Radiology

Question 1

Is AP or PA view preferred and why

Answer 1

PA view is preferred

with AP view the scapula obscure lungs,
heart shadow magnified so can’t be assessed properly
patient can’t adequately inspire

Question 2

Instructions to patient in CXR

Answer 2

Brace shoulders forward

Breath in and hold your breath

Question 3

Why may AP view be used

Answer 3

patient can’t stand (unwell, bed bound)

Question 4

what can lateral CXR tell us and why is it rarely used

Answer 4

3D structure

rarely used due to CT scan availability

Question 5

Steps before CXR

Answer 5

Confirm patients name, DOB, CHI
side marker- right way round?
Rotation- medial clavicles equidistant from spinous processes of vertebral bodies
Inspiration- at least 6 anterior ribs visible
Penetration-is there enough radiation

Question 6

Dextrocardia

Answer 6

congenital abnormality

Heart points to right instead of left

Question 7

Situs transvertus

Answer 7

congenital condition in which the major visceral organs are reversed or mirrored from their normal positions

Question 8

which bronchus is it more likely for object to fall down

Answer 8

Right (straighter, more obtuse angle)

Question 9

Draw all lung lobes, anterior and posterior
How many lobes per lung
Fissures

Answer 9

RUL, RML, RLL (3 lobes)
LUL, Lingula, LLL (2 lobes)

right- oblique and horizontal fissure
left- oblique fissure only

Question 10

Presentation and Hx of miliary TB

Answer 10

recent travel
cough, night sweats, malaise
lots of tiny diffuse nodule on CXR

Question 11

rash on shins

bilateral lymphadenopathy

Answer 11

Sarcoidosis

Question 12

differences between right and left hila

Answer 12

left hila lies superior to the right

Question 13

why are bronchi more visible on older patients

Answer 13

calcification

Question 14

difference between right and left hemidiaphragm

Answer 14

right 1.5cm above left

Question 15

diaphragm depression

Answer 15

pneumothorax, pleural effusion

Question 16

diaphragm elevation

Answer 16

sub phrenic collection (blood ect) paralysis of c345

Question 17

right middle lobe pneumonia appearance

Answer 17

right lower zone consolidation (anteriorly)
loss of right heart border
right hemidiaphragm still visible

Question 18

Lingular pneumonia appearance

Answer 18

left lower zone consolidation (anteriorly)
loss of left heart border
left hemidiaphragm still visible

Question 19

cause of lobar collapse

Answer 19

obstruction in lobar bronchus - lobe is no longer ventilated, loss of volume

eg tumours, aspirated food, mucus

Question 20

Appearance of LLL collapse

Answer 20

anteriorly- triangle on inferomedial left lung along left oblique fissure
(google image)
reduced lung volume
loss of left hemidiaphragm

Question 21

Appearance of LUL collapse

Answer 21

whole of left lung has veil like opacity
loss of left cardiac border
reduced left lung size
well defined lobar edge on lateral CXR

Question 22

Appearance of RUL collapse

Answer 22

white RUL

horizontal fissure

Question 23

loss of right cardiac border

Answer 23

pneumonia of right middle lobe

Question 24

loss of right hemidiaphragm

Answer 24

pneumonia of right lower lobe

Question 25

loss of left heart border

Answer 25

pneumonia of left lingula

Question 26

D sign on CXR

Answer 26

Empyema (pleural space)

Question 27

Bilateral pleural effusion

Answer 27

loss of costophrenic recess

obscured diaphragms

Question 28

pleural effusion in CXR

Answer 28

fluid collects at lung bases

Mencius

Question 29

ABCDEFG approach to reading CXR

Answer 29

Airways, Assess rotation, inspiration, penetration
Bones, body wall, breathing
Cardiac- cardiomegaly
Diaphragm
Effusion
Fields-lungs should be symmetrical
Great vessels

Question 30

if CXR is normal with suspected PE

Answer 30

V/Q scan

Question 31

investigation for suspected PE but can’t use radiation

Answer 31

Doppler US

Question 32

what to do if massive PE is suspected or CXR is abnormal

Answer 32

CT pulmonary angiogram

Question 33

Signs of central lung tumour

Answer 33

hilar enlargement, distal collapse/consolidation

Question 34

thumb print

Answer 34

epiglottitis