Pictures Flashcards
What type of disease does this patient have?
Obstructive Pulmonary Disease
note the scooped out pattern of the flow volume loop
What is shown here?
Pic B–centriacinar emphysema…target resp bronchioles first w/ dilation
Pic C–panacinar emphysema…target alveolar ducts & alveoli w/ dilation first, but doesn’t really psare anything.
What is shown here?
centriacinar emphysema….targets resp bronchioles first
most common form, seen in smokers
What is shown here?
panacinar emphysema
target alveoli first
less common
What is shown here?
emphysema
see the airspace dilation
What is shown here?
a bleb. thin lung tissue that is like a balloon and easy to pop
seen in emphysema
if it pops–pneumothorax
Mrs. Jones is a 64 year white female comes in with vague complaints of “not feeling well,”
She is a little short of breath, but admits to being “out of shape.”
Her PMH is unremarkable, she is on no medications, and her exam is entirely normal.
Her EKG is shown below. You inform the patient:
A.She is having a heart attack
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B.She is having ischemia
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C.She is in Atrial Fibrillation
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D.She has a very normal EKG
Answer: D. Normal EKG.
After studying this EKG you inform the patient:
A.Not to worry. In Sinus Tachycardia and when drugs wear off she will be OK.
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B.She is having an Acute Anterior MI and we need to hospitalize
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C.She is in Sinus, but with frequent PACs
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D.She is in Atrial Fibrillation with rapid ventricular response
D. A fib. The irregularly irregular beat tips off that it is 1/3 things, including maybe a fib.
also no p waves-not sinus.
See a PVC here.
ST upslope in septal leads.
V2-V3 Widened QRS complex.
When you see an irregularly irregular rhythm…there are 3 possibilities of what it is. What are the 3 options?
- atrial fibrillation.
- MAT: multifocal atrial tachycardia
- atrial flutter with varying degrees of AV block
What do you see here?
A. In Sinus Bradycardia with inverted T-waves in some precordial leads. Not to worry.
B.In Sinus Bradycardia with ischemic changes in Septal/Anterior leads. Hospitalize.
D.In Junctional rhythm with inverted T-waves V 1-3
E.In junctional rhythm with evidence of old Anterior MI
F. In junctional rhythm with evidence of old Inferior MI.
D. Junctional rhythm w/ inverted T waves in V1-3
p waves absent.
What is this wave indicative of?
this is a delta wave. This + a shortened PR interval is indicative of Wolf Parkinson White Syndrome
Describe Wolf Parkinson White Syndrome.
congential abnormality
most common cause of ventricular pre-excitation
via Bundle of Kent
usu asymptomatic
HOWEVER, if they go into afib or SVT & you give them certain meds–>can progress into ventricular fibrillation & die.
If a patient with WPW goes into afib or SVT…which meds should be given to them?
Procainamide
NOT a calcium channel blocker or something.
What is multifocal atrial tachycardia?
tachycardia, a subset of SVT often seen in patients with COPD
see 3 morphologically weird p waves + varying PR intervals
What do pathologic Q waves indicate?
an old infarct
What can a decubitus view be useful for? Lordotic?
Decubitus–determine if a fusion was a consolidation
Lordotic–see the apex of the lung
Opacification of what part of the lung will silhouette the left heart border?
- Left lower lobe
- Right upper lobe
- Left upper lobe
- Lingula
Answer: 4. Lingula
A 56 yr.-old woman with diabetes mellitus and hypertension presents to the emergency department with 6/10 chest pain and ST segment inversions in leads V2-V4. Given the appearance of this chest radiograph you suspect
1) ACS
2) Lobar pneumonia
3) Aortic Dissection
4) congestive heart failure
Answer: ACS
Lobar pneumonia: expect to find consolidation
Aortic Dissection: mediastinal widening, lose aortic notch.
Congestive Heart Failure: pleural effusion, blunting of costophrenic angles. Wispy infiltrates bilaterally.
A 72yr-old man s/p CVA developed respiratory distress after tube feeds were initiated. The most likely cause of his distress was:
1) ACS ,
2) pulmonary embolism,
3) an improperly placed naso-gastric tube or
4) acute congestive heart failure
Answer: #3, improperly placed nasogastric tube
see all the fluid splattered around in the poor guy’s lung
A 50 yr-old woman presents to her primary care physician with no complaints. She feels well. Her chest radiograpy most likely represents 1) a pleural effusion in the right lung, 2) a tension pneumothorax, 3) a lobar pneumonia or 4) she’s had a pneumonectomy
Answer: #4, surgical removal of the lung for cancer or something.
It is so white, way more than a lobe. No mediastinal shift. Pneumonectomy!!
Is this a PA view or AP view? How can you tell?
PA b/c you can’t really see the scapula & the heart appears to be a normal size.
This is the view you usu want. Appropriate estimate of heart size etc.
Which view is this?
AP
heart looks crazy large! Can see the medial border of the scapula.
do this when patient can’t move & you have to use a portable xray machine.
Which view is this?
Lateral
Which things appear hypodense–>hyperdense on a chest xray?
HYPOdense: Black
Air
Fat
Fluid or Soft tissue
Bone b/c of Ca++
Metal
HYPERdense: White
