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Acute > W3: MC > Flashcards

W3: MC Flashcards

1
Q

On a chest x-ray what does white indicate?

A

High absorption = Bone

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2
Q

On a chest x-ray what does whitish-grey indicate?

A

Medium absorption = fluid/tissue

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3
Q

On a chest x-ray what does black indicate?

A

Low absorption = air

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4
Q

What does the acronym DRS ABCDE stand for and when is it used?

A

Used to carry out a structured interpretation of a chest x-ray

D: Details
R: RIPE: Rotation, Inspiration, Picture, Exposure
S: Soft tissues and bones
Airway: trachea, carina, bronchi and hilar structures.
Breathing: lungs and pleura.
Cardiac: heart size and borders.
Diaphragm: including assessment of costophrenic angles.
Everything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas.

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5
Q

D: Details –> what does this involve?

A

Begin chest X-ray interpretation by checking the following details:

  • Patient details: name, date of birth and unique identification number.
  • Date and time the film was taken
  • Previous imaging: useful for comparison.
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6
Q

R: Ripe –> what does the R involve?

  • The medial aspect of each clavicle should be …… from the spinous processes.
  • The spinous processes should also be ….. orientated against the vertebral bodies.
A

Rotation
* The medial aspect of each clavicle should be equidistant from the spinous processes.
* The spinous processes should also be in vertically orientated against the vertebral bodies.

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7
Q

R: Ripe –> what does the I involve? what should be visible?

A

Inspiration
* The 5-6 anterior ribs, lung apices, both costophrenic angles and the lateral rib edges should be visible

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8
Q

R: Ripe –> what does the p involve?

A

Projection
* Note if the film is AP or PA: if there is no label, then assume it’s a PA film (if the scapulae are not projected within the chest, it’s PA)

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9
Q

R: Ripe –> what does the e involve? What should be visible?

A

Exposure
* The left hemidiaphragm should be visible to the spine and the vertebrae should be visible behind the heart.

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10
Q

On a chest x-ray how do we determine if lung inflation is sufficient? What specific landmarks are used to determine this?

A

We count the number of ribs. We take the rib number that dissects the diaphragm at the point of the midclavicular line

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11
Q

How many anterior ribs intersect the midclavicular line?

A

5-7

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12
Q

How many posterior ribs intersect the mid-clavicular line?

A

9

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13
Q

If the number of ribs counted is less than the specific number (ie 5-7 anterior & 9 posterior) the lungs are…..

A

Hypoinflated/underinflated

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14
Q

If the number of ribs counted is more than the specific number (ie 5-7 anterior & 9 posterior) the lungs are…..

What might this indicate?

A

Hyperinflated/overinflated

Too much air in the lungs – if this is the case they might be holding onto that extra C02 ie extra gas – consider obstructive condition

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15
Q

S: Soft tissues and bones - what does this involve?

A
  • Check soft tissue structures around the neck, thoracic wall and breasts and look for asymmetries.
  • If a patient has very thick soft tissue due to obesity, lung markings may be obscured.
  • Identify key bones- clavicle & ribs.
  • Look at position of ribs & count ribs
  • May be able to identify previous injuries or surgeries.
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16
Q

A: Airway - what does this involve for the trachea?

Inspect the trachea for evidence of …..:

  • The trachea is normally located ….. or deviating very slightly to the ……
  • If the trachea appears significantly deviated, inspect for anything that could be ….. or ….. the trachea (EG a….
A

Trachea
Inspect the trachea for evidence of deviation:

  • The trachea is normally located centrally or deviating very slightly to the right.
  • If the trachea appears significantly deviated, inspect for anything that could be pushing or pulling the trachea (Eg a pneumothorax)
17
Q

A: Airway - what is the carina?

The right main bronchus is generally ….., …… and more …… than the left main bronchus. As a result of this difference in size and orientation, it is more common for inhaled foreign objects to become lodged in the …… main bronchus.

A

The carina is cartilage situated at the point at which the trachea divides into the left and right main bronchus.

The right main bronchus is generally wider, shorter and more vertical than the left main bronchus. As a result of this difference in size and orientation, it is more common for inhaled foreign objects to become lodged in the right main bronchus.

18
Q

What is the carina?

A

The carina is the apex point there the trachea divides into the two bronchi.

19
Q

A: Airway - what does the hilar structures involves….

The hilar consist of the main ….. ……. and the ….. ……. Each hilar also has a collection of ….. …… which aren’t usually visible in healthy individuals.
* The left hilum is often positioned slightly ….. than the right, but there is a wide degree of …… between individuals.
* The hilar are usually the ….. size, so …… should raise suspicion of pathology.
* The hilar point is also a very important landmark; anatomically it is where the ….. ….. ….. intersects the ….. ….. …… When this is lost, consider the possibility of a ….. here (e.g. lung tumour or enlarged lymph nodes).

A

Pulmonary vasculature
Major bronchi
Lymph nodes
Higher
Variability
Same size
Asymmetry
Descending pulmonary artery
Superior pulmonary vein
Lesion

20
Q

B: breathing - what does this involve?

A

Lungs
* When interpreting a chest X-ray, you should divide each of the lungs into three zones, each occupying one-third of the height of the lung.
* These zones do not equate to lung lobes (e.g. the left lung has three zones but only two lobes).
* Inspect the lung zones ensuring that lung markings are present throughout.

21
Q

B: breathing - how do we divide a chest x-ray?

A

Zone 1: T1-T6
Zone 2: T6-T10
Zone 3: T10 to below diaphragm

22
Q

B: breathing - abnormalities of the lungs?

  • Compare each ….. between lungs, noting any …… (some asymmetry is normal and caused by the presence of various ….. structures e.g. the heart).
  • Some lung pathology causes …… changes in the lung fields, which can make it more difficult to recognise, so it’s important to keep this in mind (e.g. …. ….).
  • Increased …… shadowing in a given area of a lung field may indicate pathology (e.g. ……/……)
  • Inspect the ….. of each lung to ensure lung markings extend all the way to the ….. of the lung fields (the absence of lung markings should raise suspicion of a pneumothorax).
A

Inspect the lungs for abnormalities:

Zone
Asymmetry
Anatomical
Symmetrical
Pulmonary oedema
Airspace
Consolidation/malignancy
Borders
Edges

23
Q

B: breathing - abnormalities of the pleura?

  • The pleura are not usually ….. in healthy individuals. If the pleura are visible, it indicates the presence of pleural …… which is typically associated with …….
  • ……. (hydrothorax) or …… (haemothorax) can accumulate in the ……. space, resulting in an area of increased …… on a chest X-ray. In some cases, a combination of air and fluid can accumulate in the pleural space (……….), resulting in a mixed pattern of both …… and …… opacity within the pleural cavity
A

Visible
Thickening
Mesothelioma
Fluid
Blood
Pleural
Opacity
Hydropneumothorax
Increased & decreased

24
Q

B: breathing - tension pneumothorax

  • A tension pneumothorax is a life-threatening condition which involves …….
  • If a tension pneumothorax is suspected clinically (….. & …… …..) then immediate intervention should be performed without waiting for …… as this condition will result in death if left untreated.
A

An increasing amount of air being trapped within the pleural cavity displacing mediastinal structures and impairing cardiac function

SOB & tracheal deviation

Imaging

25
Q

C: Cardiac - assess heart size

  • In a healthy individual, the heart should occupy no more than ….. % of the thoracic width (e.g. a cardiothoracic ratio of less than 0.5). Generally, ….. of the heart is on the right and ….. on the left.
  • This rule only applies to ….. chest X-rays (as AP films exaggerate heart size), so you should not draw any conclusions about heart size from an ….. film.
  • …… is said to be present if the heart occupies more than 50% of the thoracic width on a PA chest X-ray. Cardiomegaly can develop for a wide variety of reasons including valvular heart disease, cardiomyopathy, pulmonary hypertension and pericardial effusion.
A

50%
1/3rd
2/3rd
PA
AP
Cardiomegaly

26
Q

D: Diaphragm

The right hemidiaphragm is, in most cases, …… than the left in healthy individuals (due to the presence of the …..)

The ….. underlies the left hemidiaphragm and is best identified by the ….. ….. located within it.

A

Higher
Liver
Stomach
Gastric bubble

27
Q

D: Diaphragm - Costophrenic angle

  • What are they formed from?
  • In a healthy individual, the costophrenic angles should be clearly ….. on a normal chest X-ray as a ….-….. …. angle.
A
  • The costophrenic angles are formed from the dome of each hemidiaphragm and the lateral chest wall.
  • Visible, well-defined acute angle
28
Q

D: Diaphragm - Costophrenic angle

Loss of the acute costophrenic angle, is referred to as what? and can indicate what?

A

Costophrenic blunting

Can indicate:
- Presence of fluid or consolidation in the area
- Lung hyperinflation
- Pleural effusion

29
Q

E: Extras - what else must we be aware of?

A
  • ETT, CVP line, NG tube, PA catheters
  • ECG electrodes, PICC line, chest tube
  • Pacemakers, metal work
30
Q

If someone lungs are hyperinflated what would you expect to occur at the diaphragm?

A

Flattening

31
Q

What would an area of white consolidation on a chest x-ray suggest?

A

Consolidation or pus/fluid/secretions, etc (increased opacity in this area) –> pneumonia? Fluid back log because the heart isn’t working well - pulmonary oedema?

32
Q

What is blood pressure? What artery is used to measure it manually?

A

Blood pressure is defined as the force distending the arterial walls. The brachial artery in the upper arm is usually chosen for the measurement site due to its position at approximately heart ‘level’ and its ease of access.

33
Q

What is systolic blood pressure?

A

The level of pressure on the arterial walls when your heart ejects blood

34
Q

What is diastolic blood pressure?

A

The level of pressure on the arterial walls when the heart is relaxed and refilling

35
Q

What are the categories of BP

A

Optimal <120/80
Normal 120-129 and/or 80-84
High 130-139 and/or 85-89

Hypertension
Stage 1: 140-159 and/or 90-99
Stage 2: 160-179 and/or 100-109
Stage 3: > 180 and/or > 110

Acute (14 decks)

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