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Y2 - Resp > Lecture 13 - CXR > Flashcards

Lecture 13 - CXR Flashcards

1
Q

What is the first thing you do when assessing a patients radiograph?

A

Ensure its the right patients image
(Name, age and sex)

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2
Q

After assessing the patients details are correct for the radiograph what is the pneumonic used to determine the quality of the image?

A

RIPE

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3
Q

What does the acronym RIPE stand for when assessing the quality of a patients CXR?

A

Rotation
Inspiration
Projection
Exposure

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4
Q

How do you assess that the Rotation is good in a CXR?
(RIPE)

A

Ensure the medial aspects of the clavicles are equidistant from the spinous process

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5
Q

How do you assess that the Inspiration is good in a CXR?
(RIPE)

A

There should be between 8-10 posterior ribs visible

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6
Q

How can you tell the difference between anterior and posterior ribs?

A

Posterior ribs run more horizontally

Anterior ribs run more diagonally

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7
Q

How do you assess that the Projection is good in a CXR?
(RIPE)

A

See whether it says AP or PA (NORMALLY PA)

If scapulae not projected in the chest its PA

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8
Q

How do you assess that the Exposure is good in a CXR?
(RIPE)

A

Left hemi-diaphragm should be fully visible and the vertebrae should be visible behind the heart

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9
Q

Why is PA normally done on a CXR?

A

Heart is an anterior structure, so if done AP then the heart would appear enlarged/magnified and therefore ma lead to a misdiagnosis of cardiomegaly

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10
Q

What is the systematic approach to assessing a CXR after determining its quality?

A

ABCDE approach

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11
Q

What is the ABCDE approach?

A

Airways
Breathing
Cardiac
Diaphragm
Everything else

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12
Q

What is assessed in the airways stage of a CXR?

A

Trachea deviation?
Bronchi normal/compare them to each other
Carina
Hilar structures

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13
Q

What is the carina?

A

Cartilage at the point where the trachea bifurcates to the left and right main bronchus

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14
Q

What is contained in thee hilar structures?

A

Pulmonary artery
Pulmonary vein
Main bronchus

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15
Q

What can cause tracheal deviation?

A

Pushing of trachea with large pleural effusion

Pulling of trachea due to lobar collapse

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16
Q

What can cause hilar enlargement?

A

Bilateral = sarcoidosis
Unilateral = malignancy

Abnormal position = May be being pushed

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17
Q

What is assessed in the Breathing stage of ABCDE approach?

A

Lungs
Pleura

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18
Q

What is assessed when look at lungs in the breathing stage?

A

Divide the lung into 3 zones:
-lung markings/fields (oedema)
-asymmetry
-increased air space in a lung field

19
Q

When assessing the lungs what is often indicative of a pneumothorax?

A

Absence of lung markings

20
Q

What is seen with the pleura when assessing breathing in the ABCDE?

A

Pleura not normally visible
Ensure lung markings extend all the way to the edges of the lung fields

21
Q

What is assessed in the cardiac stage of ABCDE for CXR?

A

Assess heart borders (left and right heart border should be well defined

Assess heart size, work out cardiac:thoracic ration

22
Q

What is classed as cardiomegaly?

A

When the cardiac:thoracic ratio exceeds 0.55

Normal 0.4 - 0.55

23
Q

What is assessed in the diaphragm stage of the ABCDE approach?

A

Right hemidiaphragm higher than the left due to the liver
Air under the right diaphragm

Costophrenic angle (diaphragm + lateral wall angle) should be sharp

24
Q

What is assessed in the everything else phase of the ABCDE approach?

A

Aortic knuckle
Aortopulmonary window
Bones
Soft tissues
Pacemakers

25
What is the aortic knuckle?
Left lateral edge of the aorta as it arches back over he left main bronchus
26
What is the aortopulmonary window?
Aortopulmonary window is a space located between the arch of the aorta and the pulmonary arteries
27
What is the gastric air bubble?
The air bubble under the left hemidiaphragm which is an air bubble in the fundus of the stomach
28
What angles are often lost due to pleural and pericardial effusions?
Costophrenic angles Cardiophrenic angles
29
How many lobes does teh right lung have? How many lobes does the left lung have?
Right = 3 Left = 2
30
What fissure is present in both lungs? Which fissure is only present in the right lung?
Both = oblique fissure Right only = horizontal fissure
31
Go to the last slide: Describe the pathology of slide 1:
Lower left lobe collapse Lower left bronchus collapsed Left hemidiaphragm not visible
32
Go to the last slide: Describe the pathology of slide 2:
Left upper lobe collapse Left lung looks smaller adn upper lobe looks hazy L hemi-dia visible but L heart border not visible
33
Go to the last slide: Describe the pathology of slide 3:
Right upper lobe collapse Has pulled the trachea to the RHS
34
Go to the last slide: Describe the pathology of slide 4:
Right middle lobe consolidation Hemi-dia visible Right Heart margin difficult to see Not a R lower lobe problem since R hemidiaphragm visible
35
Go to the last slide: Describe the pathology of slide 5:
Miliary nodules likely miliary TB Paraspinal mass also likely the TB spread to spine
36
Go to the last slide: Describe the pathology of slide 6:
Bilateral hilar lymphadenopathy
37
Go to the last slide: Describe the pathology of slide 7:
Right lower lobe mass
38
Go to the last slide: Describe the pathology of slide 8:
Left pleural effusion Possible malignancy Cant see L hemi—dia
39
Go to the last slide: Describe the pathology of slide 9:
Perihilar air space opacification (Fluffy appearance around hilum due to pulmonary oedema) Bat wings appearance (fluid around hilar space) Likely due to heart failure
40
Go to the last slide: Describe the pathology of slide 10:
Right pleural effusion Mediastinal widening Malignancy Cannot see right Costophrenic angle
41
Go to the last slide: Describe the pathology of slide 11:
Unfolding aorta (where the aorta appears to be larger as they age) Non pathological process
42
Go to the last slide: Describe the pathology of slide 12:
Right paratracheal mass Aorta is enlarged
43
Go to the last slide: Describe the pathology of slide 13:
Pneumothorax Lung collapsed on LHS Lung markings to edge of the lungs No lung markings = pneumothorax

Y2 - Resp (23 decks)

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