Pulmonary Radiography

Question 1

Chest x-ray RIP

Answer 1

Rotation - spinus processes midpoint between clavicles
Inspiration - diaphragm should intersect 5-th-7th anterior rib @ midclavicular line
Penetration - verterbae should be visible behind heart

Question 2

PA projection

Answer 2

back to front view (pt standing) with X-ray machine behind them

Question 3

AP projection

Answer 3

xray machine in front of patient.
Magnifies heart

Question 4

Hilar point

Answer 4

major bronchi and pulmonary vessels
left higher than right

Question 5

diphragm

Answer 5

smooth, dome-shaped.
Crisp white edge
stomach and spleen just under left diaphragm

Question 6

Plural lining

Answer 6

should not be visible in normal cxr

Question 7

costophrenic angles

Answer 7

bottom left and right - should be sharp.
Blunting - effusion, PNA, hyperexpansion

Question 8

COPD (on cxr)

Answer 8

Hyperexpansion of lungs.
…diaphragm at lower rib than 5-7th
flattening of diaphragm
Heart elongated and narrowed
Cloudy view, harder to see ribs

Sharkfin ETCO2 tracing.
Ventilation failure
Bronchodilators (albuterol, zopinex)
Anticholinergic drugs (iptapropium, atropine)
Corticosteroids (solumedrol, prednisone)

Question 9

Asthma (on cxr)

Answer 9

Sharkfin appearance on ETCO2

Question 10

Status asthmaticus

Answer 10

life threatening
prolonged asthma attack requiring aggressive treatment.
Left ventricle doesn’t completely fill, lowering stroke volume and BP
Respiratory alkalosis secondary to hyperventilation, progressing to respiratory acidosis.
Epi, albuterol/iptapropium, steroids, mag
try not to intubate

Question 11

Signs of impending respiratory failure

Answer 11

Paradoxical respirations…
…chest deflates during aspiration, abdomen inflates
silent chest.

Question 12

ARDS

Answer 12

diffuse alveolar damage and lung capillary endothelial injury
Associated with increased pulmonary vascular permeability
increased dead space
decreased lung compliance

Question 13

ARDS dx

Answer 13

acute onset in less than 1 week
bilateral opacities on cxr
respiratory failure can’t be explained by cardiac failure or volume overload

Question 14

pseudoARDS

Answer 14

volume overload
effusions
atelectasis

Question 15

causes of ARDS

Answer 15

pna
aspiration
near-drowning
inhalation injuries
pulmonary edema
sepsis
trauma from shock
CABG
drug OD
blood product administration
acute pancreatitis

Question 16

ARDS tx

Answer 16

oxygenation is critical
application of PEEP
conservative volume resuscitation

Question 17

PNA

Answer 17

infectious process that causes inflammatory response
CXR findings - consolidation/opacities
tx: abx, inhaled bronchodilators, O2, fluid resuscitation (cautiously)

Question 18

tension pneumothorax

Answer 18

lung pleura visible on cxr
affected lung compressed toward hilar area

Question 18

pneumomediastinum

Answer 18

presence of gas in soft tissue of mediastinum
occurs from sudden increase in intraalveolar pressure, causing alveolar rupture.
Concern for expansion of air with increased altitude

Question 19

pneumoperitoneum

Answer 19

presence of air within the peritoneal cavity
secondary to bowel perforation, injury, or perforated ulcer
complication of laparoscopy

Question 20

pulmonary embolus

Answer 20

dyspnea, hemoptysis, tachypnea and tachycardia, rales, diaphoresis
diagnosed on CTA or V/Q scan
elevated d-dimer