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Respiratory System > Session 8 > Flashcards

Session 8 Flashcards

1
Q

What is the normal projection on an x-ray?

A

PA view.

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2
Q

When may an AP x-ray be performed?

A

When a patient is too unwell and cannot stand erect, e.g. ITU, resus, etc.

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3
Q

What type of x-ray projection is more useful and why?

A

PA. The heart is closer to the receptor so there is less divergence which allows analysis of the heart and mediastinum, in AP the heart is enlarged so harder to view and analyse.

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4
Q

What anatomical features should be viewable on a good chest x-ray?

A

1st rib (usually goes higher); lateral margin of the ribs; costophrenic angle.

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5
Q

How would rotation be seen on an x-ray?

A

By looking at the alignment of the spinous processes and clavicles.

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6
Q

What might flattened diaphragms on an x-ray suggest?

A

Exaggerated expansion of the lungs, often due to COPD.

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7
Q

How would you assess lung volume on an x-ray?

A

Lungs should go down to 5-7th anterior ribs at MCL; curved diaphragms present.

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8
Q

How is adequate penetration shown on an x-ray?

A

Vertebrae are just visible through the heart, complete left hemidiaphragm is visible.

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9
Q

Where is the aortic knuckle typically seen on x-ray?

A

to the left of the spine above the heart.

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10
Q

What would a lack of sharpness in the costophrenic or cardiophrenic angles suggest?

A

Fluid buildup.

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11
Q

Which of the lung hila is usually more superior?

A

The left.

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12
Q

What are the hila of the lungs?

A

The location where the vessels enter bronchi leave the lungs.

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13
Q

How is a CXR evaluated?

A

ABCD approach: Airway (trachea deviation/rotation) and Adequacy (rotation, inspiration and penetration); Breathing (asess lungs); Circulation (heart, vessels, aortic knuckle); Diaphragm/Dem bones (angles and shape), then look at review areas.

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14
Q

What would a loss of silhouette sign at the right heart border suggest?

A

Pathology of the right middle lobe of the lung.

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15
Q

What would a loss of silhouette sign at the left heart border suggest?

A

Pathology of the lingula of the left upper lobe of the lung.

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16
Q

What would a loss of silhouette sign at the paratracheal stripe suggest?

A

Mediastinal disease.

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17
Q

What would loss of silhouette sign at the chest wall suggest?

A

Pathology of the lung, pleura or ribs.

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18
Q

What would loss of silhouette sign at the aortic knuckle suggest?

A

Pathology of the anterior mediastinum or upper lobes of the lung.

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19
Q

What would loss of silhouette sign at the diaphragm suggest?

A

pathology of the lower lung lobes.

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20
Q

What would loss of silhouette sign at the horizontal fissure of the lungs suggest?

A

Pathology of the anterior segment of the upper lobes of the lungs.

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21
Q

What would cause mediastinal shift?

A

Pushing due to increased volume or pressure or pulling due to decreased volume or pressure.

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22
Q

Give some example pathologies causing mediastinal shift via pushing.

A

Pleural effusion, tension pneumothorax.

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23
Q

Give some example pathologies causing mediastinal shift via pulling.

A

Fibrosis of the lung, collapsed lung.

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24
Q

What is a pneumothorax?

A

Air trapped in the pleural space.

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25
Q

What causes a pneumothorax?

A

Usually trauma, may be spontaneous due to asthma, bullous emphysema, Marfans syndrome, etc.

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26
Q

How would tension be diagnosed in a pneumothorax?

A

Tracheal/mediastinal shift away from pneumothorax and depressed hemidiaphragm.

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27
Q

What is a pleural effusion?

A

Collection of fluid in the pleural space.

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28
Q

How does a pleural effusion appear on x-ray?

A

Uniform white area; loss of costaphrenic angle; hemidiaphragm is obscured; meniscus at upper border.

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29
Q

How and why might a PE appear differently on supine CXR?

A

Appears as a haze because the fluid is spread throughout the pleural space since the patient is lying down.

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30
Q

How is PE treated?

A

Chest drain or aspiration.

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31
Q

How is tension pneumothorax treated?

A

Insertion of catheter into the pleural space to allow air to escape.

32
Q

What is lobar lung collapse?

A

Volume loss within a lung lobe.

33
Q

What usually causes lobar lung collapse?

A

Luminal problems: aspirated foreign material; mucous plugging; iatrogenic. Mural problems: bronchogenic carcinoma. Extrinsic problems: compression by an adjacent mass.

34
Q

How may lobar lung collapse appear on x-ray?

A

Elevation of ipsilateral hemidiaphragm; crowding of ipsilateral diaphragm; mediastinal shift towards collapse; crowding of pulmonary vessels.

35
Q

What is a veil sign on CXR?

A

Collapse of a lung lobe causes the chest to look like a veil.

36
Q

What is sail sign on CXR?

A

Change in shade of the lung, usually in a sail shape, due to a collapsed lung.

37
Q

What is lung consolidation?

A

Filling of the small airways/alveoli with stuff (pus, blood, fluid, cells, etc.).

38
Q

How does consolidation appear on CXR?

A

Dense opacification.

39
Q

What is an air bronchogram?

A

Air filled bronchi becoming visible due to the opacification of surrounding alveoli.

40
Q

How is cardiac index measured on CXR?

A

Heart should be less than 50% of the total thoracic width, can only be measured on PA images as AP causes apparent cardiac enlargement.

41
Q

What may cause a space occupying lesion in the thorax?

A

Malignancy; benign mass lesion; inflammatory response; congenital defects; mimics such as bone lesions, cutaneous lesions, nipple shadows.

42
Q

What is the function of the interstitium of the lungs?

A

Releases cytokines, convoy for substances moving between blood and alveoli, helps to give lungs structure by forming collagen.

43
Q

What is the pulmonary interstitium?

A

A collection of supporting tissues within the lungs including the alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues.

44
Q

What structures are affected by interstitial lung disease?

A

Acini, alveolar lumen, bronchiolar lumen, bronchioles.

45
Q

What affects does interstitial lung disease have on the respiratory system?

A

Reduced ventilation, diffusion and perfusion causing reduced plasma O2 and increased plasma CO2.

46
Q

How do patients with interstitial lung disease usually present?

A

Chronic shortness of breath; chronic cough.

47
Q

What would usually be found on examination of a patient with interstitial lung disease?

A

Finger clubbing, cyanosis, tachycardia, tachypnoea, signs of right heart failure.

48
Q

What typically causes interstitial lung disease?

A

Occupation: asbestosis, silicosis, coal workers pneumoconiosis.
Treatment related: radiation, methotrexate, nitrofurantoin, amidarone, chemotherapy.
Connective tissue disease: rheumatoid arthritis, SLE, polymyositis, schleroderma, Sjogren’s.
Immunological: sarcoidosis, hypersensitivity pneumonitis.
Idiopathic: idiopathic pulmonary fibrosis most common.

49
Q

Describe the effects of asbestos on the lungs.

A

Asbestos fibres are sharp and may lodge into pleura: asbestos plaques form; diffuse pleural thickening; benign asbestos pleural effusions; asbestosis (interstitial lung disease); mesothelioma; bronchogenic lung cancer; rounded atelectasis.

50
Q

What drugs may induce interstitial lung disease?

A

Methotrexate, bleomycin, amidarone, nitrofurantoin.

51
Q

What is sarcoidosis?

A

Disease causing abnormal collections of inflammatory cells in granulomas.

52
Q

How does sarcoidosis usually present?

A

Between 20 and 80 years old; often asymptomatic; may have cough or rash; non-caseating granulomas on biopsy.

53
Q

How is sarcoidosis treated?

A

No treatment given usually; may be given steroids or methotrexate but causes side effects.

54
Q

What are the functions of the pleural space?

A

Movement of the lung and chest wall; coupling of the lung and chest wall for recoil; pleural fluid circulation.

55
Q

How are the pleura of the lungs innervated?

A

Parietal pleural receives somatic, sympathetic and parasympathetic innervation from the phrenic and intercostal nerves; visceral pleural has no somatic innervation.

56
Q

Describe the presentation of pleuritic chest pain.

A

Comes from the parietal pleura, severe, sharp, knife-like pain which worsens on inspiration.

57
Q

How is pleural fluid produced?

A

Via capillary filtration from the parietal pleura.

58
Q

How is pleural fluid drained?

A

Via lymphatic drainage through the parietal pleural lymphatics through stomata.

59
Q

What effect would blocking the stomata on the parietal pleural surface have?

A

Cause PE as pleural fluid absorption would be reduced.

60
Q

What may cause pleural fluid production to increase?

A

Increase in lung interstitial fluid; increased hydrostatic pressure; increase in permeability; decrease in oncotic pressure; increased peritoneal fluid; disruption of the thoracic duct.

61
Q

What may cause pleural fluid absorption to decrease?

A

Lymphatic blockage; elevated systemic venous pressure

62
Q

What is the main difference between exudate and transudate?

A

Exudate contains more protein, transudate is more watery.

63
Q

How and why is pleural fluid sampled and examined?

A

Via thoracocentesis. Analysed for appearance, cell count, differential protein, LDH, pH, glucose and cytology to determine if transudate/exudate, infection, haemothorax or cytothorax.

64
Q

What is pleural empyema?

A

Presence of pus due to infected fluid in the pleural space.

65
Q

What does exudate in pleural effusion suggest?

A

Infection, malignancy, rheumatoid arthritis, PE, pancreatitis.

66
Q

What does transudate in pleural effusion suggest?

A

Heart failure, cirrhosis, hypoalbuminaemia, atelectasis, nephrotic syndrome, constrictive pericarditis, Meigs syndrome.

67
Q

What is chylothorax?

A

Form of pleural effusion due to thoracic duct disruption, causing a milky appearance to the pleural fluid from chyle accumulation.

68
Q

How does empyema usually show on x-ray?

A

Often pockets of fluid (loculations), bubbles of fluid may be septated.

69
Q

What type of malignancy is a primary pleural malignancy?

A

Mesothelioma.

70
Q

What risk factors increase likelihood of primary spontaneous pneumothorax?

A

Smoking, being tall and thin, previous primary pneumothoraces.

71
Q

How is pneumothorax treated?

A

If small observe, with SOB then intervene. Aspiration first line treatment, chest drain if aspiration fails, may give chemical pleurodesis (water and talc into pleural space) or open thoracotomy and pleurectomy.

72
Q

How does tension pneumothorax present?

A

CV compromise; reduced chest expansion with hyperresonance and absent breath sounds on the side of the pneumothorax; mediastinal shift (tracheal shift seen); hypoxaemia.

73
Q

How is tension pneumothorax treated?

A

Emergency. Insert cannula into second intercostal space in line with the sternal angle, then insert intercostal chest drain. Give surgical pleurodesis.

74
Q

What may cause chest wall disease?

A

Congenital: deformity, scoliosis, kyphosis or muscular dystrophy. Acquired: trauma, iatrogenic, ankylosing spondylitis, motor neurone disease.

75
Q

What effects may chest wall disease have on the respiratory system?

A

Ventilation failure; sleep disordered breathing; poor clearance of secretions; atelectasis; pneumonia.

Respiratory System (9 decks)

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