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USA: AHN 568 > Unit 2: DDX and CXR > Flashcards

Unit 2: DDX and CXR Flashcards

1
Q

Know what air, fat, soft-tissue/water, bone, metal looks like on a CXR

A 
Air: Block (least dense = radiolucent)
Fat: Intermediate dare (grey)
Soft-Tissue/water: Intermediate (grey)
Bone: Whitish (more dense = radiopaque)
Metal: Solid white
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2
Q

Where the diaphragm should be in comparison with the ribs

A

Anterior Ribs: 6-7, with the 7th rib piercing the diaphragm
Posterior Ribs: 8-10
Hyperventilation: 10 or more ribs with other correlating signs

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3
Q

Positioning of the patient to Dx a pneumothorax

A

Erect positioning on expiration is most ideal

Lateral decubitus position in a bed-bound patient with the suspected lung up

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4
Q

Best test to assess for free floating air in a suspected bowel perforation

A

Abdominal Series: Consists of spine & upright abdominal & chest x-rays

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5
Q

How distance affects viewing

A

The further an object is away from the x-ray receptor, the greater the magnification. The greater the magnification, the larger the casting shadow is = the object appears larger and less sharp than in reality.

The closer an object is to the x-ray receptor, the less magnified and more sharp is object is.

The further away from the x-ray tube, the less magnified and more sharp an object is.

The closer to the x-ray tube, the more magnified and less sharp an object is.

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6
Q

Best way to assess a bed-ridden patient with right or left pneumothorax

A

Suspect Right: left lateral decubitus

Suspected Left: right lateral decubitus

Gravity causes air to accumulate superiorly

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7
Q

Best way to assess a bed-ridden patient with right or left free pleural fluid

A

Suspect Right: Right lateral decubitus

Suspected Left: Left lateral decubitus

Gravity causes fluid to accumulate posteriorly

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8
Q

Best way to assess for a bullet in the heart

A

Fluoroscopy: can see in real-time, turn the patient, and watch motion of heart/bullet

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9
Q

Best way to assess for air trapping

A

Expiratory PA or fluoroscopy:

On expiration: the effected lobe will remain radiolucent, while the other lobes will become more dense with the surround interstitium

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10
Q

Which side of the diaphragm appears higher on cxrs

A

The right hemidiaphragm d/t underlying structures (Liver). Usually 1-2 cm above the left hemidiaphragm

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11
Q

What film is more sensitive to assess for detection of small effusions?

A

Lateral Film: posterior costophrenic sulci lie below the dome of the anterior hemidiaphragm on the AP/PA, and therefore, are not visible in these positions. The lateral film is able to detect effusions from 75ml. The PA, AP aspects take 175-250ml of fluid to be able to detect fluid.

Lateral decubitus is also helpful: 5ml

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12
Q

What causes overly white x-ray films

A

Under penetration, Under/short exposure

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13
Q

Normal anatomical positioning of the clavicles, sternum, trachea

A

Trachea: Trachea is midline and overlies the spine. Is equidistant from the medial aspects of the clavicles

Sternum: midline. Generally obscured on PA view d/t underlying mediastinal objects. Easily seen on lateral view

Clavicles: Spinous process should dissect the medial ends of the clavicles. You should not be able to see the medial end of the clavicle more on one side. should appear the same

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14
Q

Evaluating Pulmonary Nodules

A

Nodules are considered anything <3cm.

Anything >3cm is considered a mass.

Solitary nodules should always be evaluated.

Most valuable method to assessing nodules is comparing new and old films.

Benign nodules tend to remain unchanged over times.

Calcified nodules are mostly benign: Central laminar, diffuse, or popcorn

Malignant nodules: may have eccentric or stippled calcification

Smokers who are 55-74 should be evaluated for lung cancer

Benign nodules are more often found in non-smokers < 35 y/o

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15
Q

Assessing pleural effusions

A

3 Patterns of pleural effusions:
1 - Blunted costophrenic angle
2 - Meniscus sign
3 - Subpulmonic effusion

2 Types:
1 - Free Flowing: makes a meniscus respective of gravity. Fluid will shift d/t gravity on lateral decubitus view
2 - Loculated: effusion in an unusual location that defies gravity. Fluid will not shift or may partially shift on lateral decubitus view

2 Sub Types:
1 - Subpulmonic Effusion: Fluid between lung base and diaphragm that does not track up the pleura.
a: doesn’t blunt costophrenic angle
b: diaphragm more horizontal than normal (apex shifts laterally)
c: Left side: Stomach bubble sign
d: Right side: abnormally high horizontal/minor fissure
2 - Pseudotumor: Fluid collection trapped within a fissure…gives the appearance of a lung mass
a: loculated at a fissure (usually minor)
b: smooth lenticular contour to “mass”

PA/AP: requires 175-250ml of fluid to blunt one of the sulci
Lateral: requires 75ml of fluid to detect
Decubitus: good for assessing if effusion is loculated of free-flowing
Supine: just don’t do it

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16
Q

CXR finding with COPD

A

Hyperinflation: Film will have diffuse lucency with small heart structures, horizontal hemidiaphragms and > 10 ribs

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17
Q

Definitions of acini, interstitium, bronchioles, pleura

A

Acini: Cluster of alveoli arranged around terminal airways that form a secondary pulmonary lobule

Interstitium: Collection of vessels, lymphatics, bronchi, and connective tissue that is the supporting framework of the alveoli

Bronchioles: Branches from which the bronchus divides

Pleura: Serous membranes lining the thorax and enveloping the lungs

 a: Parietal pleura: membrane which is attached to the inner surface of the thoracic cavity
b: Visceral pleura: membrane that layers the individual lobes of the lungs
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18
Q

Clostridium Botulinum (Botulism)

A

Nature of sxs: Neurological

Onset: 12-72 hours

Source: Home canned or poorly canned food contain low acid)

Associated sxs: blurred vision, diplopia, ptosis, slurred speech, muscles weakness

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19
Q

Giardiasis

A

Nature of sxs: Foul-smelling, explosive, watery diarrhea

Onset: 1-4 weeks

Source: Contaminated water (farm wells, streams, lakes)

Associated sxs: mucus in stool, increased flatulence**, greasy stools

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20
Q

Gastroenteritis (viral/bacterial)

A

MOST COMMON CAUSE OF DIARRHEA

Nature of sxs: abrupt onset of diarrhea that usually lasts < 1 weeks, with no other signs of organ involvement

Onset: insidious

Associated sxs: fever, NVD, cramping pain, hyperactive peristalsis

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21
Q

Drug-Induced

A

Laxatives and ABx

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22
Q

Laxative drug-induced diarrhea

A

Usually women.

May present with hysterical behavior

Sodium Hydroxide Test: phenolphthalein in the laxative causes stool to turn red with the sodium is introduced to it

Associated sxs: Muscles weakness, hypokalemia, lassitude

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23
Q

Abx induced diarrhea

A

Causes: ampicillin, tetracycline, lincomycin, clindamycin, chloramphenicol

Sxs: mild/watery diarrhea, nonspecific cramping abdominal pain, low-grade fever

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24
Q

Pseudomembranous Entercolitis

AKA antibiotic associated colitis

A

Nature of sxs: Severe colitis with pseudomembrane formation.

Onset: days or weeks after taking abx

Source: too much bacteria build up (abx, immunosuppressed, hospital, surgery)

Associated sxs: Severe diarrhea, pus in stool, fever, dehydration, hypotension

Life-threatening diarrhea of colonic dysenteric type, generally caused by clindamycin, c-diff superinfection can precipitate

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25
Q

Staphylcococcus Toxin

A

Nature of sxs: Severe NVD

Onset: 2-4 hours after eating contaminated food (

Source: usually meat or dairy

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26
Q

Dysentery Syndrome

A

Nature of sxs: Acute, watery diarrhea (prior history of good health)

Onset: 1-3 days

Source: Usually shigella bacteria or amoeba in contaminated food or water

Associated sxs: Bloody diarrhea***, feeling of incomplete defecation, cramps, fever, malaise, NV

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27
Q

Tension HA

A

Most common

Location: occipital/suboccipital and bilateral

Pain: Constrictive band around the head or scalp tightness. May go down neck and back

Duration: Persists all days for several days

***May awaken with HA but rarely have one at night

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28
Q

Cluster HA

A

More common in men

Location: periorbital and unilateral

Pain: severe pain in eye that might radiate to the front of the face/temporal regions

Duration: 20-60 minutes (attacks short lasting, usually develop cluster/pattern of frequent attacks)

  • ***usually an early morning HA
  • ***usually occur pattern or cluster
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29
Q

Migraines

A

Classic Migraine and Common Migraine

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30
Q

Classic Migraine

A

Nature of sxs: Aura and prodrome prominent, pt will go to sleep and HA will be gone

Location: Periorbital and Unilateral

Pain: Severe throbbing

Onset: Prodrome has abrupt onset and lasts about 15 prior to HA.

Duration: 2-8 days.

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31
Q

Common Migraine

A

***More common

Nature of sxs: Aura and prodrome vague or absent (prodrome may manifest by personality change, malaise, NV)

Location: Frontotemporal or supraorbital region and is unilateral/bilateral

Pain: Throbbing

Onset: Gradual

Duration: 4-72 hours

32
Q

HA induced by Glaucoma

A

Nature of sxs: localized to eye and patient sees halo(s)

Location: localized to eye(s)

Pain: increased with intraocular pressure

33
Q

NV with Esophageal Obstruction/achalasia

A

Sxs: Vomiting regurgitated or undigested food, Odorless vomitus, Usually occurs in early morning or after large meals

34
Q

NV with Increase ICP

A

Sxs: Projectile vomiting not preceded by nausea, Papilledema

35
Q

NV associated with hepatic capsule distention/mesentertic congestion

A

Sxs: consistent with CHF (tachycardia, gallop rhythm, peripheral edema)

36
Q

NV associated with hepatitis/cirrhosis

A

sxs: Jaundice or hepatomegaly

37
Q

Presumptive DDx

A

diagnosis made solely on symptomology, prior to testing/confirmation from testing

38
Q

DDX

A

diagnosis which examines all the possible causes for a set of sxs in order to arrive at a diagnosis

39
Q

Appendicitis

A

Pain: colicky progressing to constant

Location: early - epigastrium/periumbilical. late - RLQ

Associated sxs: fever, vomiting after pain has started, constipation, involuntary guarding, rebound tenderness

Precipitating: movement and coughing

Ameliorating: lying still

40
Q

Diverticulitis

A

Pain: intermittent, cramping

Location: LLQ

Associated sxs: Constipation/diarrhea, might have palpable mass in LLQ

41
Q

Cholecystitis

A

Pain: colicky progressing to constant

Location: RUQ radiating to inferior scapula

Associated sxs: NV, dark urine, light stools, jaundice. Murphy’s sign, tenderness to RUQ

Precipitating: fatty foods, PO contraceptives, drugs

42
Q

IBS

A

Pain: Recurrent

Location: most coming in LLQ

Associated sxs: Alternating periods of constipation/ diarrhea, mucus in stool, small marble-like stools

Precipitating: stress

Ameliorating: defecation

43
Q

Carcinoma of the ampulla of vater

A

Hx of occasional silver-colored stools alternating with normal or light-colored stools

(d/t a mixture of upper GI blood from the carcinoma with alcoholic stools)

44
Q

Pancreatitis

A

Pain: steady and severe

Location: LUQ, epigastric, radiates to back

Associated sxs: NV, prostration (prone position), diaphoresis, diffuse rebound tenderness

Precipitating: lying supine

Ameliorating: leaning forward

45
Q

Most common cause of LBP

A

Mechanical origin: acute lumbosacral strain, postural backache, degenerative lumbosacral arthritis

46
Q

Sensitive diagnostic test for suspected herniated disk/tumor

A

MRI

47
Q

Airway deviation toward affected lung

A

marked atelectasis/collapsed lung

Lobectomy/pneumonectomy

pleural fibrosis

pulmonary fibrosis

48
Q

airway deviation away from affected lung

A

Tension pneumothorax

pleural effusion

Large mass

49
Q

SOB worse when upright and better when lying down (platypnea)

A

Intracardiac shunt and/or vascular lung shunt

50
Q

SOB associated with hyperventilation/anxiety

A

dizziness, lightheadedness, paresthesia (especially in perioral region and extremities), palpitations, sighing respirations, Normal PFT, “can’t get enough air

51
Q

SOB d/t cardiac etiology

A

Paroxysmal nocturnal dyspnea, SOB intensified with recumbency, slow recovery period from dyspnea and tachycardia

52
Q

SOB d/t pulmonary etiology

A

Intensified with exertion, dialy productive cough, postural changes have little or no effect, fast recovery priod from dyspnea and tachycardia
**dont usually have dyspnea at rest

53
Q

Chest pain with MI

A

Nature of pain can be different for each patient.

Pain might not be relieved from nitro

54
Q

Angina Pectoris

A

Nature of pain: Substernal, paroxysmal, and in same spot every time for the patient. generally lasts 30s to a few minutes

Precipitating: exertion, cold exposure, emotional stress, sexual activity

Ameliorating: Nitro and rest

***pain generally not sticky or sharp

55
Q

Variant Angina

A

Nature of pain: Substernal

Precipitating: Vasospasm not exertion…commonly occurs at rest or sleep

Ameliorating: nitro

**not usually sharp or sticky

56
Q

Cervical Angina

A

“pseudoangina”
Mimics angina symptomology but is not brought on my exertion

Precipitating: cervical movement, cough/sneeze, lateral head movements

57
Q

GERD

A

***Most common cause of noncardiac CP
Nature of pain: Burning (may be indentical to angina)

Precipitating: overeating, recumbency, may awaken during sleep

Ameliorating: Antacids, PPI

Physical findings: water brash, heartburn

58
Q

Esophageal Spasm

A

***especially obese people
Nature of pain: Burning (may be identical to angina)

Precipitating: Induced by ingestion of alcohol or cold liquids

Ameliorating: Occasionally relieved by nitro

59
Q

Mitral Valve Prolapse

A

Nature of pain: Sticky quality, lasts several hours, usually occurs @ rest, pain is not substernal

Precipitating:

Ameliorating: Recumbency and BB

Physical findings: Click/late systolic murmur, palpitations, arrhythmias, syncope

60
Q

HCM

A

Nature of pain: Similar to angina

Precipitating: Nitro

Ameliorating: Squatting and BB

Physical findings: Murmur intensified by nitro and valsalva maneuver. LVH and LAE

61
Q

Cervicodorsal Arthritis

A

Nature of pain: Sharp or sticky…only lasts a few seconds

Precipitating: Body movement, cough/sneeze, prolonged recumbency

62
Q

PE

A

Nature of pain: Pleuritic

Precipitating: PO contraceptives, CV risk factors, prolonged immobilization, DVT

Ameliorating:

Physical findings: DVT, tachypnea, SOB, hemoptysis, tachycardia, decreased oxygen saturation

63
Q

Pneumonia

A

Physical findings: SIRS, cough, egophony on percussion

64
Q

Pericarditis

A

Nature of pain: Precordial, sharp/dull, protracted duration

Physical findings: Fever, recent viral infection, pericardial friction rub, diffuse ST segment elevation

65
Q

Chest Wall Syndrome

A

Nature of pain: Sharp and stick, fleeting

Precipitating: Recumbency, palpation

Physical findings: Local tenderness on palpation, crowing rooster, reproducaple

66
Q

Gas Entrapment Syndrome

A

Nature of pain: Dull, achy

Precipitating: Bending and tight garments

Ameliorating: Passage of flatus, nitro

67
Q

Causes of acute cough

A

Viral URI, allergies, bacterial pneumonia

68
Q

Causes of chronic cough

A

Upper airway cough syndrome (PND), asthma, CHF, GERD, Psychogenic

69
Q

Viral URI associated cough

A

***Most common cause for acute cough

Nature of sxs: acute onset of noisey cough over hours or days, lasts 7-10 days, cough is worse at night, Sputum thick and yellow BUT minimally produced

Associated sxs: fever, sore throat, general aches/pains

**if > 14 days assess for secondary bacteral infection

70
Q

Allergy associated cough

A

Nature of sxs: reccurrent cough without dyspnea, minimally productive, may be seasonal

Associated sxs: sneezing, itching of eyes, conjunctivitis, tearing, boggy/edematous nasal mucosa

71
Q

Bacterial pneumonia associated cough

A

Nature of sxs: Acute onset of noisy cough, cough worse at night, incidence highest in winter

Associated sxs: SIRS criteria, fever/chills

72
Q

Upper Airway Cough Syndrome (PND)

A

***may not be aware of condition

Nature of sxs: frequent throat clearing and hawking, cough worse in morning

Precipitating: recumbency, various sinusitis/rhinitis

Physical findings: Mucoid secretions in posterior pharynx, Mucosa of nose and oropharynx presents with a cobble stone appearance

73
Q

Asthma associated cough

A

Nature of sxs: recurrent cough, minimally/not productive, worse in later afternoon/night

Associated sxs: SOB, wheezing

Precipitating: exercise, allergens

74
Q

CHF associated cough

A

Nature of sxs: Cough often nocturnal

Associated sxs: Dyspnea on exertion

Precipitating: Recumbency

Physical findings: CHF

75
Q

GERD associated cough

A

Nature of sxs: Irritative, nonproductive cough

Associated sxs: Heartburn, eructation, sour tase

Precipitating: recumbency, ingestion of chocolate, caffeine, alcohol

Physical findings: none

76
Q

Psychogenic (HABIT) cough

A

coughs only when awake (not during sleep), can stop coughing on demand

77
Q

Chronic Bronchitis associated cough

A

***most common chronic cough in adults (especially smokers)

Nature of sxs: minimally productive, may be worse in morning

USA: AHN 568 (10 decks)

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