/Great Vessels

Question 20

Common X-Ray Views

Answer 20

Question 21

Which x-ray view will cast a larger shadow of heart?

Answer 21

AP, because it casts a larger shadow

Question 22

What 3 variables do we assess when conducting the “Assessment” portion of the X-ray?

Answer 22

• Rotation
• Inspiration
• Penetration

RIP

Question 23

“Rotation” assessment x-ray

Answer 23

Question 24

How to assess Inspiration on x-ray

Answer 24

• count 5-7 Anterior ribs (OK)
• count 9+ Posterior Ribs (OK)

Question 25

ID ribs for inspiration X-ray

Answer 25

Question 26

What should we see on an x-ray if “Penetration” is adequate

Answer 26

1. Spaces between the vertebrae 2. Pulmonary vessels

Question 27

T. Pneumothorax x-ray

Answer 27

Question 28

Answer 28

Croup with *Steeple Sign* Common in children

Question 29

Answer 29

Acute Epiglottitis (enlarged epiglottis)

Question 30

X-ray Examples

Answer 30

Question 31

Escaping air into skin is called?

Answer 31

Subcutaneous Emphysema

Question 32

What is most important when evaluating bones on X-ray?

Answer 32

Number & smooth continuous lines (no fractures)

Question 33

Cardiac silhouette should occupy ____% of chest wall

Answer 33

50%

Question 34

Labeled x-ray

Answer 34

Question 35

Question 36

Answer 36

Extra fluid in pericardial sac

Question 37

With pulmonary HTN, what side of heart is larger?

Answer 37

Right Due to increased pressure in lungs, therefore causing RV to pump harder to circulate blood to lungs

Question 38

Answer 38

Pulmonary HTN (on right) - LV turned posteriorly in chest, therefore in pulmonary HTN, RV enlargement will be prominent (anterior) on on x-ray

Question 39

Diaphragm Assessment

Answer 39

If fluid is present in lungs, we can lose the “costaphrenic angle”

Question 40

Answer 40

COPD - Increased lung field view (hyper-inflated) - possibly flatter diaphragm

Question 41

A good diaphragm view includes what?

Answer 41

- Not flat - clear costophrenic angles - fairly symmetrical

Question 42

Answer 42

L Pleural Effusion

Question 43

High hemidiaphragm implies ____.

Answer 43

Decreased lung volume

Question 44

Potential causes of high hemidiaphragm

Answer 44

- phrenic nerve paralysis - conditions causing chest pain (splinting) - Extrapulmonic processes (enlarged spleen, liver, pancreatitis or subphrenic abscess)

Question 45

What do we assess when evaluating the lung fields?

Answer 45

- roughly symmetrical - have faint fuzzy lung markings - view apices to diaphragm

Question 46

If gastric bubble is observed, patient is likely ____.

Answer 46

Upright

Question 47

A gastric bubble viewed in the area of the esophagus implies what?

Answer 47

A hiatal hernia

Question 48

Normally, lungs are more lucent at the ____.

Answer 48

Apex

Question 49

Well expanded lungs should appear ____.

Answer 49

Radiolucent with lung markings

Question 50

If a patient has CHF or pulmonary hypertension, the ____ lungs should appear more opaque.

Answer 50

Upper Due to engorgement of the pulmonary veins in upper lung zones

Question 51

R main stem angle?

Answer 51

25-30 degrees (Steeper than left)

Question 52

Left main stem angle

Answer 52

45-50 degrees

Question 53

Trachea extends from cricoid cartilage to carina at what vertebrae?

Answer 53

T5

Question 54

ETT should be what diameter of the tracheal lumen?

Answer 54

2/3

Question 55

ETT tip should be placed how high above the carina?

Answer 55

2-3 cm

Question 56

Answer 56

Right Mainstem

Question 57

Limitations of x ray

Answer 57

- 3D images projected in 2D - details of internal objects masked by shadows of overlying and underlying structures

Question 58

CT uses ____ as energy source

Answer 58

X-rays

Question 59

- Provides great images of bone and blood - can scan entire thorax in one breath hold - helical

Answer 59

CT

Question 60

- shows no bone detail - giant electromagnet - great for soft tissue

Answer 60

MRI

Question 61

Answer 61

Epiglottis