Lau PowerPoint - Chest Radiography Flashcards
True or False: Chest xray in asthma patients in usually normal
True
In more severe cases of asthma, what does the chest xray present with?
Hyperinflated lungs
In exacerbations of asthma, what is there evidence of on the X-ray?
pneumothorax
Lung shadowing usually indicated what in patients with bronchopulmonary aspergillosis?
pneumonia or eosinophilic infiltrates
Per Lau, what is the real reason we get a chest x-ray on asthmatic patients?
to rule our pneumo - why? b/c of the presence of hyperinflated lungs which can easily cause a collapsed lung
Obvious bullae, paucity of parenchymal markings, or hyper lucency suggests the present of what?
emphysema
What happens to both the lung volume and also the diaphragm in COPD patients?
increased lung volume and flattened diaphragm
What is the current definitive test for establishing the presence or absence of emphysema in people?
CT scan
Due to the flattened diaphragm present in COPD, what organ will you now be able to palpate during exam? What does this NOT indicate and why?
liver; hepatomegaly, but really this is just liver DISPLACEMENT. The fact that the lung is hyperinflammed has caused the shift.
What should you always do before you intubate a patient?
Ventilate them until their pulse ox is AT LEAST 98%.
In general, what class of drug is being used for symptomatic benefit in patients with COPD?
bronchodilators
The three most common symptoms of COPD include: cough, ____ and _____-
sputum production, exertional dyspnea
The hallmark of COPD is what?
airflow obstruction
PFT show airflow obstruction with reduced values of ___ and what ratio?
FEV1 and FEV1/FVC
Bronchodilators along with what other drug is used for long-term treatment of COPD?
beta agonists
When is it acceptable for patients to have air in their abdominal cavity?
before they go for Continuous ambulatory peritoneal dialysis (CAPD).
In which part of the lung field should you be looking for a pneumothorax?
top
A COPD and asthma patient both come in with SOB and fever - who do you treat with AB and who do you treat with bronchodilator? Why?
COPD gets treated with AB while the asthma patient gets treated with a bronchodilator. The COPD person most likely has walking pneumo and should be given a macrolide like erythromycin
Which xray view is used to view the retrocardiac space?
Lateral
Walking patients should get what xray type?
PA and lateral (better quality than AP and more reliable in terms of accuracy)
Nonwalking patients should get what type of X-ray?
AP - these are typically portable
When checking the xray - you should check from outside to inside - True or False?
True
On which X-ray view does the aorta look wider?
AP
Criteria used to distinguish between transudative and exudative pleural effusions.
Light’s Criteria
___pleural effusions are defined as effusions that are caused by systemic factors that alter the pleural equilibrium.
Transudative
__pleural effusions are caused by alterations in local factors that influence the formation and absorption of pleural fluid.
exudative
What does SPN stand for?
Solitary pulmonary nodule
True or False: all patients who present with a cough need a chest xray?
True, per Lau
What is one reason Lau states is why we want to give a chest x-ray to all patients with a cough and/or cardiac problems?
b/c diabetics can often have a heart attack with NO PAIN.
What is the major component of each hilar shadow on the chest xray?
pulmonary artery
When you first get a chest xray what are the first two things you want to examine?
bone and soft tissue
The heart should have ____ the diaphragm - if not, what does this indicate?
half; cardiomegaly
The diaphragm should be found at what level rib posteriorly and what level rib anteriorly?
8th to 10th; 5th to 6th
Why are you asked to take a deep breath and hold it for chest xray?
to allow for maximum lung volume and provide the most clear view of the chest
A pneumothorax will be evident when there is a________of the edge of the collapsed lung, with no further lung markings beyond this line. This line may be confused with the scapula or ribs if the clinician does not look closely.
linear delineation
Are chest xrays usually taken in the inspiratory or expiratory phase?
Chest X-rays are conventionally acquired in the inspiratory phase of the respiratory cycle. The radiographer asks the patient to, ‘breathe in and hold your breath!’
What are some of the false errors that can be found if the xray is taking during the expiratory phase of the respiratory cycle?
If the image is acquired in the expiratory phase, the lungs are relatively airless and their density is increased. Also, the raised position of the diaphragm leads to exaggeration of heart size, and obscuration of the lung bases.
What is one main reason to take an expiratory chest xray?
Occasionally an erect x-ray is taken in expiration specifically to help identify a pneumothorax (which looks larger on an inspiratory film).
NOTE: When a person inspires the diaphragm drops and the lungs expand. It is therefore important to take the x-ray when the maximum amount of lung is visible i.e. on inspiration. By counting the visible ribs you can determine when the film was taken. In the normal lung you should be able to count 10 Posterior and 6 Anterior ribs if the x-ray was taken on inspiration.
OK
Pleural effusion in posterior recess of costophrenic angle is best seen in which chest view
lateral chest view
Which view should be obtained to diagnose an infiltrate in a retrocardiac location?
lateral chest view
Which chest view results in magnification of anatomic structures (for ex: the cardiac silhouette is increased by up to 15 to 20%)?
AP chest view
What is the tell tale sign of a aortic (thoracic) aneurysm on the chest xray?
wide mediastinum;
What can cause the appearance of a wide mediastinum? (falsely)
In the setting of trauma, patients are positioned supine while a chest x-ray is acquired, very often causing the mediastinum to appear wide spuriously.
Which chest xray view tells us if there is a perforation in the abdominal cavity?
lateral decubitus
Which chest xray view is used to diagnosis TB?
apical lordotic
Where will you find infiltrates associated with TB?
At the top of the lung (especially for NEW TB)
Infiltrates found in the middle of the lung are associated with which bacteria?
Klebsiella
Infiltrates in the lower lobe are associated with which condition?
pneumonia
Which xray view is best when it is necessary to demonstrate the presence of an air-fluid interface?
left lateral decubitus - you can also specifically be looking for pleural effusion
What are the three organs that can irritate pleural effusion?
pancreas, heart, and spleen
If the patient is diagnosed with bilateral pleural effusion, from where is the effusion really coming?
Right side
What are the two xray signs that indicate pancreatitis?
sentinal loop and colon cutoff sign
A patient that comes in with chronic pneumo should really be worked up for what possible diagnosis?
cancer
What tests (2) should be given to confirm diagnosis of lung cancer?
bronchoscopy with biopsy and ct with contrast
What is the tell tale sign of a tension pneumothorax?
deviated trachea - remember it turns to the opposite side of the pneumo
What chest xray view results in false widening of the mediastinum?
AP
If in the xray you note the aortic knob becoming something like a 3, what is the likely diagnosis?
coarctation of the aorta
What are the two main findings that we specifically use xray to find?
infiltrates and effusion
What are you specifically looking for in the retrosternal space?
TB
What is one indication that the patient is a young person? (based on the lateral chest xray view)
look for spacing in between the vertebrae.
What is the one very important thing that you DO NOT see in the PA view? THINK…
costophrenic angle
NOTE: NEVER underestimate the power of checking multiple films from the patients history
OK
What are the four types of lungs cancer?
small cell, large cell, squamous cell, and adenocell - large cell most rare but most curable; small cell most deadly;
What type of lung cancer do smokers typically get? Non smokers?
small cell followed by squamous cell; adenocell
When placing a chest tube, do you place the tube at the top or bottom of the rib?
Top - this way you avoid the vascular bundle (VAN)
Term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue.
crepitus
Crunching, rasping sound, synchronous with the heartbeat,[3] heard over the precordium in spontaneous mediastinal emphysema produced by the heart beating against air-filled tissues.
Hamman sign
The presence of a cervical rib can cause what?
thoracic outlet syndrome
What are some of the hallmark signs of thoracic outlet syndrome?
pain and paresthesia along with common neurologic symptoms (specifically of the upper limb).
What is it called when you have a lumbar rib?
Gorilla rib
A hilar mass may be indicative of what?
sarcoidosis
what is the most common cause of bilateral pleural effusion?
infection in the lungs - either pneumonia or pneumonitis
what test can be done to tell if the patient has pneumonia or simply pneumonitis?
CXR will tell you if its pneumonia
Two diseases that attack the interstitial, fibrous tissue of the lungs and will give you an “interstitial pneumonia”
PCP and mycoplasma
what is the most compliant way to treat mycoplasma?
azithromycin (1x/day)
what is the treatment for mycoplasma that has patients exhibit the least amount of compliance?
erythromycin (4x/day) associated with GI sx
what is the treatment for mycoplasma that only involves taking the med 2x/day?
biaxin/calrithromycin
what is the class of drugs that is best to treat bronchitis and pneumonia?
macrolides
REMEMBER YOUR MACROLIDES, name 4
Azithromycin
Erythromycin
Clarithromycin
Telithromycin
what are the two ways you can diagnosed with having bronchitis?
cough more than 6 months in an entire year or be a smoker!
the loss of normal borders between thoracic structures in CXR is called what? what does this indicate?
silhouette sign; presence of fluid or mass in the lung
____:outline of an airway made visible by increased density of the surrounding parenchyma due to consolidation or presence of fluid.
air bronchogram - please remember that this is a CXR finding and NOT a test!!!
solitary pulmonary nodules are typically made of what?
calcium
dark spots around a nodule indicate what?
that the nodule has been around for a long time, and is no longer growing in size
what is an indication that the SPN is still growing?
the area surrounding the mass is between white and black (grey)
almost always associated with a linear increased density on chest x-ray.
atelectasis
TB is often found where in a CXR? why?
top of the lungs - b/c it is aerophillic
what are the four drugs used to treat TB?
rifampin, ethanbutol, INH, and PZA (pyrazinamide)
what is the testing procedural steps for TB?
ppd + or sx –> cxr; + cxr –> sputum
Cold agglutination, Hemolytic anemia, and Bullous myringitis (vesicles on the tympanic membrane)is the triad for what?
mycoplasma
What is the two main causes of bilateral pleural effusion?
Infection in lungs: two types: pneumonia or pneumonitis
What is the cause of interstitial pneumonia?
PCP or mycoplasma
