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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
Q

What is the aortic knuckle?

A

Left lateral edge of the aorta as it arches back over he left main bronchus

26
Q

What is the aortopulmonary window?

A

Aortopulmonary window is a space located between the arch of the aorta and the pulmonary arteries

27
Q

What is the gastric air bubble?

A

The air bubble under the left hemidiaphragm which is an air bubble in the fundus of the stomach

28
Q

What angles are often lost due to pleural and pericardial effusions?

A

Costophrenic angles
Cardiophrenic angles

29
Q

How many lobes does teh right lung have?

How many lobes does the left lung have?

A

Right = 3
Left = 2

30
Q

What fissure is present in both lungs?

Which fissure is only present in the right lung?

A

Both = oblique fissure
Right only = horizontal fissure

31
Q

Go to the last slide:

Describe the pathology of slide 1:

A

Lower left lobe collapse

Lower left bronchus collapsed
Left hemidiaphragm not visible

32
Q

Go to the last slide:

Describe the pathology of slide 2:

A

Left upper lobe collapse

Left lung looks smaller adn upper lobe looks hazy

L hemi-dia visible but L heart border not visible

33
Q

Go to the last slide:

Describe the pathology of slide 3:

A

Right upper lobe collapse

Has pulled the trachea to the RHS

34
Q

Go to the last slide:

Describe the pathology of slide 4:

A

Right middle lobe consolidation

Hemi-dia visible
Right Heart margin difficult to see

Not a R lower lobe problem since R hemidiaphragm visible

35
Q

Go to the last slide:

Describe the pathology of slide 5:

A

Miliary nodules likely miliary TB

Paraspinal mass also likely the TB spread to spine

36
Q

Go to the last slide:

Describe the pathology of slide 6:

A

Bilateral hilar lymphadenopathy

37
Q

Go to the last slide:

Describe the pathology of slide 7:

A

Right lower lobe mass

38
Q

Go to the last slide:

Describe the pathology of slide 8:

A

Left pleural effusion
Possible malignancy

Cant see L hemi—dia

39
Q

Go to the last slide:

Describe the pathology of slide 9:

A

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
Q

Go to the last slide:

Describe the pathology of slide 10:

A

Right pleural effusion
Mediastinal widening
Malignancy

Cannot see right Costophrenic angle

41
Q

Go to the last slide:

Describe the pathology of slide 11:

A

Unfolding aorta (where the aorta appears to be larger as they age)
Non pathological process

42
Q

Go to the last slide:

Describe the pathology of slide 12:

A

Right paratracheal mass
Aorta is enlarged

43
Q

Go to the last slide:

Describe the pathology of slide 13:

A

Pneumothorax
Lung collapsed on LHS

Lung markings to edge of the lungs
No lung markings = pneumothorax

Resp (23 decks)

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