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Vertical Curriculum > TCM 2 Exam - First Semester > Flashcards

TCM 2 Exam - First Semester Flashcards

1
Q

Compare the position of the patient in AP and PA.

A

AP: supine
PA: upright

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2
Q

Compare the scapula of the patient in AP and PA.

A

AP: scapula projecting overlapping lung fields
PA: scapula does not overlap lung fields

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3
Q

Compare the clavicles of the patient in AP and PA.

A

AP: clavicles project above the inlet of the thorax
PA: clavicles project over the upper chest

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4
Q

Compare the air fluid levels of the patient in AP and PA.

A

AP: no air fluid levels in abdomen or chest
PA: air fluid levels in abdomen or chest

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5
Q

Compare the penetration of the patient in AP and PA.

A

AP: underpenetrated (too white, not enough rays going through the body)
PA: Penetration and exposure are normal

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6
Q

How can you tell if the patient is centered?

A
  1. Draw a line along the central spinous process
  2. Draw a line between the medial end of the clavicles.
  3. If the distance between the medial and of the clavicle and midline is equal, the patient is centered. If not, they are not (rotated in the direction of the longer line)
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7
Q

When not enough x-rays reach the plate, it is considered ___. When too many reach the plate, it is considered ___.

A

Underpenetrated; overpenetrated

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8
Q

With proper inspiration, where should the right diaphragm be located?

A

Between the 9th and 10the posterior ribs

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9
Q

What is the AP (aortico-pulmonary) window? When is this window changed?

A

Concave space between the aortic knob and the main pulmonary artery

Lymphadenopathy can lead to loss of the concavity

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10
Q

The heart is bigger in which view (AP vs. PA)?

A

AP

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11
Q

What are the three types of lung abnormalities that can be seen on CXR?

A
  1. Cavity
  2. Mass
  3. Consolidation
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12
Q

What is a consolidation?

A

Abnormal material in the alveoli or airspaces (fluid, pus, collapsed alveoli)

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13
Q

What is one hallmark of alveolar/airspace disease or consolidation?

A

Air bronchogram

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14
Q

Why do bronchi become visible in an air bronchogram?

A

Because of the density contrast between normal air in the bronchi and abnormal fluid in the surrounding alveoli

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15
Q

Consolidation may be secondary to pneumonia or atelectasis. How can you tell the difference?

A

Pneumonia: no volume loss
Atelectasis: volume loss, elevation of right minor fissure

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16
Q

What does a silhouette sign indicate?

A

Loss of silhouette (outline) is abnormal and indicates that there is airless, consolidated lung adjacent to that structure

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17
Q

What type of consolidation leads to obscuring of the left heart border?

A

Lingula consolidation

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18
Q

What type of consolidation leads to obscuring of the right heart border?

A

Right middle lobe consolidation

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19
Q

What distinguishes atelectasis and pneumonia on CXR?

A

In atelectasis, there is a forward shift of the oblique/major fissure on lateral CXR, which indicates loss of lung volume.

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20
Q

What distinguishes atelectasis and pneumonia clinically?

A

Atelectasis: hypoxia, no fever
Pneumonia: fever, cough

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21
Q

True or false - fissures are not normally seen unless outlined by an abnormal lung.

A

True

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22
Q

What are the three types of atelectasis and what causes them?

A
  1. Resorptive (endobronchial obstruction)
  2. Adhesive (loss of surfactant)
  3. Relaxation (loss of negative pressure in the pleural space)
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23
Q

What are the CXR features of resorptive atelectasis?

A
  1. Triangular density without air bronchogram
  2. Loss of lung volume
  3. Minor/horizontal fissure is elevated
  4. Compensatory hyperinflation
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24
Q

What is on the differential for a white out on CXR?

A
  1. Resorptive atelectasis (would show signs of decreased volume, mediastinum moves toward affected side)
  2. Pleural effusion (would show signs of increased volume, mediastinum moves away from affected side)
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25
Q

What are the types and sizes of solitary round lesions in the lung?

A
  1. Lung mass: >3 cm
  2. Solitary lung nodules: 1-3 cm
  3. Lung nodules <1 cm
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26
Q

How can lesions be differentiated from collapse or consolidation?

A

Distinct, sharply demarcated borders

27
Q

How is a cavity defined/identified?

A

Dense mass with a central lucency (black area) - this indicates air in the center (lung abscesses, necrotic tumor)

28
Q

If a cavity is in the apex of the lung, consider ___.

A

TB

29
Q

How can you differentiate between a lung abscess and a necrotic lung tumor based on the clinical history?

A

Abscess: pneumonia, fever, cough for weeks
Tumor: weight loss, hemoptysis for months

30
Q

How can you distinguish between diffuse alveolar disease and diffuse interstitial disease?

A

Alveolar: confluent density over a broad area
Interstitial: lines (reticulonodular - lines and dots), ground glass/hazy density

31
Q

What are features of diffuse alveolar disease on CXR?

A
  1. Soft fluffy densities over a broad area
  2. Butterfly distribution (central, near hila, bilaterally symmetric)
  3. Air bronchogram
32
Q

What are some possible causes of acute diffuse alveolar disease?

A
  1. Pulmonary edema
  2. Pulmonary hemorrhage
  3. Influenza
  4. ARDS
33
Q

How is cardiomegaly defined on CXR?

A

Width of the heart is >50% of the width of the chest

34
Q

What features on CXR supports pulmonary edema rather than ARDS or hemorrhage?

A

Cardiomegaly

35
Q

What are the three phases of CHF?

A
  1. Vascular phase
  2. Interstitial phase
  3. Alveolar phase
36
Q

What is seen on CXR in the vascular phase of CHF?

A

Cephalization of pulmonary blood flow

37
Q

What is seen on CXR in the interstitial phase of CHF?

A

Kerley B lines (interstitial, short straight lines that extend to the pleural surface)

38
Q

What is seen on CXR in the alveolar phase of CHF?

A

Basal and bilateral “batwing” densities close to the hila, pleural effusions, and cardiomegaly

39
Q

What are the features of COPD on CXR?

A
  1. Hyperinflated lungs (flattened diaphragm, retrosternal air)
  2. Hyperlucent lungs
  3. Blebs - EMPHYSEMA ONLY
  4. Avascular zones
40
Q

What are the features of pleural effusion on CXR?

A
  1. Homogenous density
  2. Dependent position
  3. Loss of diaphragm and costophrenic angle
  4. Slanting meniscus
  5. Mediastinal shift to opposite side
41
Q

What are the features of a PT?

A
  1. Loss of normal lung vascular markings in the periphery of the chest (black)
  2. Visible pleural/lung interface
  3. Relaxation atelectasis
  4. Mediastinal shift to opposite side
  5. Enlarged hemithorax
42
Q

What are some causes of mediastinal widening?

A
  1. Mediastinal nodes
  2. Mediastinal mass
  3. Aortic aneurysms
43
Q

What are the two most common tubes and where are they located?

A

ET (trachea)

NG (esophagus)

44
Q

Where should the ETT tip be located?

A

Between the carina and suprasternal notch (T1 vertebral body level)

45
Q

Where should the feeding tube tip be located?

A

At the junction of the fourth duodenum and jejunum (duodenum is C shaped)

46
Q

What is a systematic approach to reading CXRs?

A 
Airway
Bones
Cardiac shadow
Diaphragm
Everything else (abdomen, breast, neck, axilla, soft tissue)

Lung fields
Mediastinum
Pleura

47
Q

How is the trachea recognized on CXR?

A

Tracheal rings, lumen is filled with air

48
Q

Where does the trachea split into left and right main stem bronchi?

A

Carina

49
Q

Why is the right diaphragm slightly higher than the left?

A

Heart pushes down on the left side

50
Q

Which lung is larger?

A

Right

51
Q

99% of the lungs are alveoli filled with air and appear ___ as a result (normally).

A

Dark

52
Q

Which hilum is higher?

A

Left

53
Q

Where are vascular markings more prominent?

A
  1. Base of the lungs (vs. apex)

2. Inner 2/3 (vs. outer 1/3)

54
Q

What is the mediastinum?

A

Space between the left and right lung

55
Q

A consolidation will not typically cross a ___.

A

Fissure

56
Q

What are the signs of volume loss?

A
  1. Global shift of structures toward the atelectatic lung
  2. Movement of fissures and hila
  3. Compensatory hyperinflation of the rest of the lung
57
Q

What are the CXR features of relaxation atelectasis?

A
  1. Primary event is in the pleural space
  2. Trachea shifted away from the affected side
  3. Entire lung is atelectatic

*usually a PT

58
Q

What are the CXR features of adhesion atelectasis?

A
  1. Diffuse white out with smaller lungs
59
Q

When are multiple vs. single cavities seen?

A

Multiple: hematogenous etiology (metastatic, septic emboli, vasculitis) or bronchogenous (aspiration abscess, TB, coccidiomycosis), bronchiectasis

Single: primary lung cancer, post-traumatic lung cyst, others

60
Q

When can aspiration abscess be ruled out?

A

When the cavity is located in the apical segment of the upper lobes

61
Q

What is on the differential for mass lesions?

A

Malignancy (cancer, lymphoma, sarcoma), blastomycosis, Wegner’s granulomatosis

62
Q

What is on the differential for solitary pulmonary nodules?

A

Carcinoma, benign tumors, granulomas

63
Q

What is on the differential for miliary nodules?

A

Granulomas (miliary TB, sarcoid, eosinophilic granuloma, silicosis)

64
Q

What is the differential for an anterior mediastinal mass?

A
  1. Thymoma
  2. Teratoma
  3. Testicular tumor metastasis (germ cell tumor)
  4. Terrible lymphoma
  5. Thyroid

Vertical Curriculum (4 decks)

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