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Cardiopulmonary PT > Imaging > Flashcards

Imaging Flashcards

1
Q

What is the traditional projection of a chest x-ray?

A

PA.

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2
Q

During what portion of breathing should a chest x-ray be taken?

A

Inspiration.

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3
Q

How can you tell if an x-ray way taken during an inspiration?

A
  • Should be able to count 10 posterior
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4
Q

What 3 pieces of information does a chest x-ray not provide?

A
  • Blood flow
  • Ventilation
  • Perfusion
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5
Q

Order the following in terms of radiodensity from greatest to least:

  • Water
  • Fat
  • Bone
  • Metal
  • Air
A 
Metal
Bone
Water
Fat
Air
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6
Q

What state of matter does the heart have a similar density to?

A

Fluid.

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7
Q

What is a silhouette sign?

A
  • Blurring of borders
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8
Q

What lobe is implicated with an obliteration of the superior mediastinum?

A

Upper lobes

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9
Q

What lobe is implicated in an obliteration of the border of the right heart?

A

Right middle lobe.

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10
Q

What lobe is implicated in an obliteration of the border of the right hemi-diaphragm?

A

-Lower right lobe

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11
Q

What lobe is implicated in an obliteration of the border of the left hemi-diaphragm?

A
  • Lower left lobe
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12
Q

What is the upper limit of the cardiothoracic ratio of the adult heart?

A
  • Less than half the width of the chest at the level of diaphragm
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13
Q

What 3 situations can make a heart appear larger than it actually is?

A
  • Taken during expiration
  • Pregnancy
  • AP projection
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14
Q

What 3 pathologies may cause an actual enlarged heart?

A
  • Cardiomyopathy
  • CHF
  • Incompetent valves
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15
Q

What 4 structures are contained within the mediastinum?

A
  • Heart
  • Vessels
  • Trachea
  • Esophagus
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16
Q

What is the mediastinum bounded by anteriorly and posteriorly?

A
  • Sternum

- Vertebral bodies

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17
Q

Why are the individual contents of the mediastinum indistinguishable?

A
  • All the same radiodensity
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18
Q

What are the 4 bumps running down the right mediastinum in a CXR from superior in inferior?

A
  • Superior vena cava
  • Ascending Aorta
  • Right atrium
  • Inferior vena cava
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19
Q

What are the 5 bumps running down the left mediastinum in a CXR from superior to inferior?

A
  • Left subclavian vein/ artery
  • Aortic arch
  • Pulmonary artery
  • Left atrium
  • Left ventricle
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20
Q

What gives the diaphragm its opacity?

A

Its underlying structures

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21
Q

Which side of the diaphragm is larger? Why?

A

Right side is larger due to liver.

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22
Q

What will push the mediastinum to the opposite side?

A
  • Air

- Fluid

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23
Q

What will pull the mediastinum to the same side?

A
  • Removal of lung

- Atelectasis

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24
Q

What 4 things can cause a mass in the mediastinum?

A
  • Goiter
  • Lymphoma
  • Esophageal/ bronchial cancers
  • Aortic aneurysms
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25
Q

What rib level does the dome of the diaphragm typically align with?

A
  • The 10th rib
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26
Q

What 3 factors may cause an elevated diaphragm?

A
  • Excessive fluid in peritoneal space
  • Later stages of pregnancy
  • Splinting after abdominal surgery
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27
Q

What causes a flattened diaphragm?

A
  • Increased lung volume
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28
Q

What structure is contained in the left hemidiaphragm?

A
  • The stomach
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29
Q

What are the costophrenic angles?

A
  • Area where diaphragm and chest wall meet

- Usually has sharp point

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30
Q

What is the normal costophrenic angle?

A
  • 30 degrees
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31
Q

What can obscure the costophrenic angle?

A
  • Pleural effusion or other pathologies causing fluid to collect in the lungs
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32
Q

Why are lateral chest x-ray views controversial?

A
  • Increased radiation exposure

- Limited clinical information

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33
Q

What 5 structures are visible on a left lateral CXR?

A
  • Pulmonary artery
  • Right ventricle
  • Trachea
  • Aortic arch
  • Left ventricle
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34
Q

What are 4 diagnostic categories for a CXR?

A
  • Lung field abnormally white
  • Lung field abnormally black
  • Mediastinum abnormally wide
  • Heart abnormally shaped
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35
Q

What produces the consolidation seen on an x-ray with pneumonia?

A
  • Fluid filling around alveoli and bronchi
36
Q

What are 3 x-ray findings of pneumonia?

A
  • Consolidation of 1 or more lobes
  • Silhouette sign if lobe borders heart or diaphragm
  • Opacity of bronchi/ alveoli
37
Q

What is atelectasis?

A

Loss of volume of a portion of a lung.

38
Q

What 3 factors can cause atelectasis?

A
  • Obstruction of bronchi
  • Compression
  • Traction
39
Q

When is atelectasis common? Why?

A

Common post-op due to poor inspiratory effort, and secretion retention.

40
Q

Does atelectasis respond well to chest PT?

A

Yes.

41
Q

How opacities of the collapsed lobe, and the surrounding lobes change in atelectasis?

A
  • Darker surrounding lobes

- White collapsed lobe

42
Q

To which side does the medistinum shift in atelectasis?

A
  • Toward collapsed lobe
43
Q

What changes will occur in the diaphragm due to alectasis?

A
  • Hemidiaphragm elevated on collapsed side.
44
Q

What are 4 types of pleural effusion?

A
  • Serous fluid
  • Blood
  • Chyle (lymph and free fatty acids)
  • Pus
45
Q

What are the major findings of pleural effusion typically?

A
  • Blunted costophrenic angles
46
Q

What are 4 x-ray findings of tension pneumothorax?

A
  • Blacker due to absence of lung vasculature
  • Visceral lining of lung edge visble
  • Deep costophrenic angle (sulcus sign)
  • Mediastinum shifts away from collapsed lung
47
Q

What will be the 6 x-ray findings in a patient with COPD?

A
  • Bullae/ pockets of trapped air
  • Increased vertical height of lungs
  • Falltened/ scalloping of diaphragm
  • Narrowed mediastinum
  • Airspace present below heart
  • Increased retrosternal space in lateral view
48
Q

What is an aortic dissection?

A
  • Tear in inner layer of aorta: inner column of blood separates inner and middle layers
49
Q

Where does an aortic dissection usually occur, and what is it preceded by?

A
  • Ascending aorta

- Aortic aneurysm

50
Q

How is an aortic dissection typically diagnosed? (3 methods, None of which are x-ray)

A
  • Ct angiography
  • MR angiography
  • Transesophageal echocardiography
51
Q

What are the 4 x-ray findings of an aortic dissection?

A
  • Widened mediastinum
  • Obliteration of normal shape of aortic arch
  • Downward slant of left main stem bronchus
  • Tracheal deviation to right due to aortic compression
52
Q

How does an aortic dissection appear on a CT angiography?

A
  • Aorta has dual chamber appearance
53
Q

What are the 3 x-ray findings of a patient with CHF?

A
  • Enlarged heart width
  • Pleural effusion (obscured costophrenic angles)
  • Bat wing pattern
54
Q

Describe a bat wing pattern.

A
  • Fluid replaced air in lower lobes

- Upper lobes become especially dark in the shape of bat wings

55
Q

What are the 3 radiographic findings in mitral valve stenosis?

A
  • Straightening/ buldging of left heart border
  • Double line density on right heart due to left atrium aligning with right atrium
  • Upper lobe veins become very prominent
56
Q

What 7 findings can ultrasound help provide information about that chest x-rays cannot?

A
  • Blood flow
  • Cardiac output
  • Ejection fractions
  • Valvular function
  • Thickness/ movement of heart wall
  • Presence/ severity of CAD
  • State of pericardium
57
Q

What are the 5 types of cardiac ultrasound?

A
  • Trans thoracic echo (TTE)
  • Transesophageal echo (TEE)
  • Stress echocardiography
  • Doppler echo
  • 3D echo
58
Q

Where is the transducer placed in a TTE?

A
  • Chest wall
59
Q

Where is the transducer placed in a TEE?

A
  • Passed into esophagus
60
Q

What is an advantage and a disadvantage of an TEE over a TTE?

A
  • Clearer pictures

- Patient must fast/ be sedated

61
Q

What is the purpose of a stress echocardiography?

A
  • Compares blood flow at rest and under stress

- Compares pre and post exercise (bike or treadmill)

62
Q

What is the purpose of a doppler echo?

A
  • Measures velocity and direction of blood flow in the heart
63
Q

What 4 functions does a doppler echo measure?

A
  • Valve function
  • Abnormal communication between left and right heart
  • Leaky valves
  • CO
64
Q

What is the purpose of a 3D echo?

A

More precise measurements

65
Q

What a commonly used nuclear medicine scan?

A

V/Q scan

66
Q

What 3 pathologies are typically measured in a V/Q scan?

A
  • PE
  • Lung function in COPD
  • Pre/post lung lobectomy to determine performance
67
Q

How is the V measured in a V/Q scan?

A
  • Patient inhales radioactive xenon gas`
68
Q

How is the Q measured in a V/Q scan?

A
  • Radioisotope injected through IV
69
Q

How is a PE diagnosed using a V/Q scan?

A
  • Normal ventilation with abnormal perfusion
70
Q

Describe the 5 step process of a nuclear perfusion study of the coronary arteries.

A
  • Radioisotope tracer given via IV
  • HR increased by exercise or drugs
  • Photos taken at rest, after exercise and a few hours later
  • Assess obstruction of coronary arteries
71
Q

What are the 4 possible outcomes of the nuclear perfusion test, and what are their implications?

A
  • Unobstructed flow: NORMAL
  • Normal at rest; Decreased during exercise: REVERSIBLE
  • Decreased at rest and with exercise: Block of one or more coronary arteries: NON-REVERSIBLE. Permanent damage to heart tissue
  • Reversible and non-reversible aspects
72
Q

What does a MUGA scan evaluate?

A
  • The function of the ventricles
73
Q

What is a MUGA scan?

A
  • Multigated acquisition
74
Q

How is a MUGA scan carried out?

A
  • Isotope injected

- Images taken from EDV to ESV

75
Q

In what type of patients are MUGA scans often carried out?

A
  • Chemo patients to montior impact on heart
76
Q

What is being evaluated in angiograms?

A

The presence of obstructions or aneurysms

77
Q

What is the 2 step process of a normal angiogram?

A
  • Iodine based contrast delivered to heart

- Image viewed through fluoroscopy

78
Q

How is the contrast injected into the heart in an angiogram?

A
  • Catheter threaded through femoral vein into heart
79
Q

Which side of the heart is the contrast injected into in a coronary angiography?

A
  • Left heart
80
Q

Which side of the heart is the contrast injected into in a pulmonary angiography to assess the presence of PE?

A
  • Right heart
81
Q

What is ventriculography?

A

Angiography that visualizes motion of the ventricular walls

82
Q

Which types of angiography studies are free from risk?

A

None. All are invasive and have risk

83
Q

What is a more effective imaging technique for PE than a V/Q scan?

A
  • Computed tomography pulmonary angiography
84
Q

What is the non-invasive form of angiography?

A

Magnetic resonance angiography

85
Q

What is a bronchoscopy?

A
  • Visualization of proximal airways through bronchoscope inserted into trachea from mouth
86
Q

What is often collected using a bronchoscopy?

A

Lung tissue for biopsy

87
Q

What 4 characteristics are measured in a sputum test?

A
  • Color
  • Consistency
  • Smell
  • Pathogens

Cardiopulmonary PT (10 decks)

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